hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number | MN,"To the best of its knowledge and belief, the 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 indicated.",,,,,,,,,,,,,,,,,,,
Essentia Health St. Joseph's Medical Center,1/1/2025,2.0.0,St. Joseph's Hospital,"Essentia Health St. Joseph's Medical Center 523 N 3rd St Brainerd, MN 56401",415250,TRUE,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,modifiers,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,estimated_amount,standard_charge|min,standard_charge|max,standard_charge|methodology,additional_generic_notes
Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard,,,,,,,,,,both,,,,,Advocare/Security Health,Medicare,CT,,85,,,85,85,,Payment adjustment for the item or service to which the modifier is appended
"Nonexcepted service provided at an off-campus, outpatient, provider-based department of a hospital",,,,,,,,,,both,,,,,Advocare/Security Health,Medicare,PN,,40,,,40,40,,Payment adjustment for the item or service to which the modifier is appended
"Services, procedures, and/or surgeries furnished at off-campus provider-based outpatient departments",,,,,,,,,,both,,,,,Advocare/Security Health,Medicare,PO,,40,,,40,70,,Payment adjustment for the item or service to which the modifier is appended
X-rays taken using computed radiography (CR) instead of digital radiography (DR),,,,,,,,,,both,,,,,Advocare/Security Health,Medicare,FY,,93,,,93,93,,Payment adjustment for the item or service to which the modifier is appended
X ray taken using film,,,,,,,,,,both,,,,,Advocare/Security Health,Medicare,FX,,80,,,80,80,,Payment adjustment for the item or service to which the modifier is appended
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,MS-001,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,187215.89,,,,4572,540617.07,case rate,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,MS-002,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,73240.59,,,,4572,244269.8,case rate,
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,MS-003,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,142441.54,,,,4572,425339.99,case rate,
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,MS-004,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,93912.68,,,,4572,293265,case rate,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,MS-005,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,70779.45,,,,4572,206482.5,case rate,
LIVER TRANSPLANT WITHOUT MCC,MS-006,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,32229.4,,,,4572,96496.16,case rate,
LUNG TRANSPLANT,MS-007,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,86859.59,,,,4572,244714.68,case rate,
SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT,MS-008,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,36163.36,,,,4572,104970.92,case rate,
PANCREAS TRANSPLANT,MS-010,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,52991.21,,,,4572,96031.32,case rate,
TRACHEOSTOMY FOR FACEMOUTH & NECK DIAGNOSES W MCC,MS-011,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,35862.95,,,,4572,102868.19,case rate,
TRACHEOSTOMY FOR FACEMOUTH & NECK DIAGNOSES W CC,MS-012,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27274.56,,,,4572,79897.76,case rate,
TRACHEOSTOMY FOR FACEMOUTH & NECK DIAGNOSES W/O CC/MCC,MS-013,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17612.78,,,,4572,53579.72,case rate,
ALLOGENEIC BONE MARROW TRANSPLANT,MS-014,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,87078.92,,,,4572,228644.96,case rate,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,MS-016,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,40116.6,,,,4572,123231.15,case rate,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,MS-017,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,40116.6,,,,4572,123231.15,case rate,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,MS-018,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,250651.81,,,,4572,735011.87,case rate,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,MS-019,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,52687.47,,,,4572,159470.33,case rate,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,MS-020,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,53576.75,,,,4572,168625.38,case rate,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,MS-021,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,36736.27,,,,4572,122520.93,case rate,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,MS-022,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23464.21,,,,4572,78257.87,case rate,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,MS-023,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,37917.99,,,,4572,113092.56,case rate,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,MS-024,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25267.36,,,,4572,75586.56,case rate,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,MS-025,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,29724.39,,,,4572,88099.2,case rate,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,MS-026,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20328.47,,,,4572,58914.35,case rate,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,MS-027,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16401.82,,,,4572,48536.36,case rate,
SPINAL PROCEDURES WITH MCC,MS-028,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,40406.38,,,,4572,120220.7,case rate,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,MS-029,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22309.74,,,,4572,68392.59,case rate,
SPINAL PROCEDURES WITHOUT CC/MCC,MS-030,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14790.75,,,,4572,46264.05,case rate,
VENTRICULAR SHUNT PROCEDURES WITH MCC,MS-031,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27852.12,,,,4572,82126.17,case rate,
VENTRICULAR SHUNT PROCEDURES WITH CC,MS-032,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14193.91,,,,4572,42968.31,case rate,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,MS-033,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10604.22,,,,4572,32376.86,case rate,
CAROTID ARTERY STENT PROCEDURES WITH MCC,MS-034,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25845.59,,,,4572,77832.93,case rate,
CAROTID ARTERY STENT PROCEDURES WITH CC,MS-035,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15119.08,,,,4572,45875.03,case rate,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,MS-036,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12183.39,,,,4572,36073.59,case rate,
EXTRACRANIAL PROCEDURES WITH MCC,MS-037,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22071.81,,,,4572,67343.22,case rate,
EXTRACRANIAL PROCEDURES WITH CC,MS-038,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10709.24,,,,4572,31918.01,case rate,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,MS-039,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7564.86,,,,4572,22762.95,case rate,
PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,MS-040,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25070.63,,,,4572,76817.48,case rate,
PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,MS-041,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15008.75,,,,4572,44502.47,case rate,
PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,MS-042,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11681.59,,,,4572,34709.01,case rate,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,MS-052,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13375.74,,,,4572,38792.78,case rate,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,MS-053,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6123.93,,,,4572,19626.81,case rate,
NERVOUS SYSTEM NEOPLASMS WITH MCC,MS-054,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9963.52,,,,4572,29396.33,case rate,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,MS-055,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7251.15,,,,4572,21410.34,case rate,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,MS-056,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16643.08,,,,4572,47760.3,case rate,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,MS-057,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8868.87,,,,4572,27195.84,case rate,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,MS-058,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12268.47,,,,4572,34471.61,case rate,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,MS-059,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8132.45,,,,4572,23684.64,case rate,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,MS-060,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5931.19,,,,4572,17903.13,case rate,
ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,MS-061,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17967.7,,,,4572,55915.86,case rate,
ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,MS-062,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11836.45,,,,4572,37340.42,case rate,
ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,MS-063,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9336.77,,,,4572,29661.66,case rate,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,MS-064,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13220.88,,,,4572,39959.85,case rate,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,MS-065,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6758.66,,,,4572,20277.18,case rate,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,MS-066,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4574.67,,,,4319.38,13715.63,case rate,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,MS-067,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9669.75,,,,4572,28267.16,case rate,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,MS-068,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5858.74,,,,4572,17376.45,case rate,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,MS-069,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5317.73,,,,4549.38,15934.07,case rate,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,MS-070,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11556.64,,,,4572,35700.53,case rate,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,MS-071,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7004.57,,,,4572,21182.91,case rate,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,MS-072,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4986.08,,,,4409.72,15620.85,case rate,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,MS-073,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10272.57,,,,4572,30184.35,case rate,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,MS-074,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6928.14,,,,4572,20472.69,case rate,
VIRAL MENINGITIS WITH CC/MCC,MS-075,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11447.64,,,,4572,38180.31,case rate,
VIRAL MENINGITIS WITHOUT CC/MCC,MS-076,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6094.02,,,,4572,18403.88,case rate,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,MS-077,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10277.22,,,,4572,30142.46,case rate,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,MS-078,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6632.38,,,,4572,20287.16,case rate,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,MS-079,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4431.11,,,,4431.11,14778.96,case rate,
NONTRAUMATIC STUPOR AND COMA WITH MCC,MS-080,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13211.58,,,,4572,44063.57,case rate,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,MS-081,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6013.6,,,,4572,18144.53,case rate,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,MS-082,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15420.82,,,,4572,45452.09,case rate,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,MS-083,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9241.06,,,,4572,27060.18,case rate,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,MS-084,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6354.56,,,,4572,18348.02,case rate,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,MS-085,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15060.59,,,,4572,45342.36,case rate,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,MS-086,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8717.33,,,,4572,26276.15,case rate,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,MS-087,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5875.36,,,,4572,17679.69,case rate,
CONCUSSION WITH MCC,MS-088,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9375.98,,,,4572,30599.31,case rate,
CONCUSSION WITH CC,MS-089,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7125.53,,,,4572,22940.51,case rate,
CONCUSSION WITHOUT CC/MCC,MS-090,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5697.9,,,,4572,18649.26,case rate,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,MS-091,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12115.6,,,,4572,35694.54,case rate,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,MS-092,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7036.47,,,,4572,20470.7,case rate,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,MS-093,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5245.95,,,,4384.75,15449.28,case rate,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,MS-094,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,24250.47,,,,4572,72272.87,case rate,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,MS-095,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15932.59,,,,4572,47564.79,case rate,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,MS-096,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15932.59,,,,4572,43485.02,case rate,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,MS-097,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23824.44,,,,4572,72556.16,case rate,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,MS-098,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14417.89,,,,4572,42982.28,case rate,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,MS-099,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9260.34,,,,4572,26337.99,case rate,
SEIZURES WITH MCC,MS-100,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13194.96,,,,4572,39550.88,case rate,
SEIZURES WITHOUT MCC,MS-101,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6125.92,,,,4572,18146.52,case rate,
HEADACHES WITH MCC,MS-102,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7706.42,,,,4572,24071.67,case rate,
HEADACHES WITHOUT MCC,MS-103,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5650.71,,,,4572,16805.88,case rate,
ORBITAL PROCEDURES WITH CC/MCC,MS-113,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14998.11,,,,4572,50020.64,case rate,
ORBITAL PROCEDURES WITHOUT CC/MCC,MS-114,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7856.63,,,,4572,24574.41,case rate,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,MS-115,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10175.54,,,,4572,31209.78,case rate,
INTRAOCULAR PROCEDURES WITH CC/MCC,MS-116,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11090.07,,,,4572,36524.46,case rate,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,MS-117,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7168.73,,,,4572,23908.08,case rate,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,MS-121,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7731.01,,,,4572,25559.94,case rate,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,MS-122,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4508.21,,,,4194.58,14852.78,case rate,
NEUROLOGICAL EYE DISORDERS,MS-123,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5338.33,,,,4474.49,16039.8,case rate,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,MS-124,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8666.15,,,,4572,26371.91,case rate,
OTHER DISORDERS OF THE EYE WITHOUT MCC,MS-125,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5487.88,,,,4572,15910.13,case rate,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,MS-135,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16024.97,,,,4572,52909.4,case rate,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,MS-136,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6501.44,,,,4572,20833.79,case rate,
MOUTH PROCEDURES WITH CC/MCC,MS-137,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9295.56,,,,4572,30018.77,case rate,
MOUTH PROCEDURES WITHOUT CC/MCC,MS-138,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5406.79,,,,4572,17270.72,case rate,
SALIVARY GLAND PROCEDURES,MS-139,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9125.41,,,,4572,23694.62,case rate,
SIMPLE PNEUMONIA AND PLEURISY AGE 0-17,MS-140,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,28108.67,,,,4572,75373.1,case rate,
MAJOR HEAD AND NECK PROCEDURES WITH CC,MS-141,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14279.65,,,,4572,41330.42,case rate,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,MS-142,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10450.69,,,,4572,30822.75,case rate,
STOMACH ESOPHAGEAL AND DUODENAL PROC AGE 0-17,MS-143,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21945.53,,,,4572,66345.72,case rate,
OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,MS-144,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11675.61,,,,4572,34523.48,case rate,
OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,MS-145,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7874.57,,,,4572,24360.95,case rate,
EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,MS-146,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15247.35,,,,4572,42114.45,case rate,
EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,MS-147,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8273.35,,,,4572,24654.21,case rate,
EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,MS-148,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5321.72,,,,4301.55,17749.52,case rate,
DYSEQUILIBRIUM,MS-149,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4968.13,,,,4226.08,14856.77,case rate,
EPISTAXIS WITH MCC,MS-150,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9186.56,,,,4572,26224.28,case rate,
EPISTAXIS WITHOUT MCC,MS-151,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5037.92,,,,4182.69,15375.47,case rate,
OTITIS MEDIA AND URI WITH MCC,MS-152,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7542.26,,,,4572,23704.59,case rate,
OTITIS MEDIA AND URI WITHOUT MCC,MS-153,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4730.19,,,,4230.24,14659.26,case rate,
OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,MS-154,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10808.93,,,,4572,30687.09,case rate,
OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,MS-155,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6205.02,,,,4572,18884.67,case rate,
OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,MS-156,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4468.99,,,,3921.79,13077.23,case rate,
DENTAL AND ORAL DISEASES WITH MCC,MS-157,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10883.37,,,,4572,34054.65,case rate,
DENTAL AND ORAL DISEASES WITH CC,MS-158,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6251.54,,,,4572,18723.08,case rate,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,MS-159,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4383.92,,,,4031.74,13470.24,case rate,
MAJOR CHEST PROCEDURES WITH MCC,MS-163,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,30634.28,,,,4572,94036.32,case rate,
MAJOR CHEST PROCEDURES WITH CC,MS-164,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16728.82,,,,4572,50880.48,case rate,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,MS-165,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12388.76,,,,4572,37434.18,case rate,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,MS-166,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25590.37,,,,4572,80953.11,case rate,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,MS-167,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12144.18,,,,4572,36305.01,case rate,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,MS-168,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8998.47,,,,4572,27046.22,case rate,
URETHRAL PROCEDURES AGE 0-17,MS-173,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20394.94,,,,4572,61346.25,case rate,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,MS-175,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9365.35,,,,4572,27989.85,case rate,
PULMONARY EMBOLISM WITHOUT MCC,MS-176,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5413.44,,,,4572,16271.22,case rate,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,MS-177,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10743.8,,,,4572,33843.18,case rate,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,MS-178,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6593.83,,,,4572,19684.67,case rate,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,MS-179,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5115.68,,,,4572,15227.84,case rate,
RESPIRATORY NEOPLASMS WITH MCC,MS-180,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11616.46,,,,4572,34677.09,case rate,
RESPIRATORY NEOPLASMS WITH CC,MS-181,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7379.42,,,,4572,21966.95,case rate,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,MS-182,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5566.3,,,,4572,15936.06,case rate,
MAJOR CHEST TRAUMA WITH MCC,MS-183,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10549.72,,,,4572,31411.28,case rate,
MAJOR CHEST TRAUMA WITH CC,MS-184,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7098.95,,,,4572,20985.41,case rate,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,MS-185,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5168.85,,,,4352.07,15076.22,case rate,
PLEURAL EFFUSION WITH MCC,MS-186,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10501.21,,,,4572,30964.4,case rate,
PLEURAL EFFUSION WITH CC,MS-187,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6672.92,,,,4572,19876.19,case rate,
PLEURAL EFFUSION WITHOUT CC/MCC,MS-188,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4879.74,,,,4559.48,14892.68,case rate,
PULMONARY EDEMA AND RESPIRATORY FAILURE,MS-189,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8224.17,,,,4572,24578.4,case rate,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,MS-190,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7463.83,,,,4572,21984.9,case rate,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,MS-191,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5709.86,,,,4572,16937.55,case rate,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,MS-192,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4301.51,,,,4301.51,12803.91,case rate,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,MS-193,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8757.87,,,,4572,26465.67,case rate,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,MS-194,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5449.99,,,,4572,16402.89,case rate,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,MS-195,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4138.67,,,,4081.66,12480.72,case rate,
INTERSTITIAL LUNG DISEASE WITH MCC,MS-196,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12522.36,,,,4572,37813.23,case rate,
INTERSTITIAL LUNG DISEASE WITH CC,MS-197,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6579.87,,,,4572,19900.13,case rate,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,MS-198,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4655.09,,,,4507.78,15525.09,case rate,
PNEUMOTHORAX WITH MCC,MS-199,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11732.77,,,,4572,35393.3,case rate,
PNEUMOTHORAX WITH CC,MS-200,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7360.81,,,,4572,21486.15,case rate,
PNEUMOTHORAX WITHOUT CC/MCC,MS-201,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4500.23,,,,4153.57,14086.7,case rate,
BRONCHITIS AND ASTHMA WITH CC/MCC,MS-202,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6425.01,,,,4572,19102.13,case rate,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,MS-203,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4629.84,,,,4142.28,13863.26,case rate,
RESPIRATORY SIGNS AND SYMPTOMS,MS-204,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5390.18,,,,4561.86,16416.86,case rate,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,MS-205,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12546.95,,,,4572,36115.49,case rate,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,MS-206,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6020.25,,,,4572,18224.33,case rate,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,MS-207,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,42983.16,,,,4572,137814.6,case rate,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,MS-208,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17837.43,,,,4572,53940.81,case rate,
TESTES PROCEDURES AGE 0-17,MS-212,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,72404.48,,,,4572,214875.47,case rate,
OTHER HEART ASSIST SYSTEM IMPLANT,MS-215,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,70416.57,,,,4572,203785.26,case rate,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,MS-216,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,64144.42,,,,4572,193620.74,case rate,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,MS-217,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,42921.35,,,,4572,126987.74,case rate,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,MS-218,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,39541.03,,,,4572,113649.17,case rate,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,MS-219,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,51426,,,,4572,153838.44,case rate,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,MS-220,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,35203.63,,,,4572,104629.77,case rate,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,MS-221,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,30523.95,,,,4572,92739.57,case rate,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,MS-228,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,33120.67,,,,4572,100522.07,case rate,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,MS-229,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20645.5,,,,4572,63433.02,case rate,
CORONARY BYPASS WITH PTCA WITH MCC,MS-231,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,56320.36,,,,4572,161898.24,case rate,
CORONARY BYPASS WITH PTCA WITHOUT MCC,MS-232,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,40600.45,,,,4572,118674.57,case rate,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC,MS-233,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,51950.39,,,,4572,155602.02,case rate,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC,MS-234,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,35359.82,,,,4572,103698.11,case rate,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,MS-235,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,39108.35,,,,4572,117317.97,case rate,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,MS-236,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27330.38,,,,4572,80621.94,case rate,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,MS-239,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,33476.91,,,,4572,95895.66,case rate,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,MS-240,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19355.45,,,,4572,56043.54,case rate,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,MS-241,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10035.3,,,,4572,27810.3,case rate,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,MS-242,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22544.36,,,,4572,68929.25,case rate,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,MS-243,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14972.86,,,,4572,45438.12,case rate,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,MS-244,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11994.64,,,,4572,36498.53,case rate,
AICD GENERATOR PROCEDURES,MS-245,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,32479.3,,,,4572,90401.43,case rate,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,MS-250,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15370.31,,,,4572,46898.46,case rate,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,MS-251,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10385.56,,,,4572,31658.66,case rate,
OTHER VASCULAR PROCEDURES WITH MCC,MS-252,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22799.58,,,,4572,66908.31,case rate,
OTHER VASCULAR PROCEDURES WITH CC,MS-253,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16968.09,,,,4572,50894.45,case rate,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,MS-254,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11627.09,,,,4572,34615.25,case rate,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,MS-255,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17390.13,,,,4572,54810.63,case rate,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,MS-256,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11256.89,,,,4572,32712.02,case rate,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,MS-257,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5927.86,,,,4572,19770.45,case rate,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,MS-258,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18646.29,,,,4572,54036.57,case rate,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,MS-259,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11682.26,,,,4572,37238.67,case rate,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,MS-260,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22638.74,,,,4572,66138.24,case rate,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,MS-261,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12612.08,,,,4572,37541.91,case rate,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,MS-262,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10087.8,,,,4572,32823.74,case rate,
VEIN LIGATION AND STRIPPING,MS-263,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17826.13,,,,4572,56362.74,case rate,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,MS-264,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23229.6,,,,4572,65156.7,case rate,
AICD LEAD PROCEDURES,MS-265,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23708.8,,,,4572,70505.3,case rate,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC,MS-266,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,39816.85,,,,4572,124609.7,case rate,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC,MS-267,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,31269,,,,4572,97359.99,case rate,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,MS-268,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,44315.09,,,,4572,136751.27,case rate,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,MS-269,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27653.4,,,,4572,82964.07,case rate,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,MS-270,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,34115.63,,,,4572,100885.16,case rate,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,MS-271,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22892.63,,,,4572,68951.19,case rate,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,MS-272,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16630.45,,,,4572,48668.03,case rate,
PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC,MS-273,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25989.15,,,,4572,77745.15,case rate,
PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC,MS-274,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20743.2,,,,4572,64653.96,case rate,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,MS-275,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,46969.63,,,,4572,140364.21,case rate,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,MS-276,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,41170.04,,,,4572,123893.49,case rate,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,MS-277,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,30918.07,,,,4572,95408.88,case rate,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,MS-278,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,33253.6,,,,4572,88984.98,case rate,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,MS-279,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21297.51,,,,4572,63851.97,case rate,
ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,MS-280,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10909.29,,,,4572,31650.68,case rate,
ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,MS-281,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6126.59,,,,4572,18214.35,case rate,
ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,MS-282,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4819.26,,,,4451.32,14326.1,case rate,
ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,MS-283,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12996.24,,,,4572,39329.43,case rate,
ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,MS-284,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4924.93,,,,4555.91,14757.02,case rate,
ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,MS-285,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3731.25,,,,3544.41,9749.57,case rate,
CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,MS-286,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14710.33,,,,4572,43004.22,case rate,
CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,MS-287,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7242.51,,,,4572,21577.92,case rate,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,MS-288,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18154.46,,,,4572,51730.35,case rate,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,MS-289,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10479.27,,,,4572,29480.12,case rate,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,MS-290,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6506.76,,,,4572,21647.75,case rate,
HEART FAILURE AND SHOCK WITH MCC,MS-291,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8672.13,,,,4572,25613.81,case rate,
HEART FAILURE AND SHOCK WITH CC,MS-292,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5723.82,,,,4572,17087.18,case rate,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,MS-293,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3646.84,,,,3646.84,11201.93,case rate,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,MS-294,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8161.7,,,,4572,21819.32,case rate,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,MS-295,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5249.27,,,,3276.38,15902.15,case rate,
CARDIAC ARREST- UNEXPLAINED WITH MCC,MS-296,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10889.35,,,,4572,31983.84,case rate,
CARDIAC ARREST- UNEXPLAINED WITH CC,MS-297,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4681.68,,,,3877.22,14535.57,case rate,
CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,MS-298,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,2935.69,,,,2867.5,8772.02,case rate,
PERIPHERAL VASCULAR DISORDERS WITH MCC,MS-299,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10751.11,,,,4572,31445.19,case rate,
PERIPHERAL VASCULAR DISORDERS WITH CC,MS-300,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7115.56,,,,4572,21286.65,case rate,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,MS-301,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4741.49,,,,4315.82,14160.51,case rate,
ATHEROSCLEROSIS WITH MCC,MS-302,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7731.68,,,,4572,22365.95,case rate,
ATHEROSCLEROSIS WITHOUT MCC,MS-303,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4468.99,,,,3955.08,13129.1,case rate,
HYPERTENSION WITH MCC,MS-304,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7808.11,,,,4572,22922.55,case rate,
HYPERTENSION WITHOUT MCC,MS-305,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4989.4,,,,4278.37,15032.33,case rate,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,MS-306,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9952.22,,,,4572,30659.16,case rate,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,MS-307,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6157.16,,,,4572,18804.87,case rate,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,MS-308,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8014.81,,,,4572,23983.89,case rate,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,MS-309,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4913.63,,,,4537.49,14856.77,case rate,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,MS-310,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3718.62,,,,3341.76,11032.35,case rate,
ANGINA PECTORIS,MS-311,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4641.13,,,,4084.04,13927.1,case rate,
SYNCOPE AND COLLAPSE,MS-312,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5790.95,,,,4572,17226.83,case rate,
CHEST PAIN,MS-313,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4741.49,,,,4203.49,14435.82,case rate,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,MS-314,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14312.88,,,,4572,41765.33,case rate,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,MS-315,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6395.77,,,,4572,19297.64,case rate,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,MS-316,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4537.45,,,,4464.99,13819.37,case rate,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT WITH MCC,MS-317,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,41116.87,,,,4572,41116.87,case rate,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,MS-319,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,29196.01,,,,4572,87019.91,case rate,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,MS-320,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15384.93,,,,4572,44408.7,case rate,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,MS-321,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18920.78,,,,4572,57350.27,case rate,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,MS-322,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12024.55,,,,4572,36376.83,case rate,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,MS-323,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,28309.39,,,,4572,82593,case rate,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,MS-324,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21235.7,,,,4572,59223.57,case rate,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,MS-325,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19022.47,,,,4572,52753.79,case rate,
STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,MS-326,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,33756.72,,,,4572,101326.05,case rate,
STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,MS-327,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16137.96,,,,4572,49823.13,case rate,
STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,MS-328,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10590.93,,,,4572,31866.14,case rate,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,MS-329,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,30519.29,,,,4572,90110.16,case rate,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,MS-330,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15709.94,,,,4572,47323.4,case rate,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,MS-331,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10973.1,,,,4572,33356.4,case rate,
RECTAL RESECTION WITH MCC,MS-332,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23054.13,,,,4572,72903.29,case rate,
RECTAL RESECTION WITH CC,MS-333,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14125.45,,,,4572,41486.03,case rate,
RECTAL RESECTION WITHOUT CC/MCC,MS-334,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11023.61,,,,4572,32021.75,case rate,
PERITONEAL ADHESIOLYSIS WITH MCC,MS-335,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,24082.32,,,,4572,71321.25,case rate,
PERITONEAL ADHESIOLYSIS WITH CC,MS-336,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14039.05,,,,4572,42000.74,case rate,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,MS-337,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10202.79,,,,4572,29853.18,case rate,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,MS-344,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17908.54,,,,4572,54670.98,case rate,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,MS-345,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9894.4,,,,4572,30734.97,case rate,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,MS-346,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8276.68,,,,4572,25691.61,case rate,
ANAL AND STOMAL PROCEDURES WITH MCC,MS-347,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15730.54,,,,4572,50854.55,case rate,
ANAL AND STOMAL PROCEDURES WITH CC,MS-348,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8367.07,,,,4572,25962.93,case rate,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,MS-349,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5854.75,,,,4572,19467.21,case rate,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,MS-350,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16075.48,,,,4572,47880,case rate,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,MS-351,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9999.41,,,,4572,29039.22,case rate,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,MS-352,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7328.25,,,,4572,22124.55,case rate,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,MS-353,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19493.69,,,,4572,58339.79,case rate,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,MS-354,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11306.08,,,,4572,34270.11,case rate,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,MS-355,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8860.89,,,,4572,27183.87,case rate,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,MS-356,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,28351.26,,,,4572,85360.07,case rate,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,MS-357,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14967.54,,,,4572,43826.16,case rate,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,MS-358,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9006.45,,,,4572,25557.95,case rate,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,MS-368,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11099.38,,,,4572,32957.4,case rate,
MAJOR ESOPHAGEAL DISORDERS WITH CC,MS-369,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6763.31,,,,4572,19716.59,case rate,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,MS-370,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4639.14,,,,4417.44,14836.82,case rate,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,MS-371,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11617.79,,,,4572,34866.62,case rate,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,MS-372,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6841.07,,,,4572,20793.89,case rate,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,MS-373,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4821.25,,,,4502.43,14294.18,case rate,
DIGESTIVE MALIGNANCY WITH MCC,MS-374,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14033.07,,,,4572,41875.05,case rate,
DIGESTIVE MALIGNANCY WITH CC,MS-375,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8166.35,,,,4572,23906.09,case rate,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,MS-376,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5868.71,,,,4572,17783.43,case rate,
GASTROINTESTINAL HEMORRHAGE WITH MCC,MS-377,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12084.36,,,,4572,35716.49,case rate,
GASTROINTESTINAL HEMORRHAGE WITH CC,MS-378,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6552.62,,,,4572,19626.81,case rate,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,MS-379,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4231.72,,,,3881.98,12632.34,case rate,
COMPLICATED PEPTIC ULCER WITH MCC,MS-380,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12789.54,,,,4572,38872.58,case rate,
COMPLICATED PEPTIC ULCER WITH CC,MS-381,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7238.52,,,,4572,21406.35,case rate,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,MS-382,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4980.1,,,,4563.05,15104.15,case rate,
UNCOMPLICATED PEPTIC ULCER WITH MCC,MS-383,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8402.29,,,,4572,27894.09,case rate,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,MS-384,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5779.65,,,,4572,17470.22,case rate,
INFLAMMATORY BOWEL DISEASE WITH MCC,MS-385,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10798.96,,,,4572,31259.66,case rate,
INFLAMMATORY BOWEL DISEASE WITH CC,MS-386,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6596.49,,,,4572,19383.42,case rate,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,MS-387,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4455.04,,,,4140.5,13647.8,case rate,
GASTROINTESTINAL OBSTRUCTION WITH MCC,MS-388,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9769.44,,,,4572,28997.33,case rate,
GASTROINTESTINAL OBSTRUCTION WITH CC,MS-389,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5327.7,,,,4572,15888.18,case rate,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,MS-390,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3636.87,,,,3512.32,11152.05,case rate,
ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,MS-391,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8537.21,,,,4572,25450.22,case rate,
ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,MS-392,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5186.13,,,,4489.35,15672.72,case rate,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,MS-393,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11006.33,,,,4572,32311.02,case rate,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,MS-394,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6256.19,,,,4572,18691.16,case rate,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,MS-395,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4229.73,,,,4020.45,12917.63,case rate,
MAJOR HEAD AND NECK PROCEDURES WITH CC,MS-397,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16468.28,,,,4572,44819.67,case rate,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,MS-398,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10057.23,,,,4572,30190.34,case rate,
OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES AGE >17 WITH MCC,MS-399,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7469.15,,,,4572,22206.35,case rate,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,MS-402,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,26001.78,,,,4572,26001.78,case rate,
PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,MS-405,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,36080.95,,,,4572,109828.74,case rate,
PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,MS-406,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18665.56,,,,4572,57603.63,case rate,
PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,MS-407,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14195.24,,,,4572,42912.45,case rate,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,MS-408,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23270.8,,,,4572,74257.89,case rate,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,MS-409,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13934.04,,,,4572,39048.14,case rate,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,MS-410,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10309.13,,,,4572,31225.74,case rate,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,MS-411,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18187.02,,,,4572,60655.98,case rate,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,MS-412,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14167.32,,,,4572,41218.7,case rate,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,MS-413,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11049.53,,,,4572,30116.52,case rate,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,MS-414,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23287.42,,,,4572,70327.74,case rate,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,MS-415,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13147.11,,,,4572,39417.21,case rate,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,MS-416,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9106.8,,,,4572,26717.04,case rate,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,MS-417,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15795.01,,,,4572,46240.11,case rate,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,MS-418,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11022.28,,,,4572,32612.27,case rate,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,MS-419,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8757.21,,,,4572,26198.34,case rate,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,MS-420,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23458.23,,,,4572,63855.96,case rate,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,MS-421,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10884.03,,,,4572,34106.52,case rate,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,MS-422,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9766.12,,,,4572,28149.45,case rate,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,MS-423,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27033.29,,,,4572,78022.46,case rate,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,MS-424,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15175.57,,,,4572,42527.42,case rate,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,MS-425,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10273.9,,,,4572,31957.91,case rate,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,MS-426,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,69622.99,,,,4572,69622.99,case rate,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,MS-427,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,47206.91,,,,4572,47206.91,case rate,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,MS-428,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,36582.08,,,,4572,36582.08,case rate,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,MS-429,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,55434.4,,,,4572,55434.4,case rate,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,MS-430,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,36358.76,,,,4572,36358.76,case rate,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,MS-432,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13020.83,,,,4572,38224.2,case rate,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,MS-433,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7110.25,,,,4572,20568.45,case rate,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,MS-434,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4629.17,,,,3869.5,13356.53,case rate,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,MS-435,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12126.9,,,,4572,35110.01,case rate,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,MS-436,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7495.07,,,,4572,21958.97,case rate,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,MS-437,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5218.7,,,,4572,16580.45,case rate,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,MS-438,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11057.5,,,,4572,33292.56,case rate,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,MS-439,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5717.18,,,,4572,17061.24,case rate,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,MS-440,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4088.16,,,,3692.39,12281.22,case rate,
DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,MS-441,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12564.23,,,,4572,36472.59,case rate,
DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,MS-442,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6421.69,,,,4572,18982.43,case rate,
DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,MS-443,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4670.38,,,,4135.15,14258.27,case rate,
DISORDERS OF THE BILIARY TRACT WITH MCC,MS-444,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11195.08,,,,4572,32582.34,case rate,
DISORDERS OF THE BILIARY TRACT WITH CC,MS-445,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7207.95,,,,4572,21681.66,case rate,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,MS-446,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5299.12,,,,4572,15989.93,case rate,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,MS-447,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,44561.67,,,,4572,44561.67,case rate,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,MS-448,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27140.3,,,,4572,27140.3,case rate,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,MS-450,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,34229.28,,,,4572,34229.28,case rate,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,MS-451,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20510.58,,,,4572,20510.58,case rate,
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,MS-456,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,56289.12,,,,4572,168166.53,case rate,
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,MS-457,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,38145.96,,,,4572,121202.24,case rate,
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,MS-458,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,28698.86,,,,4572,90393.45,case rate,
BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC,MS-461,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,40786.55,,,,4572,136029.08,case rate,
BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC,MS-462,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19033.77,,,,4572,56783.69,case rate,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,MS-463,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,35896.84,,,,4572,112990.82,case rate,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,MS-464,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19597.38,,,,4572,59877.93,case rate,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,MS-465,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11538.7,,,,4572,37322.46,case rate,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,MS-466,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,33860.41,,,,4572,103472.67,case rate,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,MS-467,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22765.02,,,,4572,69551.69,case rate,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,MS-468,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17435.32,,,,4572,53258.52,case rate,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,MS-469,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21724.87,,,,4572,66429.51,case rate,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,MS-470,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12531.66,,,,4572,37539.92,case rate,
CERVICAL SPINAL FUSION WITH MCC,MS-471,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,32283.23,,,,4572,98134.05,case rate,
CERVICAL SPINAL FUSION WITH CC,MS-472,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19255.75,,,,4572,58960.23,case rate,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,MS-473,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15734.53,,,,4572,49088.97,case rate,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,MS-474,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,29806.81,,,,4572,85840.86,case rate,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,MS-475,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14338.13,,,,4572,42786.77,case rate,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,MS-476,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7730.35,,,,4572,23479.16,case rate,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,MS-477,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22856.74,,,,4572,67211.55,case rate,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,MS-478,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15543.11,,,,4572,47554.82,case rate,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,MS-479,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11802.56,,,,4572,37186.8,case rate,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,MS-480,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19546.86,,,,4572,58830.56,case rate,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,MS-481,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13790.48,,,,4572,41394.26,case rate,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,MS-482,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10543.74,,,,4572,31688.58,case rate,
MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,MS-483,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16936.18,,,,4572,49559.79,case rate,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,MS-485,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21396.54,,,,4572,65715.3,case rate,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,MS-486,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14096.21,,,,4572,40065.59,case rate,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,MS-487,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10502.53,,,,4572,30820.76,case rate,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,MS-488,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13062.7,,,,4572,42026.67,case rate,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,MS-489,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8230.82,,,,4572,24692.12,case rate,
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,MS-492,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23602.46,,,,4572,69068.9,case rate,
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,MS-493,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15957.84,,,,4572,47913.92,case rate,
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,MS-494,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12531,,,,4572,37290.54,case rate,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,MS-495,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23399.08,,,,4572,71444.94,case rate,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,MS-496,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13113.21,,,,4572,39650.63,case rate,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,MS-497,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8923.37,,,,4572,28476.63,case rate,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,MS-498,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16781.33,,,,4572,52089.45,case rate,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,MS-499,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7715.06,,,,4572,25731.51,case rate,
SOFT TISSUE PROCEDURES WITH MCC,MS-500,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21060.23,,,,4572,64693.86,case rate,
SOFT TISSUE PROCEDURES WITH CC,MS-501,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11861.71,,,,4572,34627.22,case rate,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,MS-502,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9286.26,,,,4572,27584.87,case rate,
FOOT PROCEDURES WITH MCC,MS-503,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17590.18,,,,4572,53503.91,case rate,
FOOT PROCEDURES WITH CC,MS-504,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11664.31,,,,4572,34455.65,case rate,
FOOT PROCEDURES WITHOUT CC/MCC,MS-505,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11664.31,,,,4572,34028.72,case rate,
MAJOR THUMB OR JOINT PROCEDURES,MS-506,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9963.52,,,,4572,29178.87,case rate,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,MS-507,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12881.92,,,,4572,42527.42,case rate,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,MS-508,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8577.76,,,,4572,28608.3,case rate,
ARTHROSCOPY,MS-509,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11675.61,,,,4572,27253.7,case rate,
SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC W MCC,MS-510,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18995.88,,,,4572,54275.97,case rate,
SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC W CC,MS-511,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13034.79,,,,4572,39776.31,case rate,
SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC W/O CC/MCC,MS-512,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10685.97,,,,4572,32195.31,case rate,
HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,MS-513,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10006.72,,,,4572,32338.95,case rate,
HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,MS-514,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6776.6,,,,4572,20777.93,case rate,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,MS-515,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20553.12,,,,4572,63071.93,case rate,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,MS-516,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13370.43,,,,4572,40713.96,case rate,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,MS-517,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9920.98,,,,4572,29813.28,case rate,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,MS-518,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23820.46,,,,4572,72853.41,case rate,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,MS-519,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13105.9,,,,4572,39273.57,case rate,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,MS-520,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9525.52,,,,4572,28558.43,case rate,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,MS-521,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19372.07,,,,4572,59734.29,case rate,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,MS-522,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14011.13,,,,4572,42138.39,case rate,
FRACTURES OF FEMUR WITH MCC,MS-533,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10134.99,,,,4572,32546.43,case rate,
FRACTURES OF FEMUR WITHOUT MCC,MS-534,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5410.11,,,,4572,16159.5,case rate,
FRACTURES OF HIP AND PELVIS WITH MCC,MS-535,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8838.96,,,,4572,25869.17,case rate,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,MS-536,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5389.51,,,,4498.86,15702.65,case rate,
SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,MS-537,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6107.98,,,,4572,19291.65,case rate,
SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,MS-538,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4463.01,,,,4320.57,14146.55,case rate,
OSTEOMYELITIS WITH MCC,MS-539,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13441.54,,,,4572,39588.78,case rate,
OSTEOMYELITIS WITH CC,MS-540,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8601.02,,,,4572,25899.09,case rate,
OSTEOMYELITIS WITHOUT CC/MCC,MS-541,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5814.88,,,,4572,17115.11,case rate,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,MS-542,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12396.08,,,,4572,36382.82,case rate,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,MS-543,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7051.09,,,,4572,21759.47,case rate,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,MS-544,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5022.63,,,,4572,15311.63,case rate,
CONNECTIVE TISSUE DISORDERS WITH MCC,MS-545,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16794.62,,,,4572,49739.34,case rate,
CONNECTIVE TISSUE DISORDERS WITH CC,MS-546,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7694.46,,,,4572,23926.04,case rate,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,MS-547,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4959.49,,,,4572,16424.84,case rate,
SEPTIC ARTHRITIS WITH MCC,MS-548,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13389.7,,,,4572,38898.51,case rate,
SEPTIC ARTHRITIS WITH CC,MS-549,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8009.5,,,,4572,24063.69,case rate,
SEPTIC ARTHRITIS WITHOUT CC/MCC,MS-550,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5729.8,,,,4572,18822.83,case rate,
MEDICAL BACK PROBLEMS WITH MCC,MS-551,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11341.3,,,,4572,33952.91,case rate,
MEDICAL BACK PROBLEMS WITHOUT MCC,MS-552,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6405.74,,,,4572,19277.69,case rate,
BONE DISEASES AND ARTHROPATHIES WITH MCC,MS-553,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8680.11,,,,4572,26962.43,case rate,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,MS-554,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5547.03,,,,4498.27,16394.91,case rate,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,MS-555,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8949.95,,,,4572,27910.05,case rate,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,MS-556,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5426.73,,,,4562.45,16446.78,case rate,
TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,MS-557,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10299.82,,,,4572,31058.16,case rate,
TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,MS-558,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5741.1,,,,4572,17524.08,case rate,
AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,MS-559,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12337.59,,,,4572,36917.48,case rate,
AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,MS-560,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7568.18,,,,4572,22585.4,case rate,
AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,MS-561,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5434.04,,,,4493.51,15564.99,case rate,
FX- SPRN- STRN & DISL EXCEPT FEMUR- HIP- PELVIS & THIGH W MCC,MS-562,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9726.91,,,,4572,30337.97,case rate,
FX- SPRN- STRN & DISL EXCEPT FEMUR- HIP- PELVIS & THIGH W/O MCC,MS-563,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5940.49,,,,4572,17867.22,case rate,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,MS-564,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10429.43,,,,4572,31159.91,case rate,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,MS-565,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6777.27,,,,4572,19938.03,case rate,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,MS-566,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4972.12,,,,4530.36,14972.48,case rate,
SKIN DEBRIDEMENT WITH MCC,MS-570,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20006.79,,,,4572,58297.89,case rate,
SKIN DEBRIDEMENT WITH CC,MS-571,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11127.95,,,,4572,33753.41,case rate,
SKIN DEBRIDEMENT WITHOUT CC/MCC,MS-572,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7592.77,,,,4572,22735.02,case rate,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,MS-573,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,40929.45,,,,4572,124051.1,case rate,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,MS-574,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23028.88,,,,4572,67945.71,case rate,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,MS-575,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13270.73,,,,4572,40817.7,case rate,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,MS-576,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,35858.96,,,,4572,113377.85,case rate,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,MS-577,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17697.85,,,,4572,52849.55,case rate,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,MS-578,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11234.96,,,,4572,32129.48,case rate,
OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,MS-579,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21663.06,,,,4572,66676.89,case rate,
OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,MS-580,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11783.95,,,,4572,34844.67,case rate,
OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,MS-581,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9565.4,,,,4572,26866.67,case rate,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,MS-582,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11639.06,,,,4572,34738.94,case rate,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,MS-583,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10917.93,,,,4572,30361.91,case rate,
BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,MS-584,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13607.7,,,,4572,39074.07,case rate,
BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,MS-585,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13193.63,,,,4572,33595.8,case rate,
SKIN ULCERS WITH MCC,MS-592,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13666.85,,,,4572,41697.5,case rate,
SKIN ULCERS WITH CC,MS-593,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8126.47,,,,4572,24137.51,case rate,
SKIN ULCERS WITHOUT CC/MCC,MS-594,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5640.74,,,,4572,15708.63,case rate,
MAJOR SKIN DISORDERS WITH MCC,MS-595,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14057.66,,,,4572,43391.25,case rate,
MAJOR SKIN DISORDERS WITHOUT MCC,MS-596,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7185.35,,,,4572,20129.55,case rate,
MALIGNANT BREAST DISORDERS WITH MCC,MS-597,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11675.61,,,,4572,31929.98,case rate,
MALIGNANT BREAST DISORDERS WITH CC,MS-598,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7170.73,,,,4572,23916.06,case rate,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,MS-599,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5681.95,,,,4257.57,13422.36,case rate,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,MS-600,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6357.88,,,,4572,20458.73,case rate,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,MS-601,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3984.48,,,,3679.91,12638.33,case rate,
CELLULITIS WITH MCC,MS-602,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9764.79,,,,4572,29675.63,case rate,
CELLULITIS WITHOUT MCC,MS-603,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5854.09,,,,4572,17649.77,case rate,
TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,MS-604,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9874.46,,,,4572,30048.69,case rate,
TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,MS-605,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6139.22,,,,4572,18130.56,case rate,
MINOR SKIN DISORDERS WITH MCC,MS-606,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10702.59,,,,4572,31636.71,case rate,
MINOR SKIN DISORDERS WITHOUT MCC,MS-607,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5743.76,,,,4572,17825.33,case rate,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,MS-614,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15146.99,,,,4572,44935.38,case rate,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,MS-615,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9524.19,,,,4572,29348.45,case rate,
AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,MS-616,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25688.08,,,,4572,78956.12,case rate,
AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,MS-617,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12838.06,,,,4572,39590.78,case rate,
AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,MS-618,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8275.35,,,,4572,23171.93,case rate,
O.R. PROCEDURES FOR OBESITY WITH MCC,MS-619,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18121.23,,,,4572,51919.88,case rate,
O.R. PROCEDURES FOR OBESITY WITH CC,MS-620,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10614.19,,,,4572,32362.89,case rate,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,MS-621,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9715.61,,,,4572,30270.14,case rate,
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,MS-622,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,24870.58,,,,4572,76320.72,case rate,
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,MS-623,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12713.11,,,,4572,37134.93,case rate,
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,MS-624,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6666.94,,,,4572,22234.28,case rate,
THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,MS-625,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19055.7,,,,4572,58277.94,case rate,
THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,MS-626,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10031.31,,,,4572,29763.41,case rate,
THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,MS-627,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8420.24,,,,4572,24658.2,case rate,
OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,MS-628,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,26224.43,,,,4572,80089.28,case rate,
OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,MS-629,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14948.27,,,,4572,45142.86,case rate,
OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,MS-630,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9313.51,,,,4572,27856.19,case rate,
DIABETES WITH MCC,MS-637,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9679.05,,,,4572,28913.54,case rate,
DIABETES WITH CC,MS-638,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6096.02,,,,4572,17943.03,case rate,
DIABETES WITHOUT CC/MCC,MS-639,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4164.59,,,,3755.39,12418.88,case rate,
MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,MS-640,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8826.33,,,,4572,26238.24,case rate,
MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,MS-641,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5193.44,,,,4468.55,15588.93,case rate,
INBORN AND OTHER DISORDERS OF METABOLISM,MS-642,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8248.76,,,,4572,26000.84,case rate,
ENDOCRINE DISORDERS WITH MCC,MS-643,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11014.97,,,,4572,32819.75,case rate,
ENDOCRINE DISORDERS WITH CC,MS-644,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6868.32,,,,4572,21180.92,case rate,
ENDOCRINE DISORDERS WITHOUT CC/MCC,MS-645,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5175.5,,,,4415.06,15179.96,case rate,
NEONATE BIRTHWT 1500-1999G WITHOUT SIGNIF O.R. PROC WITH OTHER PROB,MS-650,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,30621.65,,,,4572,89725.13,case rate,
NEONATE BIRTHWT 2000-2499G WITH SIGNIF O.R. PROC WITH MULT MAJOR PROB,MS-651,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23079.39,,,,4572,68995.08,case rate,
KIDNEY TRANSPLANT,MS-652,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20413.55,,,,4572,59937.78,case rate,
MAJOR BLADDER PROCEDURES WITH MCC,MS-653,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,37050.65,,,,4572,108001.32,case rate,
MAJOR BLADDER PROCEDURES WITH CC,MS-654,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18756.62,,,,4572,54613.13,case rate,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,MS-655,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13806.43,,,,4572,42050.61,case rate,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,MS-656,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21653.75,,,,4572,62595.12,case rate,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,MS-657,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12150.16,,,,4572,36791.79,case rate,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,MS-658,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9996.08,,,,4572,29533.98,case rate,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,MS-659,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17176.12,,,,4572,51648.56,case rate,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,MS-660,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8906.09,,,,4572,26850.71,case rate,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,MS-661,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6823.13,,,,4572,20915.58,case rate,
MINOR BLADDER PROCEDURES WITH MCC,MS-662,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20733.9,,,,4572,59784.17,case rate,
MINOR BLADDER PROCEDURES WITH CC,MS-663,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10151.61,,,,4572,29107.05,case rate,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,MS-664,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7176.71,,,,4572,21178.92,case rate,
PROSTATECTOMY WITH MCC,MS-665,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,22820.85,,,,4572,61627.55,case rate,
PROSTATECTOMY WITH CC,MS-666,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10948.5,,,,4572,34262.13,case rate,
PROSTATECTOMY WITHOUT CC/MCC,MS-667,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6831.1,,,,4572,20939.52,case rate,
TRANSURETHRAL PROCEDURES WITH MCC,MS-668,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19382.7,,,,4572,56219.1,case rate,
TRANSURETHRAL PROCEDURES WITH CC,MS-669,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10285.2,,,,4572,30615.27,case rate,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,MS-670,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6351.9,,,,4572,19203.87,case rate,
URETHRAL PROCEDURES WITH CC/MCC,MS-671,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11456.28,,,,4572,34152.41,case rate,
URETHRAL PROCEDURES WITHOUT CC/MCC,MS-672,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7273.75,,,,4572,18703.13,case rate,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,MS-673,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27845.48,,,,4572,73775.1,case rate,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,MS-674,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15342.39,,,,4572,47524.89,case rate,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,MS-675,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10403.5,,,,4572,31650.68,case rate,
RENAL FAILURE WITH MCC,MS-682,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9982.13,,,,4572,29940.96,case rate,
RENAL FAILURE WITH CC,MS-683,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5907.93,,,,4572,17970.96,case rate,
RENAL FAILURE WITHOUT CC/MCC,MS-684,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4036.98,,,,3683.48,12139.58,case rate,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,MS-686,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12532.99,,,,4572,36696.03,case rate,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,MS-687,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6996.59,,,,4572,20853.74,case rate,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,MS-688,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4813.27,,,,4572,15578.96,case rate,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,MS-689,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7778.2,,,,4572,23429.28,case rate,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,MS-690,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5334.35,,,,4572,16097.66,case rate,
URINARY STONES WITH MCC,MS-693,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9772.77,,,,4572,28255.19,case rate,
URINARY STONES WITHOUT MCC,MS-694,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5193.44,,,,4172.59,15614.87,case rate,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,MS-695,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7495.73,,,,4572,23860.2,case rate,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,MS-696,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4597.93,,,,4092.36,13807.4,case rate,
URETHRAL STRICTURE,MS-697,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6658.3,,,,4572,22206.35,case rate,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,MS-698,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11171.82,,,,4572,33005.28,case rate,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,MS-699,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6778.59,,,,4572,20364.96,case rate,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,MS-700,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4613.88,,,,4514.91,14130.59,case rate,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,MS-707,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12897.87,,,,4572,39139.91,case rate,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,MS-708,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9853.19,,,,4572,29097.08,case rate,
PENIS PROCEDURES WITH CC/MCC,MS-709,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14934.97,,,,4572,43307.46,case rate,
PENIS PROCEDURES WITHOUT CC/MCC,MS-710,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9978.8,,,,4572,25881.14,case rate,
TESTES PROCEDURES WITH CC/MCC,MS-711,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12698.48,,,,4572,42351.86,case rate,
TESTES PROCEDURES WITHOUT CC/MCC,MS-712,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7108.92,,,,4572,23708.58,case rate,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,MS-713,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9610.6,,,,4572,28941.47,case rate,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,MS-714,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6245.56,,,,4572,19122.08,case rate,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,MS-715,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15009.41,,,,4572,44039.63,case rate,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,MS-716,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9433.14,,,,4572,28372.89,case rate,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,MS-717,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12332.27,,,,4572,36183.32,case rate,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,MS-718,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8187.62,,,,4572,23457.21,case rate,
MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,MS-722,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11490.84,,,,4572,37402.26,case rate,
MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,MS-723,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7463.17,,,,4572,22230.29,case rate,
MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,MS-724,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4842.52,,,,4095.92,16149.53,case rate,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,MS-725,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8391.66,,,,4572,24755.96,case rate,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,MS-726,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4947.53,,,,4543.43,14581.46,case rate,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,MS-727,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9766.12,,,,4572,32338.95,case rate,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,MS-728,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5430.72,,,,4572,15962,case rate,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,MS-729,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7316.95,,,,4572,20027.81,case rate,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,MS-730,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4033.66,,,,3378.01,12400.92,case rate,
PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,MS-734,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13975.91,,,,4572,43363.32,case rate,
PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,MS-735,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8067.98,,,,4572,25140.99,case rate,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,MS-736,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,26170.6,,,,4572,77549.64,case rate,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,MS-737,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13282.03,,,,4572,39377.31,case rate,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,MS-738,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10081.82,,,,4572,27223.77,case rate,
UTERINEADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W MCC,MS-739,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,26458.39,,,,4572,72145.19,case rate,
UTERINEADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC,MS-740,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12085.03,,,,4572,35650.65,case rate,
UTERINEADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC,MS-741,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9129.4,,,,4572,25921.04,case rate,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,MS-742,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12140.86,,,,4572,35548.91,case rate,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,MS-743,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7966.96,,,,4572,23181.9,case rate,
D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,MS-744,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12986.93,,,,4572,37553.88,case rate,
D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,MS-745,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6811.16,,,,4572,20666.21,case rate,
VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,MS-746,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11129.95,,,,4572,33438.2,case rate,
VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,MS-747,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6348.58,,,,4572,17699.64,case rate,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,MS-748,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9054.3,,,,4572,28027.76,case rate,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,MS-749,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17204.7,,,,4572,50218.14,case rate,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,MS-750,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8570.45,,,,4572,27132,case rate,
MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,MS-754,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12025.21,,,,4572,36957.38,case rate,
MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,MS-755,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7378.09,,,,4572,21639.77,case rate,
MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,MS-756,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6347.25,,,,4572,19744.52,case rate,
INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,MS-757,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9406.55,,,,4572,29757.42,case rate,
INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,MS-758,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6774.61,,,,4572,19802.37,case rate,
INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,MS-759,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4253.65,,,,4223.7,12891.69,case rate,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,MS-760,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6550.63,,,,4572,19858.23,case rate,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,MS-761,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4213.11,,,,3265.09,12081.72,case rate,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,MS-768,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7286.37,,,,4572,24301.1,case rate,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,MS-769,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9235.08,,,,4572,30800.81,case rate,
ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,MS-770,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7151.45,,,,4572,15934.07,case rate,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,MS-776,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4742.16,,,,3916.45,14298.17,case rate,
ABORTION WITHOUT D&C,MS-779,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6212.99,,,,4482.81,19734.54,case rate,
CESAREAN SECTION WITH STERILIZATION WITH MCC,MS-783,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12243.21,,,,4572,35347.41,case rate,
CESAREAN SECTION WITH STERILIZATION WITH CC,MS-784,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7197.98,,,,4572,20430.8,case rate,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,MS-785,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5805.57,,,,4572,17282.69,case rate,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,MS-786,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10739.81,,,,4572,34902.53,case rate,
NEONATE BIRTHWT >2499G W SIGNIF O.R. PROC W/O MULT MAJOR PROB,MS-787,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7057.08,,,,4572,20969.45,case rate,
NEONATE BIRTHWT >2499G W MINOR ABDOM PROCEDURE,MS-788,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6012.94,,,,4572,17057.25,case rate,
NEONATES- DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY,MS-789,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11980.68,,,,9887.39,36297.03,case rate,
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME- NEONATE,MS-790,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,39511.12,,,,32605.15,119702,case rate,
PREMATURITY WITH MAJOR PROBLEMS,MS-791,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,26983.45,,,,22268.47,81749.12,case rate,
PREMATURITY WITHOUT MAJOR PROBLEMS,MS-792,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16281.52,,,,13435.96,49326.38,case rate,
FULL TERM NEONATE WITH MAJOR PROBLEMS,MS-793,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27718.53,,,,22874.06,83975.54,case rate,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,MS-794,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9811.32,,,,8096.17,29723.51,case rate,
NORMAL NEWBORN,MS-795,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,1327.94,,,,1095.89,4023.92,case rate,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,MS-796,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8484.71,,,,4572,28297.08,case rate,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,MS-797,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6434.98,,,,4572,19868.21,case rate,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,MS-798,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6434.98,,,,4572,16660.25,case rate,
SPLENIC PROCEDURES WITH MCC,MS-799,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,31601.98,,,,4572,98844.27,case rate,
SPLENIC PROCEDURES WITH CC,MS-800,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19366.08,,,,4572,56213.12,case rate,
SPLENIC PROCEDURES WITHOUT CC/MCC,MS-801,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10911.28,,,,4572,35704.52,case rate,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,MS-802,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23825.77,,,,4572,68444.46,case rate,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,MS-803,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11830.47,,,,4572,37071.09,case rate,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,MS-804,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7348.19,,,,4572,24147.48,case rate,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,MS-805,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6633.04,,,,4572,20113.59,case rate,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,MS-806,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4809.29,,,,4204.09,14896.67,case rate,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,MS-807,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4235.71,,,,3649.01,13053.29,case rate,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,MS-808,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15222.1,,,,4572,43692.5,case rate,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,MS-809,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8231.48,,,,4572,24027.78,case rate,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,MS-810,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6325.98,,,,4572,20039.78,case rate,
RED BLOOD CELL DISORDERS WITH MCC,MS-811,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9350.73,,,,4572,28001.82,case rate,
RED BLOOD CELL DISORDERS WITHOUT MCC,MS-812,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6133.9,,,,4572,17968.97,case rate,
COAGULATION DISORDERS,MS-813,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10288.52,,,,4572,31122,case rate,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,MS-814,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13894.16,,,,4572,42455.6,case rate,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,MS-815,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6753.34,,,,4572,19834.29,case rate,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,MS-816,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4382.59,,,,4288.48,14168.49,case rate,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,MS-817,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16849.12,,,,4572,56195.16,case rate,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,MS-818,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8560.48,,,,4572,28550.45,case rate,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,MS-819,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5426.73,,,,4572,18098.64,case rate,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,MS-820,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,38696.94,,,,4572,120631.67,case rate,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,MS-821,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14837.27,,,,4572,44530.4,case rate,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,MS-822,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7601.41,,,,4572,24714.06,case rate,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,MS-823,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,31101.51,,,,4572,89812.91,case rate,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,MS-824,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14617.94,,,,4572,44546.36,case rate,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,MS-825,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8180.31,,,,4572,25763.43,case rate,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,MS-826,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,31739.56,,,,4572,92322.62,case rate,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,MS-827,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,15684.68,,,,4572,46228.14,case rate,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,MS-828,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10653.41,,,,4572,32725.98,case rate,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,MS-829,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,20495.96,,,,4572,62918.31,case rate,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,MS-830,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9720.26,,,,4572,31544.94,case rate,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,MS-831,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7649.93,,,,4572,21452.24,case rate,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,MS-832,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4967.47,,,,4271.84,14717.12,case rate,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,MS-833,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3454.76,,,,2854.43,10210.41,case rate,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,MS-834,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,36736.27,,,,4572,111700.05,case rate,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,MS-835,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14195.9,,,,4572,44598.23,case rate,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,MS-836,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8445.49,,,,4572,28167.41,case rate,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,MS-837,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,33279.52,,,,4572,96637.8,case rate,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,MS-838,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13480.09,,,,4572,39933.92,case rate,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,MS-839,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9108.13,,,,4572,25996.85,case rate,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,MS-840,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21195.15,,,,4572,62347.74,case rate,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,MS-841,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10421.45,,,,4572,31391.33,case rate,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,MS-842,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6991.28,,,,4572,21274.68,case rate,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,MS-843,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12583.5,,,,4572,37118.97,case rate,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,MS-844,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7943.7,,,,4572,23086.14,case rate,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,MS-845,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5561.65,,,,4572,17254.76,case rate,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,MS-846,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16973.4,,,,4572,48757.8,case rate,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,MS-847,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8445.49,,,,4572,24191.37,case rate,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,MS-848,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5442.68,,,,4572,16682.19,case rate,
RADIOTHERAPY,MS-849,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17753.02,,,,4572,53693.43,case rate,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,MS-850,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,61225.35,,,,4572,61225.35,case rate,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,MS-853,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,33240.3,,,,4572,99736.04,case rate,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,MS-854,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13280.04,,,,4572,40662.09,case rate,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,MS-855,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10804.28,,,,4572,33950.91,case rate,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,MS-856,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,29985.59,,,,4572,88346.58,case rate,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,MS-857,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14481.69,,,,4572,42607.22,case rate,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,MS-858,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8563.13,,,,4572,25603.83,case rate,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,MS-862,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12220.61,,,,4572,36747.9,case rate,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,MS-863,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6645.67,,,,4572,20059.73,case rate,
FEVER AND INFLAMMATORY CONDITIONS,MS-864,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5968.41,,,,4572,17611.86,case rate,
VIRAL ILLNESS WITH MCC,MS-865,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9809.32,,,,4572,32716.01,case rate,
VIRAL ILLNESS WITHOUT MCC,MS-866,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5880.68,,,,4572,18308.12,case rate,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,MS-867,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14251.73,,,,4572,41741.39,case rate,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,MS-868,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6979.31,,,,4572,21655.73,case rate,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,MS-869,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4782.7,,,,4563.64,13779.47,case rate,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,MS-870,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,46235.21,,,,4572,138949.76,case rate,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,MS-871,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13040.77,,,,4572,39552.87,case rate,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,MS-872,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6852.37,,,,4572,20546.51,case rate,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,MS-876,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,26117.43,,,,4572,74443.43,case rate,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,MS-880,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6371.17,,,,4820.38,19044.27,case rate,
DEPRESSIVE NEUROSES,MS-881,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6075.41,,,,4507.78,18084.68,case rate,
NEUROSES EXCEPT DEPRESSIVE,MS-882,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6393.77,,,,4605.83,18739.04,case rate,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,MS-883,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12321.64,,,,7844.18,37414.23,case rate,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,MS-884,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11100.7,,,,8010.59,35050.16,case rate,
PSYCHOSES,MS-885,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9368.67,,,,7108.44,27259.68,case rate,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,MS-886,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11940.14,,,,5875.86,33549.92,case rate,
OTHER MENTAL DISORDER DIAGNOSES,MS-887,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7905.15,,,,6326.34,25847.22,case rate,
ALCOHOL/DRUG ABUSE OR DEPENDENCE- LEFT AMA,MS-894,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4147.98,,,,3071.94,11461.28,case rate,
ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY,MS-895,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9623.23,,,,8515.15,32095.56,case rate,
ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC,MS-896,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11835.79,,,,10381.25,35473.1,case rate,
ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC,MS-897,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5863.39,,,,4878.02,17069.22,case rate,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,MS-901,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,29446.58,,,,4572,86339.61,case rate,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,MS-902,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12612.08,,,,4572,37599.77,case rate,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,MS-903,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8102.54,,,,4572,24767.93,case rate,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,MS-904,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25662.15,,,,4572,64961.19,case rate,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,MS-905,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10954.49,,,,4572,31594.82,case rate,
HAND PROCEDURES FOR INJURIES,MS-906,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14505.62,,,,4572,37537.92,case rate,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,MS-907,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,26477,,,,4572,74204.03,case rate,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,MS-908,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,13406.32,,,,4572,39981.8,case rate,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,MS-909,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8429.54,,,,4572,27058.19,case rate,
TRAUMATIC INJURY WITH MCC,MS-913,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10755.76,,,,4572,29815.28,case rate,
TRAUMATIC INJURY WITHOUT MCC,MS-914,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6090.7,,,,4572,18108.62,case rate,
ALLERGIC REACTIONS WITH MCC,MS-915,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11550.66,,,,4572,35391.3,case rate,
ALLERGIC REACTIONS WITHOUT MCC,MS-916,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4413.83,,,,3775.6,13143.06,case rate,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,MS-917,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10897.99,,,,4572,31838.21,case rate,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,MS-918,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5879.35,,,,4572,17174.96,case rate,
COMPLICATIONS OF TREATMENT WITH MCC,MS-919,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12120.25,,,,4572,36402.77,case rate,
COMPLICATIONS OF TREATMENT WITH CC,MS-920,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6752.01,,,,4572,20624.31,case rate,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,MS-921,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,4570.68,,,,4199.33,13921.11,case rate,
OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,MS-922,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11228.31,,,,4572,34810.76,case rate,
OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,MS-923,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6778.59,,,,4572,20177.43,case rate,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,MS-927,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,157669.62,,,,4572,525856.07,case rate,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,MS-928,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,44390.19,,,,4572,138048.02,case rate,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,MS-929,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21138,,,,4572,64149.23,case rate,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,MS-933,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,28758.02,,,,4572,60488.4,case rate,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,MS-934,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14261.7,,,,4572,41745.38,case rate,
NON-EXTENSIVE BURNS,MS-935,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14598.01,,,,4572,40719.95,case rate,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,MS-939,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,21095.46,,,,4572,64145.24,case rate,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,MS-940,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,14033.07,,,,4572,43223.67,case rate,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,MS-941,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,12988.93,,,,4572,37027.2,case rate,
REHABILITATION WITH CC/MCC,MS-945,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,10145.63,,,,8111.62,30114.53,case rate,
REHABILITATION WITHOUT CC/MCC,MS-946,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7420.63,,,,6196.78,20203.37,case rate,
SIGNS AND SYMPTOMS WITH MCC,MS-947,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,8548.51,,,,4572,24969.42,case rate,
SIGNS AND SYMPTOMS WITHOUT MCC,MS-948,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,5280.51,,,,4572,15979.95,case rate,
AFTERCARE WITH CC/MCC,MS-949,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7171.39,,,,4572,21402.36,case rate,
AFTERCARE WITHOUT CC/MCC,MS-950,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3895.42,,,,3895.42,12740.07,case rate,
OTHER FACTORS INFLUENCING HEALTH STATUS,MS-951,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,3768.47,,,,3768.47,11770.5,case rate,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,MS-955,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,45383.15,,,,4572,121499.49,case rate,
LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,MS-956,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,25404.94,,,,4572,77370.09,case rate,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,MS-957,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,49609.56,,,,4572,144288.38,case rate,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,MS-958,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,27315.1,,,,4572,80693.76,case rate,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,MS-959,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17572.24,,,,4572,50521.38,case rate,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,MS-963,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,18056.09,,,,4572,54549.29,case rate,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,MS-964,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9970.16,,,,4572,29944.95,case rate,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,MS-965,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6065.44,,,,4572,19070.21,case rate,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,MS-969,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,42033.4,,,,4572,137108.37,case rate,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,MS-970,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,17634.71,,,,4572,55453.02,case rate,
HIV WITH MAJOR RELATED CONDITION WITH MCC,MS-974,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,19847.28,,,,4572,58184.18,case rate,
HIV WITH MAJOR RELATED CONDITION WITH CC,MS-975,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9447.1,,,,4572,27197.84,case rate,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,MS-976,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,6666.27,,,,4572,16863.74,case rate,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,MS-977,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,9583.35,,,,4572,28251.2,case rate,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,MS-981,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,31596,,,,4572,94570.98,case rate,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,MS-982,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,16272.22,,,,4572,49595.7,case rate,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,MS-983,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11087.41,,,,4572,32622.24,case rate,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,MS-987,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,23280.11,,,,4572,67365.17,case rate,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,MS-988,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,11405.11,,,,4572,33855.15,case rate,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,MS-989,MS-DRG,,,,,,,facility,inpatient,,,,,Advocare/Security Health,Medicare,,7679.84,,,,4572,21551.99,case rate,
Rbc dna hea 35 ag 11 bld grp,0001U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,720,,,,720,720,fee schedule,
Liver dis 10 assays w/ash,0002M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,503.4,,,,503.4,503.4,fee schedule,
Onc clrct 3 ur metab alg plp,0002U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25,,,,25,25,fee schedule,
Liver dis 10 assays w/nash,0003M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,503.4,,,,503.4,503.4,fee schedule,
Onc ovar 5 prtn ser alg scor,0003U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,950,,,,950,950,fee schedule,
Scoliosis dna alys,0004M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,79,,,,79,79,fee schedule,
Onco prst8 3 gene ur alg,0005U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Onc hep gene risk classifier,0006M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,150,,,,150,150,fee schedule,
Onc gastro 51 gene nomogram,0007M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,375,,,,375,375,fee schedule,
Rx test prsmv ur w/def conf,0007U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.43,,,,114.43,114.43,fee schedule,
Hpylori detcj abx rstnc dna,0008U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,597.91,,,,597.91,597.91,fee schedule,
Onc brst ca erbb2 amp/nonamp,0009U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,107,,,,107,107,fee schedule,
Nfct ds strn typ whl gen seq,0010U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,427.26,,,,427.26,427.26,fee schedule,
Onc prst8 ca mrna 12 gen alg,0011M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Rx mntr lc-ms/ms oral fluid,0011U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.43,,,,114.43,114.43,fee schedule,
Onc mrna 5 gen rsk urthl ca,0012M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Onc mrna 5 gen recr urthl ca,0013M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Adrnl cortcl tum bchm asy 25,0015M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1305.37,,,,1305.37,1305.37,fee schedule,
Onc bladder mrna 219 gen alg,0016M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3489.63,,,,3489.63,3489.63,fee schedule,
Onc hmtlmf neo rna bcr/abl1,0016U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,163.96,,,,163.96,182.18,fee schedule,
Anesth pharyngeal surgery,00176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Onc dlbcl mrna 20 genes alg,0017M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2510.21,,,,2510.21,2510.21,fee schedule,
Onc hmtlmf neo jak2 mut dna,0017U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.66,,,,91.66,101.85,fee schedule,
Trnsplj rnl meas cd154+cll,0018M,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,640.73,,,,640.73,640.73,fee schedule,
Onc thyr 10 microrna seq alg,0018U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3002.09,,,,3002.09,3002.09,fee schedule,
Anesth facial bone surgery,00192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Onc rna tiss predict alg,0019U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3675,,,,3675,3675,fee schedule,
Anesth cran surg hemotoma,00211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth skull drainage,00214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth skull repair/fract,00215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Onc prst8 detcj 8 autoantb,0021U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Tgsap nsm lung neo dna&rna23,0022U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1950,,,,1950,2047.5,fee schedule,
Onc aml dna detcj/nondetcj,0023U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.51,,,,248.51,248.51,fee schedule,
Glyca nuc mr spectrsc quan,0024U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.19,,,,34.19,35.06,fee schedule,
Tenofovir liq chrom ur quan,0025U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.43,,,,85.77,114.43,fee schedule,
Onc thyr dna&mrna 112 genes,0026U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3600,,,,3600,3600,fee schedule,
Jak2 gene trgt seq alys,0027U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.91,,,,121.91,150.52,fee schedule,
Rx metab advrs trgt seq alys,0029U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,742.27,,,,742.27,742.27,fee schedule,
Rx metab warf trgt seq alys,0030U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,134.13,,,,134.13,134.13,fee schedule,
Cyp1a2 gene,0031U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,174.81,fee schedule,
Comt gene,0032U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,174.81,fee schedule,
Htr2a htr2c genes,0033U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,349.62,,,,349.62,349.62,fee schedule,
Tpmt nudt15 genes,0034U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,466.17,,,,466.17,466.17,fee schedule,
Neuro csf prion prtn qual,0035U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,540.99,,,,540.99,540.99,fee schedule,
Xome tum & nml spec seq alys,0036U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4780,,,,4780,4780,fee schedule,
Trgt gen seq dna 324 genes,0037U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3500,,,,3500,5775,fee schedule,
Vitamin d srm microsamp quan,0038U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.6,,,,29.6,32.89,fee schedule,
Dna antb 2strand hi avidity,0039U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.74,,,,13.74,15.27,fee schedule,
Bcr/abl1 gene major bp quan,0040U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,409.9,,,,409.9,455.45,fee schedule,
B brgdrferi antb 5 prtn igm,0041U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.21,,,,17.21,17.21,fee schedule,
B brgdrferi antb 12 prtn igg,0042U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.21,,,,17.21,17.21,fee schedule,
Tbrf b grp antb 4 prtn igm,0043U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.86,,,,14.86,14.86,fee schedule,
Tbrf b grp antb 4 prtn igg,0044U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.86,,,,14.86,14.86,fee schedule,
Onc brst dux carc is 12 gene,0045U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,3873,fee schedule,
Flt3 gene itd variants quan,0046U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,407.43,,,,165.51,407.43,fee schedule,
Anesth surgery of rib,00474,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Onc prst8 mrna 17 gene alg,0047U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Onc sld org neo dna 468 gene,0048U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2919.6,,,,2919.6,2919.6,fee schedule,
Npm1 gene analysis quan,0049U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,407.43,,,,246.52,407.43,fee schedule,
Trgt gen seq dna 194 genes,0050U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2916.6,,,,2916.6,2916.6,fee schedule,
Rx mntr lc-ms/ms ur/bld 31,0051U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,246.92,,,,193.71,246.92,fee schedule,
Anesth chest drainage,00524,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Lpoprtn bld w/5 maj classes,0052U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.86,,,,33.86,33.86,fee schedule,
Anesth chest surgery,00540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesthesia removal pleura,00542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth lung chest wall surg,00546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Rx mntr 14+ drugs & sbsts,0054U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,198.74,,,,148.96,198.74,fee schedule,
Card hrt trnspl 96 dna seq,0055U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3240,,,,3240,3240,fee schedule,
Anesth heart surg w/o pump,00560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth heart surg <1 yr,00561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth hrt surg w/pmp age 1+,00562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth cabg w/pump,00567,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth heart/lung transplnt,00580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Onc merkel cll carc srm quan,0058U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,322.96,,,,322.96,358.85,fee schedule,
Onc merkel cll carc srm +/-,0059U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,322.96,,,,322.96,358.85,fee schedule,
Anesth sitting procedure,00604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Twn zyg gen seq alys chrms2,0060U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,759.05,,,,759.05,759.05,fee schedule,
Tc meas 5 bmrk sfdi m-s alys,0061U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.1,,,,25.1,27.85,fee schedule,
Ai sle igg&igm alys 80 bmrk,0062U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,380.72,,,,380.72,380.72,fee schedule,
Anesth removal of nerves,00632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Neuro autism 32 amines alg,0063U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,750,,,,750,750,fee schedule,
Antb tp total&rpr ia qual,0064U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.33,,,,31.33,31.33,fee schedule,
Syfls tst nontreponemal antb,0065U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.09,,,,18.09,18.09,fee schedule,
Onc brst imhchem prfl 4 bmrk,0067U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1897,,,,1897,1897,fee schedule,
Candida species pnl amp prb,0068U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,142.63,fee schedule,
Onc clrct microrna mir-31-3p,0069U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,380,,,,380,380,fee schedule,
Cyp2d6 gen com&slct rar vrnt,0070U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,676.37,,,,676.37,676.37,fee schedule,
Us leiomyomata ablate <200,0071T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Cyp2d6 full gene sequence,0071U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,600,,,,600,600,fee schedule,
Fcsd us abltj leiomyom>=200,0072T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Cyp2d6 gen cyp2d6-2d7 hybrid,0072U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,450.91,,,,450.91,450.91,fee schedule,
Cyp2d6 gen cyp2d7-2d6 hybrid,0073U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,450.91,,,,450.91,450.91,fee schedule,
Cyp2d6 nonduplicated gene,0074U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,450.91,,,,450.91,450.91,fee schedule,
Perq stent/chest vert art,0075T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,593.38,19766.37,case rate,
Cyp2d6 5 gene dup/mlt,0075U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,450.91,,,,450.91,450.91,fee schedule,
S&i stent/chest vert art,0076T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,354.73,40232.02,case rate,
Cyp2d6 3 gene dup/mlt,0076U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,450.91,,,,450.91,450.91,fee schedule,
Ig paraprotein qual bld/ur,0077U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.43,,,,43.43,43.43,fee schedule,
Anes iper upr abd prtl hptc,00792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anes iper upr abd pncrtect,00794,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anes iper upr abd lvr trnspl,00796,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Onc lng 5 clin rsk factr alg,0080U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3520,,,,3520,3520,fee schedule,
Rx test def 90+ rx/sbsts ur,0082U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,246.92,,,,246.92,246.92,fee schedule,
Onc rspse chemo cntrst tomog,0083U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,167.35,,,,167.35,167.35,fee schedule,
Anesth pelvis surgery,00844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth hysterectomy,00846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth pelvic organ surg,00848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Rbc dna gnotyp 10 bld groups,0084U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,720,,,,720,720,fee schedule,
Anesth removal of bladder,00864,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth removal of adrenal,00866,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth kidney transplant,00868,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Nfct ds bact&fng org id 6+,0086U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200,,,,200,200,fee schedule,
Crd hrt trnspl mrna 1283 gen,0087U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3159.42,,,,3159.42,3159.42,fee schedule,
Anesth major vein ligation,00882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Trnsplj kdn algrft rej 1494,0088U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3159.42,,,,3159.42,3159.42,fee schedule,
Onc mlnma prame & linc00518,0089U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Anesth perineal surgery,00904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth removal of prostate,00908,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Onc cutan mlnma mrna 23 gene,0090U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1950,,,,1755,1950,fee schedule,
Onc lng 3 prtn bmrk plsm alg,0092U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2488,,,,2488,2488,fee schedule,
Anesth amputation of penis,00932,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth penis nodes removal,00934,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth penis nodes removal,00936,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Rx mntr 65 com drugs urine,0093U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62.14,,,,62.14,62.14,fee schedule,
Genome rapid sequence alys,0094U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7582.2,,,,7582.2,12510.63,fee schedule,
Rmvl artific disc addl crvcl,0095T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,825.3,82992.02,case rate,
Ee&mj bsc prtn elisa est dev,0095U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,771.98,,,,771.98,771.98,fee schedule,
Hpv hi risk types male urine,0096U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,35.09,fee schedule,
Rev artific disc addl,0098T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,513.31,82992.02,case rate,
Esw muscskel sys nos,0101T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,227.35,11281.54,fee schedule,
Hered colon ca do 15 genes,0101U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1743.95,,,,1743.95,1743.95,fee schedule,
Esw phy anes lat hmrl epcndl,0102T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Hered brst ca rltd do 17 gen,0102U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1303.95,,,,1303.95,1303.95,fee schedule,
Hered ova ca pnl 24 genes,0103U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1743.95,,,,1743.95,1743.95,fee schedule,
Neph ckd mult eclia tum nec,0105U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,950,,,,950,950,fee schedule,
Touch quant sensory test,0106T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Gstr emptg 7 timed brth spec,0106U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,874.49,,,,874.49,874.49,fee schedule,
Vibrate quant sensory test,0107T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
C diff tox ag detcj ia stool,0107U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16,,,,16,16,fee schedule,
Cool quant sensory test,0108T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Gi barrett esoph 9 prtn bmrk,0108U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4950,,,,4950,4950,fee schedule,
Heat quant sensory test,0109T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Id aspergillus dna 4 species,0109U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,142.63,fee schedule,
Nos quant sensory test,0110T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Rx mntr 1+oral onc rx&sbsts,0110U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.11,,,,27.11,27.11,fee schedule,
Onc colon ca kras&nras alys,0111U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,682.29,,,,682.29,682.29,fee schedule,
Iadi 16s&18s rrna genes,0112U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,356.13,,,,356.13,356.13,fee schedule,
Onc prst8 pca3&tmprss2-erg,0113U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Anesth amputation at pelvis,01140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Gi barretts esoph vim&ccna1,0114U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1938.01,,,,1938.01,1938.01,fee schedule,
Anesth pelvic tumor surgery,01150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Respir iadna 18 viral&2 bact,0115U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,275.35,,,,275.35,275.35,fee schedule,
Rx mntr nzm ia 35+oral flu,0116U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,246.92,,,,246.92,246.92,fee schedule,
Pain mgmt 11 endogenous anal,0117U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,840.65,,,,840.65,840.65,fee schedule,
Trnsplj don-drv cll-fr dna,0118U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2753.25,,,,2753.25,2753.25,fee schedule,
Crd ceramides liq chrom plsm,0119U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,83.76,,,,83.76,83.76,fee schedule,
Onc b cll lymphm mrna 58 gen,0120U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2510.21,,,,2510.21,2510.21,fee schedule,
Anesth hip disarticulation,01212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Sc dis vcam-1 whole blood,0121U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,509.2,,,,509.2,509.2,fee schedule,
Sc dis p-selectin whl blood,0122U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,526.23,,,,526.23,526.23,fee schedule,
Anesth amputation of femur,01232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth radical femur surg,01234,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Mchnl fragility rbc prflg,0123U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,357.63,,,,357.63,357.63,fee schedule,
Anesth femoral artery surg,01272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth femoral embolectomy,01274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Hered brst ca rltd do panel,0129U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1303.95,,,,1303.95,1303.95,fee schedule,
Hered colon ca do mrna pnl,0130U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,584.9,fee schedule,
Hered brst ca rltd do pnl 13,0131U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,710,,,,710,710,fee schedule,
Hered ova ca rltd do pnl 17,0132U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,741.64,,,,741.64,741.64,fee schedule,
Hered prst8 ca rltd do 11,0133U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,690.29,,,,690.29,690.29,fee schedule,
Hered pan ca mrna pnl 18 gen,0134U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,748.39,,,,748.39,748.39,fee schedule,
Hered gyn ca mrna pnl 12 gen,0135U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.56,,,,700.56,700.56,fee schedule,
Atm mrna seq alys,0136U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,407.43,,,,407.43,407.43,fee schedule,
Palb2 mrna seq alys,0137U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Brca1 brca2 mrna seq alys,0138U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,468.33,,,,468.33,468.33,fee schedule,
Anesth amputation at knee,01404,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Nfct ds fungi dna 15 trgt,0140U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,156.75,,,,156.75,156.75,fee schedule,
Nfct ds bact&fng gram pos,0141U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,156.75,,,,156.75,156.75,fee schedule,
Nfct ds bact&fng gram neg,0142U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,156.75,,,,156.75,156.75,fee schedule,
Anesth knee artery surg,01442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth knee artery repair,01444,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth lwr leg embolectomy,01502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Nfct bct fng prst dna >1000,0152U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2126.2,,,,2126.2,2126.2,fee schedule,
Onc breast mrna 101 genes,0153U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3159.42,,,,3159.42,3159.42,fee schedule,
Onc urthl ca rna fgfr3 gene,0154U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,482.14,,,,482.14,482.14,fee schedule,
Onc brst ca dna pik3ca gene,0155U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Copy number sequence alys,0156U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1740,,,,1740,1740,fee schedule,
Apc mrna seq alys,0157U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Mlh1 mrna seq alys,0158U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Msh2 mrna seq alys,0159U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Msh6 mrna seq alys,0160U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Pms2 mrna seq alys,0161U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Hered colon ca trgt mrna pnl,0162U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,486.54,,,,486.54,486.54,fee schedule,
Anesth shoulder joint amput,01634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth forequarter amput,01636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Remove lumb artif disc addl,0164T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Gi ibs ia anti-cdtb&vinculin,0164U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,112.02,,,,112.02,112.02,fee schedule,
Anesth shoulder vessel surg,01652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth shoulder vessel surg,01654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Anesth arm-leg vessel surg,01656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Revise lumb artif disc addl,0165T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Peanut allg asmt epi,0165U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,463.76,,,,463.76,463.76,fee schedule,
Liver ds 10 biochem asy srm,0166U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,503.4,,,,503.4,503.4,fee schedule,
Nudt15&tpmt gene com vrnt,0169U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,466.17,,,,466.17,466.17,fee schedule,
Neuro asd rna next gen seq,0170U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1950,,,,1755,1950,fee schedule,
Trgt gen seq alys pnl dna 23,0171U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1519.06,,,,1519.06,1519.06,fee schedule,
Onc sld tum alys brca1 brca2,0172U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3030,,,,3030,4999.5,fee schedule,
Psyc gen alys panel 14 genes,0173U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,466.17,,,,466.17,466.17,fee schedule,
Onc solid tumor 30 prtn trgt,0174U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1305.37,,,,1305.37,1305.37,fee schedule,
Anesth radical humerus surg,01756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Psyc gen alys panel 15 genes,0175U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1336.09,,,,1336.09,1336.09,fee schedule,
Cdtb&vinculin igg antb ia,0176U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.19,,,,64.19,64.19,fee schedule,
Onc brst ca dna pik3ca 11,0177U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Peanut allg asmt epi clin rx,0178U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,459.86,,,,459.86,459.86,fee schedule,
Onc nonsm cll lng ca alys 23,0179U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1943.21,,,,1943.21,1943.21,fee schedule,
Abo gnotyp abo 7 exons,0180U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Co gnotyp aqp1 exon 1,0181U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Crom gnotyp cd55 exons 1-10,0182U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,301.35,,,,301.35,301.35,fee schedule,
Di gnotyp slc4a1 exon 19,0183U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Exc rectal tumor endoscopic,0184T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Do gnotyp art4 exon 2,0184U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Fut1 gnotyp fut1 exon 4,0185U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Fut2 gnotyp fut2 exon 2,0186U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Fy gnotyp ackr1 exons 1-2,0187U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Ge gnotyp gypc exons 1-4,0188U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Gypa gnotyp ntrns 1 5 exon 2,0189U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Gypb gnotyp ntrns 1 5 seux 3,0190U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
In gnotyp cd44 exons 2 3 6,0191U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Jk gnotyp slc14a1 exon 9,0192U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Jr gnotyp abcg2 exons 2-26,0193U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Kel gnotyp kel exon 8,0194U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Klf1 targeted sequencing,0195U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,375.25,,,,375.25,375.25,fee schedule,
Lu gnotyp bcam exon 3,0196U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Lw gnotyp icam4 exon 1,0197U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Ocular blood flow measure,0198T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Rhd&rhce gntyp rhd1-10&rhce5,0198U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Support for organ donor,01990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Sc gnotyp ermap exons 4 12,0199U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Perq sacral augmt unilat inj,0200T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Xk gnotyp xk exons 1-3,0200U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Perq sacral augmt bilat inj,0201T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Yt gnotyp ache exon 2,0201U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,185.2,fee schedule,
Post vert arthrplst 1 lumbar,0202T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Nfct ds 22 trgt sars-cov-2,0202U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,687.69,fee schedule,
Ai ibd mrna xprsn prfl 17,0203U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Oph amd alys 3 gene variants,0205U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47,,,,47,47,fee schedule,
Neuro alzheimer cell aggregj,0206U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2215.4,,,,2215.4,2215.4,fee schedule,
Clear eyelid gland w/heat,0207T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Audiometry air only,0208T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Audiometry air & bone,0209T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Cytog const alys interrog,0209U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,787.15,,,,787.15,787.15,fee schedule,
Speech audiometry threshold,0210T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Syphilis tst antb ia quan,0210U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.63,,,,18.63,18.63,fee schedule,
Speech audiom thresh & recog,0211T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Compre audiometry evaluation,0212T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Rare ds gen dna alys proband,0212U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5475.2,,,,5475.2,5475.2,fee schedule,
Njx paravert w/us cer/thor,0213T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Rare ds gen dna alys ea comp,0213U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2709.95,,,,2709.95,2709.95,fee schedule,
Rare ds xom dna alys proband,0214U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5224.6,,,,5224.6,5224.6,fee schedule,
Rare ds xom dna alys ea comp,0215U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2574.65,,,,2574.65,2574.65,fee schedule,
Njx paravert w/us lumb/sac,0216T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Neuro inh ataxia dna 12 com,0216U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1537.02,,,,1537.02,1537.02,fee schedule,
Neuro inh ataxia dna 51 gene,0217U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2198.35,,,,2198.35,2198.35,fee schedule,
Neuro musc dys dmd seq alys,0218U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2279,,,,2279,2279,fee schedule,
Plmt post facet implt cerv,0219T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Nfct agt hiv gnrj seq alys,0219U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,725,,,,725,725,fee schedule,
Plmt post facet implt thor,0220T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Onc brst ca ai assmt 12 feat,0220U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,706.25,,,,706.25,706.25,fee schedule,
Plmt post facet implt lumb,0221T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Abo gnotyp next gnrj seq abo,0221U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Rhd&rhce gntyp next gnrj seq,0222U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,282.88,fee schedule,
Nfct ds 22 trgt sars-cov-2,0223U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Antibody sars-cov-2 titer(s),0224U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.43,,,,51.43,51.43,fee schedule,
Nfct ds dna&rna 21 sarscov2,0225U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Svnt sarscov2 elisa plsm srm,0226U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.28,,,,42.28,42.28,fee schedule,
Rx asy prsmv 30+rx/metablt,0227U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62.14,,,,62.14,62.14,fee schedule,
Onc prst8 ma molec prfl alg,0228U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.03,,,,173.03,173.03,fee schedule,
Bcat1&ikzf1 prmtr mthyln aly,0229U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,384,,,,384,384,fee schedule,
Ar full sequence analysis,0230U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,301.35,,,,301.35,301.35,fee schedule,
Cacna1a full gene analysis,0231U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,846.27,,,,846.27,846.27,fee schedule,
Njx platelet plasma,0232T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Cstb full gene analysis,0232U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Fxn gene analysis,0233U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,274.83,fee schedule,
Trluml perip athrc renal art,0234T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Mecp2 full gene analysis,0234U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,527.87,,,,527.87,527.87,fee schedule,
Trluml perip athrc visceral,0235T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2550.33,19766.37,case rate,
Pten full gene analysis,0235U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,600,,,,600,600,fee schedule,
Trluml perip athrc abd aorta,0236T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Smn1&smn2 full gene analysis,0236U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,602.7,,,,602.7,602.7,fee schedule,
Trluml perip athrc brchiocph,0237T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Car ion chnlpthy gen seq pnl,0237U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,584.9,fee schedule,
Trluml perip athrc iliac art,0238T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Onc lnch syn gen dna seq aly,0238U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,584.9,fee schedule,
Trgt gen seq alys pnl 311+,0239U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3500,,,,3500,5775,fee schedule,
Nfct ds vir resp rna 3 trgt,0240U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,235.34,fee schedule,
Nfct ds vir resp rna 4 trgt,0241U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,235.34,fee schedule,
Trgt gen seq alys pnl 55-74,0242U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5000,,,,5000,8250,fee schedule,
Ob pe biochem assay pgf alg,0243U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.41,,,,64.41,64.41,fee schedule,
Onc solid orgn dna 257 genes,0244U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3500,,,,3500,3500,fee schedule,
Onc thyr mut alys 10 gen&37,0245U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1266.07,,,,1266.07,1266.07,fee schedule,
Rbc dna gnotyp 16 bld groups,0246U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,720,,,,720,720,fee schedule,
Ob prtrm brth ibp4 shbg meas,0247U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,750,,,,750,750,fee schedule,
Onc brn sphrd cll 12 rx pnl,0248U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3033.86,,,,3033.86,3033.86,fee schedule,
Onc brst alys 32 phsprtn alg,0249U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2219.13,,,,2219.13,2219.13,fee schedule,
Onc sld org neo dna 505 gene,0250U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2919.6,,,,2919.6,2919.6,fee schedule,
Hepcidin-25 elisa serum/plsm,0251U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,17.27,fee schedule,
Ftl aneuploidy str alys dna,0252U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,759.05,,,,759.05,759.05,fee schedule,
Insert aqueous drain device,0253T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Rprdtve med rna gen prfl 238,0253U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3159.42,,,,3159.42,3159.42,fee schedule,
Reprdtve med alys 24 chrmsm,0254U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,759.05,,,,759.05,759.05,fee schedule,
Andrology infertility assmt,0255U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.6,,,,31.6,31.6,fee schedule,
Tma/tmao prfl ms/ms ur alg,0256U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.95,,,,159.95,159.95,fee schedule,
Vlcad leuk nzm actv whl bld,0257U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.47,,,,712.47,712.47,fee schedule,
Ai psor mrna 50-100 gen alg,0258U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3675,,,,3675,3675,fee schedule,
Neph ckd nuc mrs meas gfr,0259U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.71,,,,52.71,52.71,fee schedule,
Rare ds id opt genome mapg,0260U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1263.53,,,,1263.53,1263.53,fee schedule,
Onc clrct ca img alys w/ai,0261U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2513.25,,,,2513.25,4950,fee schedule,
Onc sld tum rt-pcr 7 gen,0262U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3200,,,,3200,3200,fee schedule,
Im b1 mrw cel ther cmpl,0263T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4688.68,,,,2034.24,15766.4,fee schedule,
Neuro asd meas 16 c metblt,0263U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,750,,,,750,750,fee schedule,
Im b1 mrw cel ther xcl hrvst,0264T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4688.68,,,,2034.24,15766.4,fee schedule,
Rare ds id opt genome mapg,0264U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1263.53,,,,1263.53,1263.53,fee schedule,
Im b1 mrw cel ther hrvst onl,0265T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4688.68,,,,2034.24,15766.4,fee schedule,
Rar do whl gn&mtcdrl dna als,0265U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5475.8,,,,5475.8,5475.8,fee schedule,
Implt/rpl crtd sns dev total,0266T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47851.42,,,,14356.3,111268.64,fee schedule,
Unxpl cnst hrtbl do gn xprsn,0266U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3200,,,,3200,3200,fee schedule,
Implt/rpl crtd sns dev lead,0267T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Rare do id opt gen mapg&seq,0267U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6739.33,,,,6739.33,6739.33,fee schedule,
Implt/rpl crtd sns dev gen,0268T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31460.67,,,,14356.3,111268.64,case rate,
Hem ahus gen seq alys 15 gen,0268U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Rev/remvl crtd sns dev total,0269T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Hem aut dm cgen trmbctpna 22,0269U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Rev/remvl crtd sns dev lead,0270T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Hem cgen coagj do 20 genes,0270U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Rev/remvl crtd sns dev gen,0271T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Hem cgen neutropenia 24 gen,0271U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Interrogate crtd sns dev,0272T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Hem genetic bld do 60 genes,0272U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Interrogate crtd sns w/pgrmg,0273T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Hem gen hyprfibrnlysis 8 gen,0273U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Perq lamot/lam crv/thrc,0274T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hem gen pltlt do 62 genes,0274U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Perq lamot/lam lumbar,0275T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hem heprn nduc trmbctpna srm,0275U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.37,,,,18.37,18.37,fee schedule,
Hem inh thrombocytopenia 42,0276U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2448.56,,,,2448.56,2448.56,fee schedule,
Hem gen pltlt funcj do 40,0277U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Tempr,0278T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Hem gen thrombosis 14 genes,0278U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.17,,,,608.17,608.17,fee schedule,
Hem vw factor&clgn iii bndg,0279U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,11.53,fee schedule,
Hem vw factor&clgn iv bndg,0280U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,17.27,fee schedule,
Hem vwd propeptide ag lvl,0281U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,17.27,fee schedule,
Rbc dna gntyp 12 bld grp gen,0282U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,720,,,,720,720,fee schedule,
Vw factor type 2b eval plsm,0283U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.4,,,,18.4,18.4,fee schedule,
Vw factor type 2n eval plsm,0284U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,17.27,fee schedule,
Onc rsps radj cll fr dna tox,0285U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,443.31,,,,443.31,731.46,fee schedule,
Cep72 nudt15&tpmt gene alys,0286U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,134.13,,,,134.13,221.31,fee schedule,
Onc thyr dna&mrna 112 genes,0287U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3600,,,,3600,5940,fee schedule,
Onc lung mrna quan pcr 11&3,0288U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Neuro alzheimer mrna 24 gen,0289U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,1254,fee schedule,
Pain mgmt mrna gen xprsn 36,0290U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,1254,fee schedule,
Psyc mood do mrna 144 genes,0291U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1755,,,,497.5,2895.75,fee schedule,
Psyc strs do mrna 72 genes,0292U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1755,,,,497.5,2895.75,fee schedule,
Psyc suicidal idea mrna 54,0293U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,1254,fee schedule,
Onc brst dux carc 7 proteins,0295U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5435,,,,1897,8967.75,fee schedule,
Onc orl&/orop ca 20 mlc feat,0296U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1950,,,,1755,3217.5,fee schedule,
Onc pan tum whl gen seq dna,0297U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2919.6,,,,2919.6,5031.2,fee schedule,
Onc pan tum whl trns seq rna,0298U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2919.6,,,,2919.6,4817.34,fee schedule,
Onc pan tum whl gen opt mapg,0299U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1863.22,,,,1863.22,5031.2,fee schedule,
Onc pan tum whl gen seq&opt,0300U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4183.13,,,,4183.13,6902.16,fee schedule,
Iadna bartonella ddpcr,0301U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,262.72,,,,262.72,433.49,fee schedule,
Iadna brtnla ddpcr flwg liq,0302U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,361.37,,,,361.37,596.26,fee schedule,
Hem rbc ads whl bld hypoxic,0303U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2201.62,,,,2201.62,2201.62,fee schedule,
Hem rbc ads whl bld normoxic,0304U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2075.8,,,,2075.8,2075.8,fee schedule,
Hem rbc fnclty&dfrm shr strs,0305U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,662.58,,,,662.58,662.58,fee schedule,
Onc mrd nxt-gnrj alys 1st,0306U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3878.45,,,,759.53,3878.45,fee schedule,
Onc mrd nxt-gnrj alys sbsq,0307U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,794.49,,,,759.53,794.49,fee schedule,
Insj ocular telescope prosth,0308T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17577.64,,,,8846,68561.02,case rate,
Crd cad alys 3 prtn 3 param,0308U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,390.75,,,,390.75,390.75,fee schedule,
Crd cv ds aly 4 prtn plm alg,0309U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,390.75,,,,390.75,390.75,fee schedule,
Ped vsclts kd alys 3 bmrks,0310U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,390.75,,,,390.75,390.75,fee schedule,
Nfct ds bct quan antmcrb sc,0311U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.08,,,,8.08,8.08,fee schedule,
Ai ds sle alys 8 igg autoant,0312U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,840.65,,,,840.65,840.65,fee schedule,
Onc pncrs dna&mrna seq 74,0313U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3600,,,,3600,3600,fee schedule,
Onc cutan mlnma mrna 35 gene,0314U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1950,,,,1755,1950,fee schedule,
Onc cutan sq cll ca mrna 40,0315U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8500,,,,1755,8500,fee schedule,
B brgdrferi lyme ds ospa evl,0316U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.66,,,,18.66,18.66,fee schedule,
Onc lung ca 4-prb fish assay,0317U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2030,,,,2030,2030,fee schedule,
Ped whl gen mthyltn alys 50+,0318U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1770.48,,,,802.13,1770.48,fee schedule,
Neph rna pretrnspl perph bld,0319U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2650,,,,2650,3240,fee schedule,
Neph rna psttrnspl perph bld,0320U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2650,,,,2650,3240,fee schedule,
Iadna gu pthgn 20bct&fng org,0321U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,634.84,,,,634.84,634.84,fee schedule,
Neuro asd meas 14 acyl carn,0322U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,750,,,,750,750,fee schedule,
Iadna cns pthgn next gen seq,0323U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2126.2,,,,2126.2,2126.2,fee schedule,
Trgt gen seq alys pnl 83+,0326U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5000,,,,2919.6,5000,fee schedule,
Ftl aneuploidy trsmy dna seq,0327U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,795,,,,795,795,fee schedule,
Drug assay 120+ rx&metablt,0328U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.43,,,,114.43,114.43,fee schedule,
Onc neo xome&trns seq alys,0329U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3437.98,,,,3406,3437.98,fee schedule,
Tear film img uni/bi w/i&r,0330T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Iadna vag pthgn panel 27 org,0330U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Heart symp image plnr,0331T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Onc hl neo opt gen mapping,0331U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1863.22,,,,802.13,1863.22,fee schedule,
Heart symp image plnr spect,0332T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Onc pan tum gen prflg 8 dna,0332U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1142.06,,,,760,1142.06,fee schedule,
Onc lvr surveilanc hcc cfdna,0333U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,662.32,,,,662.32,1938.01,fee schedule,
Insj sinus tarsi implant,0335T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Rare ds whl gen seq feta,0335U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5224.6,,,,5224.6,5224.6,fee schedule,
Rare ds whl gen seq bld/slv,0336U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2574.65,,,,2574.65,2574.65,fee schedule,
Onc plsm cell do&myeloma id,0337U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2435,,,,250.78,2435,fee schedule,
Trnscth renal symp denrv unl,0338T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Onc sld tum crcg tum cl slct,0338U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2435,,,,250.78,2435,fee schedule,
Trnscth renal symp denrv bil,0339T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Onc prst8 mrna hoxc6 & dlx1,0339U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Onc pan ca alys mrd plasma,0340U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3590,,,,3590,3920,fee schedule,
Ftl aneup dna seq cmpr alys,0341U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1900.2,,,,607.24,1900.2,fee schedule,
Thxp apheresis w/hdl delip,0342T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4688.68,,,,2034.24,15766.4,fee schedule,
Onc prst8 xom aly 442 sncrna,0343U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Hep nafld semiq evl 28 lipid,0344U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,792.17,,,,792.17,792.17,fee schedule,
Transcath mtral vlve repair,0345T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3693.75,8759.27,case rate,
Psyc genom alys pnl 15 gen,0345U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1336.09,,,,1336.09,1336.09,fee schedule,
Beta amyl ab40&ab42 lc-ms/ms,0346U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,93.26,,,,93.26,93.26,fee schedule,
Ins bone device for rsa,0347T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Rx metab/pcx dna 16 gen alys,0347U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1336.09,,,,1336.09,1336.09,fee schedule,
Rsa spine exam,0348T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Rx metab/pcx dna 25 gen alys,0348U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,742.27,,,,742.27,742.27,fee schedule,
Rsa upper extr exam,0349T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Rx metab/pcx dna 27gen rx ia,0349U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,742.27,,,,742.27,742.27,fee schedule,
Rsa lower extr exam,0350T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Rx metab/pcx dna 27 gen alys,0350U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1336.09,,,,1336.09,1336.09,fee schedule,
Nfct ds bct/viral trail ip10,0351U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,260.5,,,,260.5,260.5,fee schedule,
Nfct ds bv&vaginitis amp prb,0352U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,235.34,fee schedule,
Apol1 risk variants,0355U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,216.42,fee schedule,
Onc orop/anal 17 dna ddpcr,0356U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1800,,,,1800,1938,fee schedule,
Bia whole body,0358T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Neuro alys b-amyl 1-42&1-40,0358U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,260.5,,,,260.5,260.5,fee schedule,
Onc prst8 ca alys all psa,0359U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Onc lung elisa 7 autoant alg,0360U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,840.65,,,,840.65,3520,fee schedule,
Bhv id suprt assmt ea 15 min,0362T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Onc pap thyr ca rna 82&10,0362U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3600,,,,2510.21,3600,fee schedule,
Onc urthl mrna 5 gen alg,0363U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Onc bldr 10 prb bldr ca,0365U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,897,,,,897,897,fee schedule,
Onc bldr 10 prb recr bldr ca,0366U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,897,,,,897,897,fee schedule,
Onc bldr 10 flwg trurl rescj,0367U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,902.18,,,,902.18,902.18,fee schedule,
Iadna gi pthgn 31 org&21 arg,0369U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Iadna surg wnd pthgn 34&21,0370U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Iadna gu pthgn semiq dna16&1,0371U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Nfct ds gu pthgn arg detcj,0372U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Adapt bhv tx ea 15 min,0373T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Iadna rsp tr nfct 17 8 13&16,0373U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Iadna gu pthgn 21 org&21arg,0374U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Onc ovrn bchm asy 7 prtn alg,0375U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,897,,,,897,897,fee schedule,
Onc prst8 ca img alys 128,0376U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,706.25,,,,706.25,706.25,fee schedule,
Cv ds quan advsrm/plsm lprtn,0377U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.58,,,,47.58,47.58,fee schedule,
Rfc1 repeat xpnsj vrnt alys,0378U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,137,fee schedule,
Vis field assmnt tech suppt,0379T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Rx metb advrs trgt sq aly 20,0380U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,416.78,fee schedule,
Neph ckd rsk hi stg kdn ds,0384U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,750,,,,750,750,fee schedule,
Neph ckd alg rsk dbtc kdn ds,0385U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,390.75,,,,390.75,390.75,fee schedule,
Onc mlnma ambra1&amlo,0387U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,948.5,,,,948.5,948.5,fee schedule,
Ob pe kdr eng&rbp4 ia alg,0390U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.41,,,,64.41,64.41,fee schedule,
Onc sld tum dna&rna 437 gen,0391U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3600,,,,3600,3600,fee schedule,
Rx metab genrx ia 16 genes,0392U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1336.09,,,,1336.09,1336.09,fee schedule,
Neu prksn msfl a-syncln prtn,0393U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,540.99,,,,540.99,540.99,fee schedule,
Hdr elctrnc skn surf brchytx,0394T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.29,,,,128.57,996.5,fee schedule,
Pfas 16 pfas compnd lc ms/ms,0394U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,198.74,,,,198.74,198.74,fee schedule,
Hdr elctr ntrst/ntrcv brchtx,0395T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.4,,,,352.92,2735.32,fee schedule,
Mrgfus strtctc les abltj,0398T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Colgn crs-link crn&pachymtry,0402T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,978.51,8012.89,case rate,
Nfct agt sti mult amp prb tq,0402U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,142.63,fee schedule,
Onc prst8 mrna 18 gen dre ur,0403U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Onc brst semiq meas thym kn,0404U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,322.96,,,,322.96,322.96,fee schedule,
Onc pncrtc 59 mthltn blk mrk,0405U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1770.48,,,,1770.48,1770.48,fee schedule,
Onc lung flow cytmtry 5 mrk,0406U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Neph dbtc ckd mult eclia alg,0407U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,950,,,,950,950,fee schedule,
Insj/rplc cardiac modulj sys,0408T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33331.84,,,,15685.33,121569.29,case rate,
Insj/rplc car modulj pls gn,0409T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Onc sld tum dna 80 & rna 36,0409U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2919.6,,,,2919.6,2919.6,fee schedule,
Insj/rplc car modulj atr elt,0410T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Onc pncrtc dna whl gn seq 5-,0410U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1160,,,,1160,1160,fee schedule,
Insj/rplc car modulj vnt elt,0411T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Psyc genom alys pnl 15 gen,0411U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1336.09,,,,1336.09,1336.09,fee schedule,
Rmvl cardiac modulj pls gen,0412T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Rmvl car modulj tranvns elt,0413T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Onc hl neo opt gen mapg dna,0413U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1263.53,,,,1263.53,1263.53,fee schedule,
Rmvl & rpl car modulj pls gn,0414T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Onc lng aug alg aly whl sld8,0414U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,706.25,,,,706.25,706.25,fee schedule,
Repos car modulj tranvns elt,0415T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Cv ds acs bld alg 5 yr score,0415U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,390.75,,,,390.75,390.75,fee schedule,
Reloc skin pocket pls gen,0416T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Prgrmg eval cardiac modulj,0417T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interro eval cardiac modulj,0418T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Onc brst aug alg aly whl sl8,0418U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,706.25,,,,706.25,706.25,fee schedule,
Dstrj neurofibroma xtnsv,0419T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Nrpsyc gen seq vrnt aly 13,0419U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1336.09,,,,1336.09,1336.09,fee schedule,
Dstrj neurofibroma xtnsv,0420T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Waterjet prostate abltj cmpl,0421T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Tactile breast img uni/bi,0422T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Abltj perc uxtr/perph nrv,0440T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Abltj perc lxtr/perph nrv,0441T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Abltj perc plex/trncl nrv,0442T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Insj impltbl glucose sensor,0446T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,541.07,6541.01,fee schedule,
Rmvl impltbl glucose sensor,0447T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Remvl insj impltbl gluc sens,0448T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,541.07,6541.01,fee schedule,
Insj aqueous drain dev 1st,0449T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Visual ep test for glaucoma,0464T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Prgrmg io rta eltrd ra,0472T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,case rate,
Reprgrmg io rta eltrd ra,0473T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,case rate,
Onc sld tum bld/slv 648 gene,0473U,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4500,,,,4500,4500,fee schedule,
Fxjl abl lsr 1st 100 sq cm,0479T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Njx autol wbc concentrate,0481T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Tmvi percutaneous approach,0483T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,65103.1,case rate,
Tmvi transthoracic exposure,0484T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,65103.1,case rate,
Oct mid ear i&r unilateral,0485T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Oct mid ear i&r bilateral,0486T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Prep & cannulj cdvr don lung,0494T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1485,8759.27,case rate,
Mntr cdvr don lng 1st 2 hrs,0495T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,879.25,8759.27,case rate,
Mntr cdvr don lng ea addl hr,0496T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,439.63,8759.27,case rate,
Ev fempop artl revsc,0505T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Mac pgmt opt dns meas hfp,0506T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Near ifr 2img mibmn glnd i&r,0507T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Pattern erg w/i&r,0509T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Rmvl sinus tarsi implant,0510T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Rmvl&rinsj sinus tarsi implt,0511T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Esw integ wnd hlg 1st wnd,0512T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Insj wcs lv compl sys,0515T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Insj wcs lv eltrd only,0516T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,3991.59,30936.9,case rate,
Insj wcs lv both compnt pg,0517T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,3991.59,30936.9,case rate,
Rmvl pg wcs lv battery only,0518T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Rmv&rplcmt pg wcs lv both,0519T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,1638.6,12700.02,case rate,
Rmv&rplcmt pg wcs lv battery,0520T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,10295.03,86481.43,case rate,
Interrog dev eval wcs ip,0521T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Prgrmg dev eval wcs ip,0522T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Ev cath dir chem abltj w/img,0524T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insj/rplcmt compl iims,0525T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Insj/rplcmt iims eltrd only,0526T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Insj/rplcmt iims implt mntr,0527T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Prgrmg dev eval iims ip,0528T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interrog dev eval iims ip,0529T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Removal complete iims,0530T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Removal iims electrode only,0531T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Removal iims implt mntr only,0532T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Car-t cll admn autologous,0540T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Myocardial imaging mcg,0541T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Ta mv rpr w/artif chord tend,0543T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,65103.1,case rate,
Tcat mv annulus rcnstj,0544T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,65103.1,case rate,
Tcat tv annulus rcnstj,0545T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,65103.1,case rate,
B1 str&fx rsk transmis data,0555T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,19.24,30.17,fee schedule,
B1 str & fx rsk assessment,0556T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,236.24,258.34,fee schedule,
Ct scan f/biomchn ct alys,0558T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,69.81,92.06,fee schedule,
Antmc mdl 3d print 1st cmpnt,0559T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Antmc guide 3d print 1st gd,0561T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Evac meibomian glnd heat bi,0563T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Onc chemo rx cytotox csc 14,0564T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Ttvr perq appr 1st prosth,0569T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,65103.1,case rate,
Ttvr perq ea addl prosth,0570T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,65103.1,case rate,
Insj/rplcmt icds ss eltrd,0571T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33331.84,,,,15685.33,121569.29,case rate,
Insertion ss dfb electrode,0572T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Removal ss dfb electrode,0573T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Repos prev ss impl dfb eltrd,0574T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Prgrmg dev eval icds ss ip,0575T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interrog dev eval icds ss ip,0576T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Ephys eval icds ss,0577T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1205.79,,,,546.24,4233.66,case rate,
Rem interrog dev icds tech,0579T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Rmvl ss impl dfb pg only,0580T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Abltj mal brst tum perq crtx,0581T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Tmpst auto tube dlvr sys,0583T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Perq islet cell transplant,0584T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Laps islet cell transplant,0585T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Open islet cell transplant,0586T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Perq impltj/rplcmt isdns ptn,0587T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6929.1,,,,3229.28,25028.59,case rate,
Revision/removal isdns ptn,0588T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Elec alys smpl prgrmg iins,0589T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,fee schedule,
Elec alys cplx prgrmg iins,0590T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,fee schedule,
Osteot hum xtrnl lngth dev,0594T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Temp fml iu vlv-pmp 1st insj,0596T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Temp fml iu valve-pmp rplcmt,0597T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Ncntc r-t fluor wnd img 1st,0598T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Ire abltj 1+tum organ perq,0600T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Ire abltj 1+tumors open,0601T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Mrs disc pain acquisj data,0609T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mrs disc pain alg alys data,0611T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Rmvl&rplcmt ss impl dfb pg,0614T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Eye mvmt alys w/o calbrj i&r,0615T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,fee schedule,
Insertion of iris prosthesis,0616T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17577.64,,,,8846,68561.02,case rate,
Insj iris prosth w/rmvl&insj,0617T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17577.64,,,,8846,68561.02,case rate,
Insj iris prosth sec io lens,0618T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17577.64,,,,8846,68561.02,case rate,
Cysto w/prst8 commissurotomy,0619T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,2299.37,17821.26,case rate,
Evasc ven artlz tibl/prnl vn,0620T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29242.74,,,,8399.85,65103.1,fee schedule,
Trabeculostomy interno laser,0621T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,259.55,4119.32,case rate,
Auto quan c plaq cptr alys,0625T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,464.79,3602.4,fee schedule,
Perq njx algc fluor lmbr 1st,0627T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Perq njx algc ct lmbr 1st,0629T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Tc vis lit hyperspectral img,0631T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Perq tcat us abltj nrv p-art,0632T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Ct breast w/3d uni c-,0633T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct breast w/3d uni c+,0634T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct breast w/3d uni c-/c+,0635T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct breast w/3d bi c-,0636T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Ct breast w/3d bi c+,0637T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Ct breast w/3d bi c-/c+,0638T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Ncntc ifr spctrsc o/t pad 1,0640T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,38.67,40.63,fee schedule,
Tcat l ventr rstrj dev implt,0643T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,65103.1,case rate,
Tcat rmvl/dblk icar mas perq,0644T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Tcat impltj c sins rdctj dev,0645T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Ttvi/rplcmt w/prstc vlv perq,0646T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,65103.1,case rate,
Insj gtube perq mag gastrpxy,0647T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Quan mr alys tiss w/o mri,0648T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,464.79,3602.4,fee schedule,
Quan mr tiss w/mri 1orgn,0649T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,464.79,3602.4,fee schedule,
Prgrmg dev eval scrms remote,0650T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Mag ctrld capsule endoscopy,0651T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Egd flx transnasal dx br/wa,0652T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,403.67,3128.68,case rate,
Egd flx transnasal bx 1/mlt,0653T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,403.67,3128.68,case rate,
Egd flx transnasal tube/cath,0654T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,851.64,6600.63,case rate,
Tprnl focal abltj mal prst8,0655T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Vrt bdy tethering ant <7 seg,0656T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,82992.02,case rate,
Vrt bdy tethering ant 8+ seg,0657T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,82992.02,case rate,
Elec impd spectrsc 1+skn les,0658T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Tcat intra-c nfs supersat o2,0659T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2550.33,19766.37,case rate,
Implt ant sgm io nbio rx sys,0660T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,129.44,4119.32,case rate,
Rmvl&rimpltj ant sgm implt,0661T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,129.44,4119.32,case rate,
Scalp cool 1st meas&calbrj,0662T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1329.72,,,,904.89,7013.4,fee schedule,
Insj ant sgm aq drg dev 1+,0671T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1055.97,8184.28,case rate,
Abltj b9 thyr ndul perq lasr,0673T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Histotripsy mal hepatcel tis,0686T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18609.21,,,,6112.74,47376.9,fee schedule,
Quan us tis charac w/o dx us,0689T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Therapeutic ultrafiltration,0692T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Compre ful bdy 3d mtn alys,0693T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,372.7,,,,171.39,1328.4,fee schedule,
Bdy surf mapg pm/cvdfb f/up,0696T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Quan mr tis wo mri mlt orgn,0697T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,114.19,1010.71,fee schedule,
Quan mr tiss w/mri mlt orgn,0698T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,961.79,1010.71,fee schedule,
Njx pst chmbr eye medication,0699T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Njx b1 sub mtrl sbchdrl dfct,0707T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
N-nvs artl plaq alys quan,0712T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Tprnl lsr ablt b9 prst8 hypr,0714T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Car acous wavfrm rec cad rsk,0716T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Adrc ther prtl rc tear,0717T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,3458.87,3634.82,fee schedule,
Adrc ther prtl rc tear njx,0718T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,132.95,3634.82,fee schedule,
Prq elc nrv stim cn wo implt,0720T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Quan ct tiss charac w/o ct,0721T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,691.71,,,,318.09,2465.4,fee schedule,
Quan ct tiss charac w/ct,0722T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,691.71,,,,318.09,2465.4,fee schedule,
Qmrcp w/o dx mri sm anat ses,0723T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,464.79,3602.4,fee schedule,
Qmrcp w/dx mri same anatomy,0724T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,464.79,3602.4,fee schedule,
Augmnt ai-based fcl phnt a/r,0731T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Rem r-t mtn nrehab ther sply,0733T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Colonic lavage 35+l water,0736T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,150.6,158.26,fee schedule,
Xenograft impltj artclr surf,0737T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,101.23,13334.26,case rate,
Rem auton alg nsln cal setup,0740T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Rem auton alg nsln data coll,0741T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,fee schedule,
Insj bioprostc vlv fem vn,0744T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Tc mag stimj pn 1st nerve,0766T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Smmg cncrnt appl imu snr,0778T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Gi myoelectrical actv study,0779T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,case rate,
Instlj fecal microbiota ssp,0780T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,123.15,129.42,fee schedule,
Tc auriculr neurostimulation,0783T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Ins/rplmt eltrd ra spi nstim,0784T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,13133.14,13801.21,case rate,
Revj/rmvl nea spi w/nstim,0785T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Insj/rplcmt prq ra sac nstim,0786T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,13133.14,13801.21,case rate,
Revj/rmvl nea sac w/nstim,0787T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Elec aly smp iins sp/sac nrv,0788T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,93.33,98.07,fee schedule,
Elec aly cpx iins sp/sac nrv,0789T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,93.33,98.07,fee schedule,
Revj rplcmt/rmvl vrt tethrg,0790T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Prq tcat thrm ablt nrv p-art,0793T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,16905.79,17765.77,case rate,
Pt spec alg rx-onc tx option,0794T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,58.97,61.97,fee schedule,
Tcat ins 2chmbr ldls pm cmpl,0795T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Tcat ins 2chmbr ldls pm ra,0796T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Tcat ins 2chmbr ldls pm rv,0797T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Tcat rmv 2chmbr ldls pm cmpl,0798T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,3073.09,3229.42,case rate,
Tcat rmvl 2chmbr ldls pm ra,0799T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,3073.09,3229.42,case rate,
Tcat rmvl 2chmbr ldls pm rv,0800T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,3073.09,3229.42,case rate,
Tcat rmv&rpl 2chmbr ldls pm,0801T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Tcat rmv&rpl2chmb ldls pm ra,0802T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Tcat rmv&rpl2chmb ldls pm rv,0803T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Prgrmg evl ldls pm 2chmbr ip,0804T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,36.36,38.21,case rate,
Tcat s&ivc prstc vl impl prq,0805T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Tcat s&ivc prstc vl impl opn,0806T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Pulm tiss vntj alys prev ct,0807T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,302.62,318.01,fee schedule,
Pulm tiss vntj alys w/ct,0808T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,302.62,318.01,fee schedule,
Subrta njx rx agt w/vtrc,0810T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4519.78,,,,4300.99,4519.78,fee schedule,
Rem mlt day uroflow setup,0811T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,127.45,133.93,fee schedule,
Rem mlt day uroflow dev sply,0812T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,36.36,38.21,case rate,
Egd vol adjmt bariatric balo,0813T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,873.95,918.41,fee schedule,
Opn insj/rplcmt ins ptn subq,0816T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22163.29,,,,21090.45,22163.29,case rate,
Opn insj/rplcmt ins ptn subf,0817T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22163.29,,,,21090.45,22163.29,case rate,
Revj/rmvl ins ptn subq,0818T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Revj/rmvl ins ptn subf,0819T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Tcat ins 1chmbr ldls pm ra,0823T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Tcat rmv 1chmbr ldls pm ra,0824T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,3073.09,3229.42,case rate,
Tcat rmv&rpl1chmb ldls pm ra,0825T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,18785.9,19741.52,case rate,
Prgrmg evl ldls pm 1chmbr ip,0826T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,36.36,38.21,case rate,
Opto-acoustic img breast uni,0857T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,111.39,fee schedule,
Rmvl pg wcs lv both compnt,0861T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,3786.07,3978.66,case rate,
Rlcj pg wcs lv battery only,0862T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,1758.17,1847.61,fee schedule,
Rlcj pg wcs lv trnsmtr only,0863T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,1758.17,1847.61,fee schedule,
Low ntsty eswt corpus cvrnsm,0864T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,238.27,250.4,fee schedule,
Quan mri alys brn w/o dx mri,0865T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,236.24,248.26,fee schedule,
Quan mri alys brn w/dx mri,0866T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,236.24,248.26,fee schedule,
Tpla b9 prst8 hyprplsa>=50ml,0867T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,4988.65,5242.42,case rate,
Hi-res gastric ep mapping,0868T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,516.74,543.03,fee schedule,
Njx b1 sub mtrl hw fixj aug,0869T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,3120.67,3279.42,case rate,
Augmnt alys ch ct ild w/o ct,0877T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,691.71,,,,658.23,691.71,fee schedule,
Augmnt alys ch ct ild w/ct,0878T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,691.71,,,,658.23,691.71,fee schedule,
Cryotherapy oral cavity,0881T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,384.14,403.68,case rate,
Esphgsc flx 1st tndsc dilat,0884T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,3692.31,3880.13,case rate,
Colsc flx 1st tndsc dilat,0885T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,2707.03,2844.73,case rate,
Sgmdsc flx 1st tndsc dilat,0886T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,2707.03,2844.73,case rate,
Histotripsy mal renal tissue,0888T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18609.21,,,,17708.41,18609.21,fee schedule,
Prsnlz trgt dvl arhfcmrigtbs,0889T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1010.71,,,,961.79,1010.71,fee schedule,
Arhfcmrigtbs 1st tx day,0890T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2393.07,,,,2277.23,2393.07,fee schedule,
Arhfcmrigtbs sbsq tx day,0891T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2393.07,,,,2277.23,2393.07,fee schedule,
Arhfcmrigtbs sbsq per tx day,0892T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2393.07,,,,2277.23,2393.07,fee schedule,
N-invas assmt bld oxygnation,0893T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,58.97,61.97,case rate,
Cannulation liver allograft,0894T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Connj lvr algrft prfu dev 1,0895T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Connj lvr algrft prfu dev ea,0896T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
N-invas augmnt arrhyt alys,0897T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,1008.02,1059.29,fee schedule,
N-invas prst8 cancer est map,0898T,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,1008.02,1059.29,fee schedule,
Fna bx w/us gdn 1st les,10005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Fna bx w/fluor gdn 1st les,10007,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Fna bx w/ct gdn 1st les,10009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Fna bx w/mr gdn 1st les,10011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Fna bx w/o img gdn 1st les,10021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Img gid flu coll drg sft tis,10030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Plmt sft tiss loclzj dev 1st,10035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Acne surgery,10040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
I&d abscess simple/single,10060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
I&d abscess comp/multiple,10061,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
I&d pilonidal cyst simple,10080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
I&d pilonidal cyst comp,10081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Inc&rmvl fb subq tiss smpl,10120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Inc&rmvl fb subq tiss comp,10121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
I&d hmtma seroma/fluid collj,10140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Pnxr aspir absc hmtma bulla,10160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
I&d complex po wound infctj,10180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Dbrdmt ecz/infected skin<10%,11000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Dbrdmt skin xtrnl gent&per,11004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,223.38,8759.27,case rate,
Dbrdmt skin abdominal wall,11005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,223.38,8759.27,case rate,
Dbrdmt skin xtrnl gent per,11006,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,223.38,8759.27,case rate,
Rmv prstc mtrl/mesh abd wall,11008,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,189.15,8759.27,case rate,
Debride skin at fx site,11010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Debride skin musc at fx site,11011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Deb skin bone at fx site,11012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Dbrdmt subq tis 1st 20sqcm/<,11042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dbrdmt musc&/fsca 1st 20/<,11043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Dbrdmt bone 1st 20 sq cm/<,11044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Paring/cutg b9 hyprker les 1,11055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Parng/cutg b9 hyprkr les 2-4,11056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Parng/cutg b9 hyprkr les >4,11057,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Tangntl bx skin single les,11102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Punch bx skin single lesion,11104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Incal bx skn single les,11106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Rmvl skin tags up to&inc 15,11200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Shave skin lesion 0.5 cm/<,11300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Shave skin lesion 0.6-1.0 cm,11301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Shave skin lesion 1.1-2.0 cm,11302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Shave skin lesion >2.0 cm,11303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Shave skin lesion 0.5 cm/<,11305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Shave skin lesion 0.6-1.0 cm,11306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Shave skin lesion 1.1-2.0 cm,11307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Shave skin lesion >2.0 cm,11308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Shave skin lesion 0.5 cm/<,11310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Shave skin lesion 0.6-1.0 cm,11311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Shave skin lesion 1.1-2.0 cm,11312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Shave skin lesion >2.0 cm,11313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Exc tr-ext b9+marg 0.5 cm<,11400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc tr-ext b9+marg 0.6-1 cm,11401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Exc tr-ext b9+marg 1.1-2 cm,11402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc tr-ext b9+marg 2.1-3cm,11403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc tr-ext b9+marg 3.1-4 cm,11404,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc tr-ext b9+marg >4.0 cm,11406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc h-f-nk-sp b9+marg 0.5/<,11420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc h-f-nk-sp b9+marg 0.6-1,11421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc h-f-nk-sp b9+marg 1.1-2,11422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc h-f-nk-sp b9+marg 2.1-3,11423,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc h-f-nk-sp b9+marg 3.1-4,11424,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc h-f-nk-sp b9+marg >4 cm,11426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc face-mm b9+marg 0.5 cm/<,11440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc face-mm b9+marg 0.6-1 cm,11441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc face-mm b9+marg 1.1-2 cm,11442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc face-mm b9+marg 2.1-3 cm,11443,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc face-mm b9+marg 3.1-4 cm,11444,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc face-mm b9+marg >4 cm,11446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc skn hdrdnt ax smpl/ntrm,11450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc skn hdrdnt ax complex,11451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc skn hdrdnt ing smpl/ntrm,11462,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc skn hdrdnt ing complex,11463,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc skn h/p/p/u smpl/ntrm,11470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc skn h/p/p/u complex,11471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc tr-ext mal+marg 0.5 cm/<,11600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc tr-ext mal+marg 0.6-1 cm,11601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc tr-ext mal+marg 1.1-2 cm,11602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Exc tr-ext mal+marg 2.1-3 cm,11603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc tr-ext mal+marg 3.1-4 cm,11604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc tr-ext mal+marg >4 cm,11606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc h-f-nk-sp mal+marg 0.5/<,11620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc s/n/h/f/g mal+mrg 0.6-1,11621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc s/n/h/f/g mal+mrg 1.1-2,11622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc s/n/h/f/g mal+mrg 2.1-3,11623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc s/n/h/f/g mal+mrg 3.1-4,11624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc s/n/h/f/g mal+mrg >4 cm,11626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc f/e/e/n/l mal+mrg 0.5cm<,11640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc f/e/e/n/l mal+mrg 0.6-1,11641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc f/e/e/n/l mal+mrg 1.1-2,11642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exc f/e/e/n/l mal+mrg 2.1-3,11643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc f/e/e/n/l mal+mrg 3.1-4,11644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc f/e/e/n/l mal+mrg >4 cm,11646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Trim nail(s) any number,11719,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Debride nail 1-5,11720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Debride nail 6 or more,11721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Removal of nail plate,11730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Drain blood from under nail,11740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Removal of nail bed,11750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Biopsy nail unit,11755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Repair of nail bed,11760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Reconstruction of nail bed,11762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Excision of nail fold toe,11765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Remove pilonidal cyst simple,11770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove pilonidal cyst exten,11771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove pilonidal cyst compl,11772,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Inject skin lesions </w 7,11900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Inject skin lesions >7,11901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Correct skin color 6.0 cm/<,11920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Correct skn color 6.1-20.0cm,11921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Tx contour defects 1 cc/<,11950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Tx contour defects 1.1-5.0cc,11951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Tx contour defects 5.1-10cc,11952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Tx contour defects >10.0 cc,11954,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Insert tissue expander(s),11960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Rplcmt tiss xpndr perm implt,11970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Rmvl tis xpndr wo insj implt,11971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove contraceptive capsule,11976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,case rate,
Implant hormone pellet(s),11980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Insertion drug dlvr implant,11981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Remove drug implant device,11982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Remove/insert drug implant,11983,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Rpr s/n/ax/gen/trnk 2.5cm/<,12001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Rpr s/n/ax/gen/trk7.6-12.5cm,12004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Rpr s/n/a/gen/trk12.6-20.0cm,12005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Rpr s/n/a/gen/trk20.1-30.0cm,12006,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Rpr s/n/ax/gen/trnk >30.0 cm,12007,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Rpr f/e/e/n/l/m 2.5 cm/<,12011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Rpr fe/e/en/l/m 12.6-20.0 cm,12016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Rpr fe/e/en/l/m 20.1-30.0 cm,12017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Rpr f/e/e/n/l/m >30.0 cm,12018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Tx supfc wnd dehsn smpl clsr,12020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Tx supfc wnd dehsn w/packing,12021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr s/a/t/ext 2.5 cm/<,12031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr s/a/t/ext 2.6-7.5,12032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr s/tr/ext 7.6-12.5,12034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr s/a/t/ext 12.6-20,12035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr s/a/t/ext 20.1-30,12036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Intmd rpr s/tr/ext >30.0 cm,12037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Intmd rpr n-hf/genit 2.5cm/<,12041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Intmd rpr n-hf/genit2.6-7.5,12042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr n-hf/genit7.6-12.5,12044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Intmd rpr n-hf/genit12.6-20,12045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Intmd rpr n-hf/genit20.1-30,12046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Intmd rpr n-hf/genit >30.0cm,12047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Intmd rpr face/mm 2.5 cm/<,12051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr face/mm 2.6-5.0 cm,12052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr face/mm 5.1-7.5 cm,12053,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr face/mm 7.6-12.5cm,12054,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Intmd rpr face/mm 12.6-20 cm,12055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Intmd rpr face/mm 20.1-30.0,12056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Intmd rpr face/mm >30.0 cm,12057,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Cmplx rpr trunk 1.1-2.5 cm,13100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Cmplx rpr trunk 2.6-7.5 cm,13101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Cmplx rpr s/a/l 1.1-2.5 cm,13120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Cmplx rpr s/a/l 2.6-7.5 cm,13121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Sec clsr surg wnd/dehsn xtn,13160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr trunk 10 sq cm/<,14000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr trunk 10.1-30sqcm,14001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr s/a/l 10 sq cm/<,14020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr s/a/l 10.1-30 sqcm,14021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr f/c/c/m/n/a/g/h/f,14040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr f/c/c/m/n/a/g/h/f,14041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr e/n/e/l 10 sq cm/<,14060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr e/n/e/l10.1-30sqcm,14061,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Tis trnfr any 30.1-60 sq cm,14301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Filleted finger/toe flap,14350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Wound prep trk/arm/leg,15002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Wound prep f/n/hf/g,15004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Harvest cultured skin graft,15040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Pinch graft up to 2 cm diam,15050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Skin splt grft trnk/arm/leg,15100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Epidrm autogrft trnk/arm/leg,15110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Epidrm a-grft face/nck/hf/g,15115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Skn splt a-grft fac/nck/hf/g,15120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Derm autograft trnk/arm/leg,15130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Derm autograft face/nck/hf/g,15135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Cult skin grft t/arm/leg,15150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Cult skin graft f/n/hf/g,15155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Fth grf fr trnk 20 sq cm/<,15200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Fth grf fr s/a/l 20 sq cm/<,15220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Fth gr fr f/c/c/m/n/ax/g/h/f,15240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Fth grf fr n/e/e/l 20 sqcm/<,15260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Skin sub graft trnk/arm/leg,15271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Skin sub grft t/arm/lg child,15273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Skin sub graft face/nk/hf/g,15275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Skn sub grft f/n/hf/g child,15277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Skin pedicle flap trunk,15570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Skin pedicle flap arms/legs,15572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Pedicle e/n/e/l/ntroral,15576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Delay flap trunk,15600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Delay flap arms/legs,15610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Delay flap f/c/c/n/ax/g/h/f,15620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Delay flap eye/nos/ear/lip,15630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Transfer skin pedicle flap,15650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Mdfc flap w/prsrv vasc pedcl,15730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Forehead flap w/vasc pedicle,15731,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Musc myoq/fscq flp h&n pedcl,15733,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Muscle-skin graft trunk,15734,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Muscle-skin graft arm,15736,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Muscle-skin graft leg,15738,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Island pedicle flap graft,15740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Neurovascular pedicle flap,15750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Free myo/skin flap microvasc,15756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,284.08,8759.27,case rate,
Free skin flap microvasc,15757,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,284.08,8759.27,case rate,
Free fascial flap microvasc,15758,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,284.08,8759.27,case rate,
Composite skin graft,15760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Grfg autol soft tiss dir exc,15769,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Derma-fat-fascia graft,15770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Grfg autol fat lipo 50 cc/<,15771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Grfg autol fat lipo 25 cc/<,15773,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Hair trnspl 1-15 punch grfts,15775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Hair trnspl >15 punch grafts,15776,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Impl absrb msh/prsth dly cls,15778,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,270.51,8759.27,case rate,
Dermabrasion total face,15780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Dermabrasion segmental face,15781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Dermabrasion other than face,15782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Dermabrasion suprfl any site,15783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Abrasion lesion single,15786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Chemical peel face epiderm,15788,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Chemical peel face dermal,15789,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Chemical peel nonfacial,15792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,case rate,
Chemical peel nonfacial,15793,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Plastic surgery neck,15819,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Revision of lower eyelid,15820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Revision of lower eyelid,15821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Revision of upper eyelid,15822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Revision of upper eyelid,15823,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Removal of forehead wrinkles,15824,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Removal of neck wrinkles,15825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Removal of brow wrinkles,15826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Removal of face wrinkles,15828,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Removal of skin wrinkles,15829,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Exc skin abd,15830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Excise excessive skin thigh,15832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excise excessive skin leg,15833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excise excessive skin hip,15834,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excise excessive skin buttck,15835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excise excessive skin arm,15836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excise excess skin arm/hand,15837,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excise excess skin fat pad,15838,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excise excess skin & tissue,15839,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Nerve palsy fascial graft,15840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Nerve palsy muscle graft,15841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Nerve palsy microsurg graft,15842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Skin and muscle repair face,15845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Removal sutr/staple req anes,15851,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Dressing change not for burn,15852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,case rate,
Test for blood flow in graft,15860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Suction lipectomy head&neck,15876,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Suction lipectomy trunk,15877,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Suction lipectomy upr extrem,15878,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Suction lipectomy lwr extrem,15879,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Removal of tail bone ulcer,15920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Removal of tail bone ulcer,15922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Remove sacrum pressure sore,15931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove sacrum pressure sore,15933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove sacrum pressure sore,15934,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Remove sacrum pressure sore,15935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Remove sacrum pressure sore,15936,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Remove sacrum pressure sore,15937,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Remove hip pressure sore,15940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove hip pressure sore,15941,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove hip pressure sore,15944,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Remove hip pressure sore,15945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Remove hip pressure sore,15946,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Remove thigh pressure sore,15950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Remove thigh pressure sore,15951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove thigh pressure sore,15952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Remove thigh pressure sore,15953,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Remove thigh pressure sore,15956,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Remove thigh pressure sore,15958,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Unlisted px exc pressure ulc,15999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Initial treatment of burn(s),16000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dress/debrid p-thick burn s,16020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dress/debrid p-thick burn m,16025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Dress/debrid p-thick burn l,16030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Incision of burn scab initi,16035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Escharotomy addl incision,16036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,58.3,8759.27,case rate,
Destruct premalg lesion,17000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Destroy premal lesions 15/>,17004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Destruction of skin lesions,17106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Destruction of skin lesions,17107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Destruction of skin lesions,17108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Destruct b9 lesion 1-14,17110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Destruct lesion 15 or more,17111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Chem caut of granltj tissue,17250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dstrj mal les t/a/l 0.5 cm/<,17260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dstrj mal les t/a/l .6-1.0cm,17261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dstrj mal les t/a/l 1.1-2.0,17262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dstrj mal les t/a/l 2.1-3.0,17263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dstrj mal les t/a/l 3.1-4.0,17264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstrj mal les t/a/l >4.0 cm,17266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstr mal les s/n/h/f/g .5 /<,17270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Dstr mal les s/n/h/f/g 0.6-1,17271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Dstr mal les s/n/h/f/g 1.1-2,17272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dstr mal les s/n/h/f/g 2.1-3,17273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstr mal les s/n/h/f/g 3.1-4,17274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstr mal les s/n/h/f/g >4.0,17276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstr mal ls f/e/e/n/l/m .5/<,17280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dstr mal ls f/e/e/n/l/m .6-1,17281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstr mal ls f/e/e/n/l/m1.1-2,17282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstr mal ls f/e/e/n/l/m2.1-3,17283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Dstr mal ls f/e/e/n/l/m3.1-4,17284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Dstr mal ls f/e/e/n/l/m>4.0,17286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Mohs 1 stage h/n/hf/g,17311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Mohs 1 stage t/a/l,17313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Cryotherapy of skin,17340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Skin peel therapy,17360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Hair removal by electrolysis,17380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Unlistd px skn muc memb subq,17999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Puncture aspir cyst breast,19000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Mastotomy expl drg absc dp,19020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Bx breast 1st lesion strtctc,19081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Bx breast 1st lesion us imag,19083,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Bx breast 1st lesion mr imag,19085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Bx breast percut w/o image,19100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy of breast open,19101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Cryosurg ablate fa each,19105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Nipple exploration,19110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Excise breast duct fistula,19112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Removal of breast lesion,19120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Excision breast lesion,19125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Perq device breast 1st imag,19281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,649.14,5683.29,case rate,
Perq dev breast 1st strtctc,19283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,case rate,
Perq dev breast 1st us imag,19285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,case rate,
Perq dev breast 1st mr guide,19287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,case rate,
Place po breast cath for rad,19296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9550.63,,,,4306.01,33373.75,case rate,
Place breast rad tube/caths,19298,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Removal of breast tissue,19300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Partial mastectomy,19301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
P-mastectomy w/ln removal,19302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Mast simple complete,19303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Mast radical,19305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,825.04,22524.54,case rate,
Mast rad urban type,19306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,875.3,22524.54,case rate,
Mast mod rad,19307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Suspension of breast,19316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Breast reduction,19318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Breast augmentation w/implt,19325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9550.63,,,,4306.01,33373.75,case rate,
Rmvl intact breast implant,19328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Rmvl ruptured breast implant,19330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Insj breast implt sm d mast,19340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Insj/rplcmt brst implt sep d,19342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9550.63,,,,4306.01,33373.75,case rate,
Breast reconstruction,19350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Correct inverted nipple(s),19355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Tiss xpndr plmt brst rcnstj,19357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17853.71,,,,8158.36,63231.49,case rate,
Brst rcnstj latsms drsi flap,19361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1140.91,22524.54,case rate,
Brst rcnstj free flap,19364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1981.75,22524.54,case rate,
Brst rcnstj 1 pdcl tram flap,19367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1295.86,13029.26,case rate,
Brst rcnstj 1pdcl tram anast,19368,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1582.97,22524.54,case rate,
Brst rcnstj 2 pdcl tram flap,19369,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1471.55,13029.26,case rate,
Revj peri-implt capsule brst,19370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Peri-implt capslc brst compl,19371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Revj reconstructed breast,19380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Design custom breast implant,19396,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Unlisted procedure breast,19499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Explore wound neck,20100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Explore wound chest,20101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Explore wound abdomen,20102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Explore wound extremity,20103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,649.14,5683.29,case rate,
Excise epiphyseal bar,20150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Muscle biopsy superficial,20200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Deep muscle biopsy,20205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Biopsy muscle perq needle,20206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Bone biopsy trocar/ndl supfc,20220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Bone biopsy trocar/ndl deep,20225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Bone biopsy open superficial,20240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Bone biopsy open deep,20245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Biopsy vrt bdy open thoracic,20250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy vrt bdy open lmbr/crv,20251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Injection of sinus tract,20500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Removal of foreign body,20520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Removal of foreign body,20525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Ther injection carp tunnel,20526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Inj dupuytren cord w/enzyme,20527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Inj tendon sheath/ligament,20550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Inj tendon origin/insertion,20551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Inj trigger point 1/2 muscl,20552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Inject trigger points 3/>,20553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Place ndl musc/tis for rt,20555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Ndl insj w/o njx 1 or 2 musc,20560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Ndl insj w/o njx 3+ musc,20561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Drain/inj joint/bursa w/o us,20600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Drain/inj joint/bursa w/us,20604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Drain/inj joint/bursa w/o us,20605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Drain/inj joint/bursa w/us,20606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Drain/inj joint/bursa w/o us,20610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Drain/inj joint/bursa w/us,20611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Aspirate/inj ganglion cyst,20612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Treatment of bone cyst,20615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Insert and remove bone pin,20650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Apply rem fixation device,20660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Application halo cranial,20661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,377.8,8759.27,case rate,
Application halo pelvic,20662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Application halo femoral,20663,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Appl halo cranial 6+pins,20664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Rmvl tongs/halo anthr indiv,20665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Removal implant superficial,20670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Removal of implant deep,20680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Appl unipln uni ext fixj sys,20690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Appl mltpln uni ext fixj sys,20692,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Adjmt/revj ext fixj sys anes,20693,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Rmvl ext fixj sys under anes,20694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
App mltpln uni xtrnl fix 1st,20696,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
App mltpln uni xtrnl fix xch,20697,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Replantation arm complete,20802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Replant forearm complete,20805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,18560.03,case rate,
Replantation hand complete,20808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,18560.03,case rate,
Replantation digit complete,20816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Replantation digit complete,20822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Replantation thumb complete,20824,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Replantation thumb complete,20827,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Replantation foot complete,20838,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,18560.03,case rate,
Removal of bone for graft,20900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Removal of bone for graft,20902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove cartilage for graft,20910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Remove cartilage for graft,20912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Removal of fascia for graft,20920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Removal of fascia for graft,20922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Removal of tendon for graft,20924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fluid pressure muscle,20950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Fibula bone graft microvasc,20955,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Iliac bone graft microvasc,20956,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Mt bone graft microvasc,20957,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Other bone graft microvasc,20962,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Bone/skin graft microvasc,20969,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Bone/skin graft iliac crest,20970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Bone/skin graft metatarsal,20972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Bone/skin graft great toe,20973,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Electrical bone stimulation,20974,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.17,,,,48.17,104.67,fee schedule,
Us bone stimulation,20979,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Ablate bone tumor(s) perq,20982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,3234.55,25069.45,case rate,
Ablate bone tumor(s) perq,20983,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Unlisted px muscskel general,20999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Incision of jaw joint,21010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Exc face les sc <2 cm,21011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc face les sbq 2 cm/>,21012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc face tum deep < 2 cm,21013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc face tum deep 2 cm/>,21014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect face/scalp tum < 2 cm,21015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect face/scalp tum 2 cm/>,21016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Excision of bone lower jaw,21025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excision of facial bone(s),21026,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Contour of face bone lesion,21029,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excise max/zygoma b9 tumor,21030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove exostosis mandible,21031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Remove exostosis maxilla,21032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excise max/zygoma mal tumor,21034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise mandible lesion,21040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of jaw bone lesion,21044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Extensive jaw surgery,21045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Remove mandible cyst complex,21046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise lwr jaw cyst w/repair,21047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove maxilla cyst complex,21048,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excis uppr jaw cyst w/repair,21049,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of jaw joint,21050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove jaw joint cartilage,21060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove coronoid process,21070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Mnpj of tmj w/anesth,21073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Prepare face/oral prosthesis,21076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Prepare face/oral prosthesis,21077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Prepare face/oral prosthesis,21079,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Prepare face/oral prosthesis,21080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Prepare face/oral prosthesis,21081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Prepare face/oral prosthesis,21082,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Prepare face/oral prosthesis,21083,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Prepare face/oral prosthesis,21084,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Prepare face/oral prosthesis,21085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Prepare face/oral prosthesis,21086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Prepare face/oral prosthesis,21087,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Prepare face/oral prosthesis,21088,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Unlisted maxlfcl prosth px,21089,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Maxillofacial fixation,21100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Interdental fixation,21110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Reconstruction of chin,21120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of chin,21121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Reconstruction of chin,21122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of chin,21123,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Augmentation lower jaw bone,21125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Augmentation lower jaw bone,21127,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reduction of forehead,21137,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Reduction of forehead,21138,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reduction of forehead,21139,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lefort i-1 piece w/o graft,21141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lefort i-2 piece w/o graft,21142,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lefort i-3/> piece w/o graft,21143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lefort i-1 piece w/ graft,21145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Lefort i-2 piece w/ graft,21146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Lefort i-3/> piece w/ graft,21147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Lefort ii anterior intrusion,21150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lefort ii w/bone grafts,21151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Lefort iii w/o lefort i,21154,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Lefort iii w/ lefort i,21155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Lefort iii w/fhdw/o lefort i,21159,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Lefort iii w/fhd w/ lefort i,21160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Reconstruct orbit/forehead,21172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct orbit/forehead,21175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct entire forehead,21179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Reconstruct entire forehead,21180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Contour cranial bone lesion,21181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct cranial bone,21182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Reconstruct cranial bone,21183,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Reconstruct cranial bone,21184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Reconstruction of midface,21188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Reconst lwr jaw w/o graft,21193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconst lwr jaw w/graft,21194,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconst lwr jaw w/o fixation,21195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconst lwr jaw w/fixation,21196,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstr lwr jaw segment,21198,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstr lwr jaw w/advance,21199,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct upper jaw bone,21206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Augmentation of facial bones,21208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reduction of facial bones,21209,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Face bone graft,21210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lower jaw bone graft,21215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rib cartilage graft,21230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Ear cartilage graft,21235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of jaw joint,21240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of jaw joint,21242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of jaw joint,21243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Reconstruction of lower jaw,21244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of jaw,21245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of jaw,21246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct lower jaw bone,21247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Reconstruction of jaw,21248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of jaw,21249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct lower jaw bone,21255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of orbit,21256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise eye sockets,21260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise eye sockets,21261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise eye sockets,21263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise eye sockets,21267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise eye sockets,21268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Augmentation cheek bone,21270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision orbitofacial bones,21275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of eyelid,21280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Revision of eyelid,21282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Revision of jaw muscle/bone,21295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Revision of jaw muscle/bone,21296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Unlisted cranfcl&maxlfcl px,21299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Clsd tx nsl fx mnpj wo stblj,21315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Clsd tx nsl fx w/mnpj&stablj,21320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Open tx nose fx uncomplicatd,21325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Open tx nose fx w/skele fixj,21330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Open tx nose & septal fx,21335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Open tx septal fx w/wo stabj,21336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Closed tx septal&nose fx,21337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Open nasoethmoid fx w/o fixj,21338,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Open nasoethmoid fx w/ fixj,21339,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Perq tx nasoethmoid fx,21340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Open tx dprsd front sinus fx,21343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,820.12,10782.66,case rate,
Open tx compl front sinus fx,21344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Closed tx nose/jaw fx,21345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Opn tx nasomax fx w/fixj,21346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx nasomax fx multple,21347,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx nasomax fx w/graft,21348,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Perq tx malar fracture,21355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Opn tx dprsd zygomatic arch,21356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx dprsd malar fracture,21360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx complx malar fx,21365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx complx malar w/grft,21366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx orbit fx transantral,21385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx orbit fx periorbital,21386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx orbit fx combined,21387,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx orbit periorbtl implt,21390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx orbit periorbt w/grft,21395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Closed tx orbit w/o manipulj,21400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Closed tx orbit w/manipulj,21401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Opn tx orbit fx w/o implant,21406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx orbit fx w/implant,21407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Opn tx orbit fx w/bone grft,21408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat mouth roof fracture,21421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Treat mouth roof fracture,21422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat mouth roof fracture,21423,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Treat craniofacial fracture,21431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Treat craniofacial fracture,21432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Treat craniofacial fracture,21433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Treat craniofacial fracture,21435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Treat craniofacial fracture,21436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Treat dental ridge fracture,21440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Treat dental ridge fracture,21445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat lower jaw fracture,21450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Treat lower jaw fracture,21451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Treat lower jaw fracture,21452,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat lower jaw fracture,21453,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat lower jaw fracture,21454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat lower jaw fracture,21461,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat lower jaw fracture,21462,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat lower jaw fracture,21465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treat lower jaw fracture,21470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reset dislocated jaw,21480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Reset dislocated jaw,21485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Repair dislocated jaw,21490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Interdental wiring,21497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Unlisted muscskel px head,21499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drain neck/chest lesion,21501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Drain chest lesion,21502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Drainage of bone lesion,21510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Biopsy of neck/chest,21550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc neck les sc 3 cm/>,21552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc neck tum deep 5 cm/>,21554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc neck les sc < 3 cm,21555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc neck tum deep < 5 cm,21556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect neck thorax tumor<5cm,21557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect neck tumor 5 cm/>,21558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Partial removal of rib,21600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Exc chest wall tumor w/ribs,21601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc ch wal tum w/o lymphadec,21602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Exc ch wal tum w/lymphadec,21603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Partial removal of rib,21610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of rib,21615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Removal of rib and nerves,21616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Partial removal of sternum,21620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Sternal debridement,21627,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Extensive sternum surgery,21630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Extensive sternum surgery,21632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Hyoid myotomy & suspension,21685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of neck muscle,21700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Revision of neck muscle/rib,21705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Revision of neck muscle,21720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of neck muscle,21725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Reconstruction of sternum,21740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Repair stern/nuss w/o scope,21742,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair sternum/nuss w/scope,21743,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of sternum separation,21750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Optx of rib fx w/fixj scope,21811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Treatment of rib fracture,21812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Treatment of rib fracture,21813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat sternum fracture,21820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat sternum fracture,21825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Unlisted px neck/thorax,21899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Biopsy soft tissue of back,21920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy soft tissue of back,21925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc back les sc < 3 cm,21930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc back les sc 3 cm/>,21931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc back tum deep < 5 cm,21932,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc back tum deep 5 cm/>,21933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect back tum < 5 cm,21935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect back tum 5 cm/>,21936,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
I&d p-spine c/t/cerv-thor,22010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
I&d abscess p-spine l/s/ls,22015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Remove part of neck vertebra,22100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove part thorax vertebra,22101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove part lumbar vertebra,22102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove part of neck vertebra,22110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Remove part thorax vertebra,22112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Remove part lumbar vertebra,22114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Remove extra spine segment,22116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Incis spine 3 column thorac,22206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incis spine 3 column lumbar,22207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incis spine 3 column adl seg,22208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incis 1 vertebral seg cerv,22210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incis 1 vertebral seg thorac,22212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incis 1 vertebral seg lumbar,22214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incis addl spine segment,22216,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Osteot dsc ant 1 vrt sgm crv,22220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Osteot dsc ant 1vrt sgm thrc,22222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Osteot dsc ant 1vrt sgm lmbr,22224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Osteot dsc ant 1vrt sgm ea,22226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Closed tx vert fx w/o manj,22310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Closed tx vert fx w/manj,22315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat odontoid fx w/o graft,22318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Treat odontoid fx w/graft,22319,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Treat spine fracture,22325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1044.78,25069.45,case rate,
Treat neck spine fracture,22326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1062.4,25069.45,case rate,
Treat thorax spine fracture,22327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1086.23,25069.45,case rate,
Treat each add spine fx,22328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,192.26,25069.45,case rate,
Manipulation of spine,22505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Perq cervicothoracic inject,22510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Perq lumbosacral injection,22511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Perq vertebral augmentation,22513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Perq vertebral augmentation,22514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Arthrd lat xtrcvtry tq thrc,22532,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd lat xtrcvtry tq lmbr,22533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd lat xtrcvtry tq ea ad,22534,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd ant toral/xoral c1-c2,22548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd ant ntrbdy cervical,22551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Arthrd ant ntrbd min dsc crv,22554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Arthrd ant ntrbd min dsc thc,22556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd ant ntrbd min dsc lum,22558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Arthrd pre-sac ntrbdy l5-s1,22586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Arthrd pst tq craniocervical,22590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd pst tq atlas-axis,22595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd pst tq 1ntrspc crv,22600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Arthrd pst tq 1ntrspc thrc,22610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd pst tq 1ntrspc lumbar,22612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Arthrd pst tq 1ntrspc lum,22630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,7530.35,82992.02,case rate,
Arthrd cmbn 1ntrspc lumbar,22633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,7530.35,82992.02,case rate,
Arthrd pst dfrm<6 vrt sgm,22800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd pst dfrm 7-12 vrt sgm,22802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd pst dfrm 13+ vrt sgm,22804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd ant dfrm 2-3 vrt sgm,22808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd ant dfrm 4-7 vrt sgm,22810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd ant dfrm 8+ vrt sgm,22812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Kyphectomy 1-2 segments,22818,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Kyphectomy 3 or more,22819,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Exploration of spinal fusion,22830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,13107.45,case rate,
Ant thrc vrt body tethrg <7,22836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Ant thrc vrt body tethrg 8+,22837,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Rev rplc/rmv thrc vrt tethrg,22838,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Insert spine fixation device,22841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Insert spine fixation device,22843,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Insert spine fixation device,22844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Insert spine fixation device,22846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Insert spine fixation device,22847,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Insert pelv fixation device,22848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Reinsert spinal fixation,22849,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Remove spine fixation device,22850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,13107.45,case rate,
Remove spine fixation device,22852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,13107.45,case rate,
Removal anterior instrmj,22855,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,13107.45,case rate,
Tot disc arthrp 1ntrspc crv,22856,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Tot disc arthrp 1ntrspc lmbr,22857,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Tot disc arthrp 2ntrspc lmbr,22860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,386.86,25069.45,case rate,
Rev rplcm arthrp 1ntrspc crv,22861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Rev rplcm rthrp 1ntrspc lmbr,22862,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Rmvl tot arthrp 1ntrspc crv,22864,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Rmvl tot arthrp 1ntrspc lmbr,22865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3234.55,25069.45,case rate,
Insj stablj dev w/dcmprn,22867,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Insj stablj dev w/o dcmprn,22869,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Unlisted procedure spine,22899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Exc abdl tum deep < 5 cm,22900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc abdl tum deep 5 cm/>,22901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc abd les sc < 3 cm,22902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc abd les sc 3 cm/>,22903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Radical resect abd tumor<5cm,22904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Rad resect abd tumor 5 cm/>,22905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Unlisted px abdomen muscskel,22999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Removal of calcium deposits,23000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Release shoulder joint,23020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Drain shoulder lesion,23030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Drain shoulder bursa,23031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Drain shoulder bone lesion,23035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Exploratory shoulder surgery,23040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exploratory shoulder surgery,23044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy shoulder tissues,23065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy shoulder tissues,23066,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc shoulder les sc 3 cm/>,23071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc shoulder tum deep 5 cm/>,23073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc shoulder les sc < 3 cm,23075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc shoulder tum deep < 5 cm,23076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect shoulder tumor < 5 cm,23077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect shoulder tumor 5 cm/>,23078,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Biopsy of shoulder joint,23100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Shoulder joint surgery,23101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove shoulder joint lining,23105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of collarbone joint,23106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Explore treat shoulder joint,23107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Partial removal collar bone,23120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of collar bone,23125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove shoulder bone part,23130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of bone lesion,23140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of bone lesion,23145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of bone lesion,23146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Removal of humerus lesion,23150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of humerus lesion,23155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Removal of humerus lesion,23156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove collar bone lesion,23170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove shoulder blade lesion,23172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove humerus lesion,23174,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove collar bone lesion,23180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove shoulder blade lesion,23182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove humerus lesion,23184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Partial removal of scapula,23190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of head of humerus,23195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Resect clavicle tumor,23200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Resect scapula tumor,23210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Resect prox humerus tumor,23220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Remove shoulder foreign body,23330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,649.14,5683.29,case rate,
Remove shoulder fb deep,23333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Shoulder prosthesis removal,23334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Shoulder prosthesis removal,23335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Muscle transfer shoulder/arm,23395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Muscle transfers,23397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fixation of shoulder blade,23400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of tendon & muscle,23405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incise tendon(s) & muscle(s),23406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair rotator cuff acute,23410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair rotator cuff chronic,23412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Release of shoulder ligament,23415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of shoulder,23420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair biceps tendon,23430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove/transplant tendon,23440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair shoulder capsule,23450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair shoulder capsule,23455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair shoulder capsule,23460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair shoulder capsule,23462,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair shoulder capsule,23465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair shoulder capsule,23466,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruct shoulder joint,23470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Reconstruct shoulder joint,23472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,6380.51,49452.22,case rate,
Revis reconst shoulder joint,23473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revis reconst shoulder joint,23474,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Revision of collar bone,23480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of collar bone,23485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Reinforce clavicle,23490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reinforce shoulder bones,23491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Cltx clavicular fx w/o mnpj,23500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx clavicular fx w/mnpj,23505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx clavicular fx w/int fix,23515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx strnclav dislc w/o mnpj,23520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Cltx strnclav dislc w/mnpj,23525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Optx strnclav dislc aqt/chrn,23530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Optx strclv dslc aq/chrn grf,23532,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx acromclav dislc wo mnpj,23540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx acromclav dislc w/mnpj,23545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Optx acromclv dislc aqt/chrn,23550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Optx acrclv dslc aq/chrn grf,23552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx scapular fx w/o mnpj,23570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx scap fx w/mnpj +-tractj,23575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx scapular fx w/int fixj,23585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx prox humrl fx w/o mnpj,23600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx prx hmrl fx mnpj+-tract,23605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx prox humrl fx w/int fix,23615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Optx prx hmrl fx fix rpr rpl,23616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Cltx gr hmrl tbrs fx wo mnpj,23620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx gr hmrl tbrs fx w/mnpj,23625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx gr hmrl tbrs fx int fix,23630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx sho dslc w/mnpj wo anes,23650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx sho dslc w/mnpj w/anes,23655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx acute shoulder dislc,23660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx sho dslc fx gr hmrl tbr,23665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx sho dislc fx,23670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx sho dislc neck fx mnpj,23675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx sho dislc neck fx fixj,23680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Mnpj anes sho jt fixj aprats,23700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Arthrodesis glenohumeral jt,23800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Arthrd glenohumeral jt w/grf,23802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Interthoracoscplr amputation,23900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Disarticulation shoulder,23920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Disarticulation sho sec clsr,23921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Unlisted procedure shoulder,23929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
I&d upr a/e dp absc/hmtma,23930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
I&d upr a/e bursa,23931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Inc dp opn b1 crtx hum/elbw,23935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Arthrt elbw expl drg/rmvl fb,24000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Arthrt elbw capsl exc rls,24006,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy arm/elbow soft tissue,24065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy arm/elbow soft tissue,24066,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc arm/elbow les sc 3 cm/>,24071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Ex arm/elbow tum deep 5 cm/>,24073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc arm/elbow les sc < 3 cm,24075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Ex arm/elbow tum deep < 5 cm,24076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Rad rescj tum tiss a/e <5cm,24077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Rad rescj tum tiss a/e 5 cm+,24079,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Arthrt elbw synovial bx only,24100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Arthrt elbw jt expl bx rmvl,24101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Arthrt elbow w/synovectomy,24102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Excision olecranon bursa,24105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exc/curtg b1 cst/b9 tum hum,24110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exc/crtg b1 cst/tum hum agrf,24115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Exc/crtg b1 cst/tum hum algr,24116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Exc/crtg b1 cst/b9 tum rds,24120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exc/crtg b1 cst/tum rds agrf,24125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exc/crtg b1 cst/tum rds algr,24126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Excision radial head,24130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sequestrectomy shft/dstl hum,24134,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Sequestrectomy radial h/n,24136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sequestrectomy olecrn proces,24138,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Partial exc bone humerus,24140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Prtl exc bone radial h/n,24145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Prtl exc bone olecrn process,24147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Radical resection of elbow,24149,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Rad rescj tum dstl/shft hum,24150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Rad resection tum radial h/n,24152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Resection of elbow joint,24155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Rmvl prosthhumrl&ulnar cmpnt,24160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal prosth radial head,24164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Rmvl fb upper arm/elbw subq,24200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Rmvl fb upper arm/elbw deep,24201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Mnpj elbow under anes,24300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Musc/tdn transfer upr a/e 1,24301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Tendon lngth upr a/e ea tdn,24305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Tnot opn elbw to sho ea tdn,24310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Tenoplasty elbow to sho 1,24320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Flexor-plasty elbow,24330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Flexor-plasty elbw w/advmnt,24331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Tenolysis triceps,24332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Tenodesis biceps tdn at elbw,24340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Rpr tdn/musc upr a/e each,24341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of ruptured tendon,24342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repr elbow lat ligmnt w/tiss,24343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reconstruct elbow lat ligmnt,24344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repr elbw med ligmnt w/tissu,24345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruct elbow med ligmnt,24346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Repair elbow perc,24357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair elbow w/deb open,24358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair elbow deb/attch open,24359,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reconstruct elbow joint,24360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruct elbow joint,24361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Reconstruct elbow joint,24362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Replace elbow joint,24363,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Reconstruct head of radius,24365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Reconstruct head of radius,24366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revise reconst elbow joint,24370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revise reconst elbow joint,24371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Revision of humerus,24400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of humerus,24410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of humerus,24420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of humerus,24430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Repair humerus with graft,24435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of elbow joint,24470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompression of forearm,24495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reinforce humerus,24498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat humerus fracture,24500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat humerus fracture,24505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat humerus fracture,24515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat humerus fracture,24516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat humerus fracture,24530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat humerus fracture,24535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat humerus fracture,24538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat humerus fracture,24545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat humerus fracture,24546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat humerus fracture,24560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat humerus fracture,24565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat humerus fracture,24566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat humerus fracture,24575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat humerus fracture,24576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat humerus fracture,24577,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat humerus fracture,24579,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat humerus fracture,24582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Treat elbow fracture,24586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat elbow fracture,24587,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat elbow dislocation,24600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat elbow dislocation,24605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat elbow dislocation,24615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat elbow fracture,24620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat elbow fracture,24635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat elbow dislocation,24640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat radius fracture,24650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat radius fracture,24655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat radius fracture,24665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat radius fracture,24666,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat ulnar fracture,24670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat ulnar fracture,24675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat ulnar fracture,24685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of elbow joint,24800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion/graft of elbow joint,24802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Amputation of upper arm,24900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Amputation of upper arm,24920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Amputation follow-up surgery,24925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation follow-up surgery,24930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Amputate upper arm & implant,24931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Revision of amputation,24935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of upper arm,24940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1004.9,13107.45,case rate,
Unlisted px humerus/elbow,24999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Incision of tendon sheath,25000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incise flexor carpi radialis,25001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompress forearm 1 space,25020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Decompress forearm 1 space,25023,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompress forearm 2 spaces,25024,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompress forearm 2 spaces,25025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Drainage of forearm lesion,25028,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Drainage of forearm bursa,25031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat forearm bone lesion,25035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Explore/treat wrist joint,25040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy forearm soft tissues,25065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy forearm soft tissues,25066,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc forearm les sc 3 cm/>,25071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc forearm tum deep 3 cm/>,25073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc forearm les sc < 3 cm,25075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc forearm tum deep < 3 cm,25076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Resect forearm/wrist tum<3cm,25077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect forarm/wrist tum 3cm>,25078,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Incision of wrist capsule,25085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy of wrist joint,25100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Explore/treat wrist joint,25101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove wrist joint lining,25105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove wrist joint cartilage,25107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Excise tendon forearm/wrist,25109,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove wrist tendon lesion,25110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove wrist tendon lesion,25111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Reremove wrist tendon lesion,25112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove wrist/forearm lesion,25115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove wrist/forearm lesion,25116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Excise wrist tendon sheath,25118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Partial removal of ulna,25119,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of forearm lesion,25120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove/graft forearm lesion,25125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove/graft forearm lesion,25126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of wrist lesion,25130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove & graft wrist lesion,25135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove & graft wrist lesion,25136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove forearm bone lesion,25145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of ulna,25150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of radius,25151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect radius/ulnar tumor,25170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Removal of wrist bone,25210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of wrist bones,25215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of radius,25230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of ulna,25240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove forearm foreign body,25248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of wrist prosthesis,25250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of wrist prosthesis,25251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Manipulate wrist w/anesthes,25259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Repair forearm tendon/muscle,25260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair forearm tendon/muscle,25263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair forearm tendon/muscle,25265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair forearm tendon/muscle,25270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair forearm tendon/muscle,25272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair forearm tendon/muscle,25274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair forearm tendon sheath,25275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise wrist/forearm tendon,25280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incise wrist/forearm tendon,25290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release wrist/forearm tendon,25295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of tendons at wrist,25300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of tendons at wrist,25301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transplant forearm tendon,25310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transplant forearm tendon,25312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise palsy hand tendon(s),25315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revise palsy hand tendon(s),25316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/revise wrist joint,25320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revise wrist joint,25332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Realignment of hand,25335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reconstruct ulna/radioulnar,25337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of radius,25350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of radius,25355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of ulna,25360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revise radius & ulna,25365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revise radius or ulna,25370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise radius & ulna,25375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Shorten radius or ulna,25390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Lengthen radius or ulna,25391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Shorten radius & ulna,25392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Lengthen radius & ulna,25393,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair carpal bone shorten,25394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair radius or ulna,25400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft radius or ulna,25405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair radius & ulna,25415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft radius & ulna,25420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft radius or ulna,25425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft radius & ulna,25426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Vasc graft into carpal bone,25430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair nonunion carpal bone,25431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft wrist bone,25440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruct wrist joint,25441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Reconstruct wrist joint,25442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Reconstruct wrist joint,25443,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruct wrist joint,25444,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Reconstruct wrist joint,25445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Wrist replacement,25446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Repair wrist joints,25447,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove wrist joint implant,25449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of wrist joint,25450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of wrist joint,25455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reinforce radius,25490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reinforce ulna,25491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Reinforce radius and ulna,25492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat fracture of radius,25500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat fracture of radius,25505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat fracture of radius,25515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fracture of radius,25520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat fracture of radius,25525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fracture of radius,25526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fracture of ulna,25530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat fracture of ulna,25535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat fracture of ulna,25545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fracture radius & ulna,25560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat fracture radius & ulna,25565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat fracture radius & ulna,25574,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fracture radius/ulna,25575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fracture radius/ulna,25600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat fracture radius/ulna,25605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat fx distal radial,25606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat fx rad extra-articul,25607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fx rad intra-articul,25608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat fx radial 3+ frag,25609,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat wrist bone fracture,25622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat wrist bone fracture,25624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat wrist bone fracture,25628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat wrist bone fracture,25630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat wrist bone fracture,25635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat wrist bone fracture,25645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat wrist bone fracture,25650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Pin ulnar styloid fracture,25651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat fracture ulnar styloid,25652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat wrist dislocation,25660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat wrist dislocation,25670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Pin radioulnar dislocation,25671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat wrist dislocation,25675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat wrist dislocation,25676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat wrist fracture,25680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat wrist fracture,25685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Treat wrist dislocation,25690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat wrist dislocation,25695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of wrist joint,25800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion/graft of wrist joint,25805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion/graft of wrist joint,25810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Fusion of hand bones,25820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fuse hand bones with graft,25825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion radioulnar jnt/ulna,25830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Amputation of forearm,25900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,13107.45,case rate,
Amputation of forearm,25905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Amputation follow-up surgery,25907,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation follow-up surgery,25909,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Amputation of forearm,25915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Amputate hand at wrist,25920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Amputate hand at wrist,25922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Amputation follow-up surgery,25924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1263.21,9790.52,case rate,
Amputation of hand,25927,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Amputation follow-up surgery,25929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Amputation follow-up surgery,25931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Unlisted px forearm/wrist,25999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Drainage of finger abscess,26010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Drainage of finger abscess,26011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Drain hand tendon sheath,26020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Drainage of palm bursa,26025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Drainage of palm bursas,26030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat hand bone lesion,26034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Decompress fingers/hand,26035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompress fingers/hand,26037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release palm contracture,26040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Release palm contracture,26045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incise finger tendon sheath,26055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incision of finger tendon,26060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Explore/treat hand joint,26070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Explore/treat finger joint,26075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Explore/treat finger joint,26080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Biopsy hand joint lining,26100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy finger joint lining,26105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy finger joint lining,26110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Exc hand les sc 1.5 cm/>,26111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc hand tum deep 1.5 cm/>,26113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc hand les sc < 1.5 cm,26115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc hand tum deep < 1.5 cm,26116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Rad resect hand tumor < 3 cm,26117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Rad resect hand tumor 3 cm/>,26118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Release palm contracture,26121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release palm contracture,26123,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove wrist joint lining,26130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise finger joint each,26135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise finger joint each,26140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Tendon excision palm/finger,26145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove tendon sheath lesion,26160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of palm tendon each,26170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of finger tendon,26180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove finger bone,26185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove hand bone lesion,26200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove/graft bone lesion,26205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Removal of finger lesion,26210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Remove/graft finger lesion,26215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of hand bone,26230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal finger bone,26235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Partial removal finger bone,26236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Extensive hand surgery,26250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect prox finger tumor,26260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect distal finger tumor,26262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of implant from hand,26320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Manipulate finger w/anesth,26340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Manipulat palm cord post inj,26341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Repair finger/hand tendon,26350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair/graft hand tendon,26352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair finger/hand tendon,26356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair finger/hand tendon,26357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair/graft hand tendon,26358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair finger/hand tendon,26370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair/graft hand tendon,26372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair finger/hand tendon,26373,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise hand/finger tendon,26390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft hand tendon,26392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair hand tendon,26410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Repair/graft hand tendon,26412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Excision hand/finger tendon,26415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Graft hand or finger tendon,26416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair finger tendon,26418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Repair/graft finger tendon,26420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair finger/hand tendon,26426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair/graft finger tendon,26428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair finger tendon,26432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Repair finger tendon,26433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair/graft finger tendon,26434,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Realignment of tendons,26437,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release palm/finger tendon,26440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Release palm & finger tendon,26442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release hand/finger tendon,26445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release forearm/hand tendon,26449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of palm tendon,26450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of finger tendon,26455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incise hand/finger tendon,26460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Fusion of finger tendons,26471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of finger tendons,26474,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Tendon lengthening,26476,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Tendon shortening,26477,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Lengthening of hand tendon,26478,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Shortening of hand tendon,26479,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transplant hand tendon,26480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transplant/graft hand tendon,26483,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transplant palm tendon,26485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transplant/graft palm tendon,26489,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise thumb tendon,26490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Tendon transfer with graft,26492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Hand tendon/muscle transfer,26494,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise thumb tendon,26496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Finger tendon transfer,26497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Finger tendon transfer,26498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of finger,26499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Hand tendon reconstruction,26500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hand tendon reconstruction,26502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release thumb contracture,26508,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Thumb tendon transfer,26510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of knuckle joint,26516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of knuckle joints,26517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of knuckle joints,26518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Release knuckle contracture,26520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release finger contracture,26525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Revise knuckle joint,26530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Revise knuckle with implant,26531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revise finger joint,26535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise/implant finger joint,26536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair hand joint,26540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair hand joint with graft,26541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair hand joint with graft,26542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reconstruct finger joint,26545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair nonunion hand,26546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruct finger joint,26548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Construct thumb replacement,26550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Great toe-hand transfer,26551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Single transfer toe-hand,26553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Double transfer toe-hand,26554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Positional change of finger,26555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Toe joint transfer,26556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Repair of web finger,26560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Repair of web finger,26561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of web finger,26562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Correct metacarpal flaw,26565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Correct finger deformity,26567,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Lengthen metacarpal/finger,26568,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair hand deformity,26580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reconstruct extra finger,26587,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair finger deformity,26590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Repair muscles of hand,26591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release muscles of hand,26593,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Excision constricting tissue,26596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat metacarpal fracture,26600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat metacarpal fracture,26605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat metacarpal fracture,26607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat metacarpal fracture,26608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat metacarpal fracture,26615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat thumb dislocation,26641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat thumb fracture,26645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat thumb fracture,26650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat thumb fracture,26665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat hand dislocation,26670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat hand dislocation,26675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Pin hand dislocation,26676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat hand dislocation,26685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat hand dislocation,26686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat knuckle dislocation,26700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat knuckle dislocation,26705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Pin knuckle dislocation,26706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat knuckle dislocation,26715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat finger fracture each,26720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat finger fracture each,26725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat finger fracture each,26727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat finger fracture each,26735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat finger fracture each,26740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat finger fracture each,26742,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat finger fracture each,26746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat finger fracture each,26750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat finger fracture each,26755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Pin finger fracture each,26756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat finger fracture each,26765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat finger dislocation,26770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat finger dislocation,26775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Pin finger dislocation,26776,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat finger dislocation,26785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Thumb fusion with graft,26820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of thumb,26841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Thumb fusion with graft,26842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of hand joint,26843,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion/graft of hand joint,26844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of knuckle,26850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of knuckle with graft,26852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of finger joint,26860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion/graft of finger joint,26862,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputate metacarpal bone,26910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation of finger/thumb,26951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation of finger/thumb,26952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Unlisted px hands/fingers,26989,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Drainage of pelvis lesion,26990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Drainage of pelvis bursa,26991,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Drainage of bone lesion,26992,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Incision of hip tendon,27000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incision of hip tendon,27001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of hip tendon,27003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of hip tendon,27005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Incision of hip tendons,27006,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of hip/thigh fascia,27025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Buttock fasciotomy,27027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Drainage of hip joint,27030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,686.41,8759.27,case rate,
Exploration of hip joint,27033,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Denervation of hip joint,27035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Excision of hip joint/muscle,27036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Biopsy of soft tissues,27040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy of soft tissues,27041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc hip pelvis les sc 3 cm/>,27043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc hip/pelv tum deep 5 cm/>,27045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc hip/pelvis les sc < 3 cm,27047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc hip/pelv tum deep < 5 cm,27048,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect hip/pelv tum < 5 cm,27049,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Biopsy of sacroiliac joint,27050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Biopsy of hip joint,27052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of hip joint lining,27054,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Buttock fasciotomy w/dbrdmt,27057,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Resect hip/pelv tum 5 cm/>,27059,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Removal of ischial bursa,27060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove femur lesion/bursa,27062,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove hip bone les super,27065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove hip bone les deep,27066,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove/graft hip bone lesion,27067,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Part remove hip bone super,27070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Part removal hip bone deep,27071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Resect hip tumor,27075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Resect hip tum incl acetabul,27076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Resect hip tum w/innom bone,27077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Rsect hip tum incl femur,27078,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,13107.45,case rate,
Removal of tail bone,27080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove hip foreign body,27086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove hip foreign body,27087,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of hip prosthesis,27090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Removal of hip prosthesis,27091,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Revision of hip tendon,27097,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transfer tendon to pelvis,27098,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transfer of abdominal muscle,27100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Transfer of spinal muscle,27105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transfer of iliopsoas muscle,27110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Transfer of iliopsoas muscle,27111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reconstruction of hip socket,27120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,13107.45,case rate,
Reconstruction of hip socket,27122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,13107.45,case rate,
Partial hip replacement,27125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,13107.45,case rate,
Total hip arthroplasty,27130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Total hip arthroplasty,27132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Revise hip joint replacement,27134,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Revise hip joint replacement,27137,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Revise hip joint replacement,27138,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Transplant femur ridge,27140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,13107.45,case rate,
Incision of hip bone,27146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Revision of hip bone,27147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Incision of hip bones,27151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Revision of hip bones,27156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Revision of pelvis,27158,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Incision of neck of femur,27161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Incision/fixation of femur,27165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Repair/graft femur head/neck,27170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat slipped epiphysis,27175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat slipped epiphysis,27176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,13107.45,case rate,
Treat slipped epiphysis,27177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat slipped epiphysis,27178,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Revise head/neck of femur,27179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat slipped epiphysis,27181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Revision of femur epiphysis,27185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Reinforce hip bones,27187,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Clsd tx pelvic ring fx,27197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Clsd tx pelvic ring fx,27198,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat tail bone fracture,27200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat tail bone fracture,27202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat hip socket fracture,27220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat hip socket fracture,27222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Treat hip wall fracture,27226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat hip fracture(s),27227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat hip fracture(s),27228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat thigh fracture,27230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat thigh fracture,27232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Treat thigh fracture,27235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat thigh fracture,27236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat thigh fracture,27238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat thigh fracture,27240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Treat thigh fracture,27244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat thigh fracture,27245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat thigh fracture,27246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat thigh fracture,27248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat hip dislocation,27250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat hip dislocation,27252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat hip dislocation,27253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat hip dislocation,27254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat hip dislocation,27256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat hip dislocation,27257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat hip dislocation,27258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat hip dislocation,27259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat hip dislocation,27265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat hip dislocation,27266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Cltx thigh fx,27267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Cltx thigh fx w/mnpj,27268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Optx thigh fx,27269,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Manipulation of hip joint,27275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Arthrd si jt prq wo tfxj dev,27278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,17967.23,18881.2,case rate,
Arthrd si jt perq/min nvas,27279,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Arthr si jt opn b1grf instrm,27280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrodesis symphysis pubis,27282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrodesis hip joint,27284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Arthrd hip jt sbtrchc osteot,27286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Amputation of leg at hip,27290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Amputation of leg at hip,27295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,82992.02,case rate,
Unlisted px pelvis/hip joint,27299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Drain thigh/knee lesion,27301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Drainage of bone lesion,27303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,471.86,8759.27,case rate,
Incise thigh tendon & fascia,27305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of thigh tendon,27306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of thigh tendons,27307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exploration of knee joint,27310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy thigh soft tissues,27323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy thigh soft tissues,27324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Neurectomy hamstring,27325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Neurectomy popliteal,27326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Exc thigh/knee les sc < 3 cm,27327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc thigh/knee tum deep <5cm,27328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect thigh/knee tum < 5 cm,27329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Biopsy knee joint lining,27330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Explore/treat knee joint,27331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of knee cartilage,27332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of knee cartilage,27333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove knee joint lining,27334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove knee joint lining,27335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Exc thigh/knee les sc 3 cm/>,27337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc thigh/knee tum dep 5cm/>,27339,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Removal of kneecap bursa,27340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of knee cyst,27345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove knee cyst,27347,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of kneecap,27350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Remove femur lesion,27355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove femur lesion/graft,27356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Remove femur lesion/graft,27357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Partial removal leg bone(s),27360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect thigh/knee tum 5 cm/>,27364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect femur/knee tumor,27365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Removal of foreign body,27372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Repair of kneecap tendon,27380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft kneecap tendon,27381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of thigh muscle,27385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft of thigh muscle,27386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of thigh tendon,27390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of thigh tendons,27391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of thigh tendons,27392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Lengthening of thigh tendon,27393,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Lengthening of thigh tendons,27394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Lengthening of thigh tendons,27395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Transplant of thigh tendon,27396,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Transplants of thigh tendons,27397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revise thigh muscles/tendons,27400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of knee cartilage,27403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair of knee ligament,27405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of knee ligament,27407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of knee ligaments,27409,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Autochondrocyte implant knee,27412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Osteochondral knee allograft,27415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Osteochondral knee autograft,27416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair degenerated kneecap,27418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of unstable kneecap,27420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of unstable kneecap,27422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision/removal of kneecap,27424,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Lat retinacular release open,27425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reconstruction knee,27427,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruction knee,27428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Reconstruction knee,27429,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of thigh muscles,27430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of knee joint,27435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise kneecap,27437,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revise kneecap with implant,27438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of knee joint,27440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of knee joint,27441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of knee joint,27442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of knee joint,27443,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of knee joint,27445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Revision of knee joint,27446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Total knee arthroplasty,27447,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Incision of thigh,27448,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Incision of thigh,27450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Realignment of thigh bone,27454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Realignment of knee,27455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Realignment of knee,27457,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Shortening of thigh bone,27465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Lengthening of thigh bone,27466,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Shorten/lengthen thighs,27468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Repair of thigh,27470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Repair/graft of thigh,27472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Surgery to stop leg growth,27475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Surgery to stop leg growth,27477,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Surgery to stop leg growth,27479,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Surgery to stop leg growth,27485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Revise/replace knee joint,27486,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Revise/replace knee joint,27487,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Removal of knee prosthesis,27488,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Reinforce thigh,27495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Decompression of thigh/knee,27496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompression of thigh/knee,27497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompression of thigh/knee,27498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Decompression of thigh/knee,27499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Treatment of thigh fracture,27500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of thigh fracture,27501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of thigh fracture,27502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of thigh fracture,27503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of thigh fracture,27506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treatment of thigh fracture,27507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treatment of thigh fracture,27508,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of thigh fracture,27509,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of thigh fracture,27510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of thigh fracture,27511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treatment of thigh fracture,27513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treatment of thigh fracture,27514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat thigh fx growth plate,27516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat thigh fx growth plate,27517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat thigh fx growth plate,27519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat kneecap fracture,27520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat kneecap fracture,27524,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat knee fracture,27530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat knee fracture,27532,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat knee fracture,27535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,654.79,8759.27,case rate,
Treat knee fracture,27536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat knee fracture(s),27538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat knee fracture,27540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Treat knee dislocation,27550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat knee dislocation,27552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat knee dislocation,27556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Treat knee dislocation,27557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Treat knee dislocation,27558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Treat kneecap dislocation,27560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat kneecap dislocation,27562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat kneecap dislocation,27566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fixation of knee joint,27570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Fusion of knee,27580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,13107.45,case rate,
Amputate leg at thigh,27590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,18560.03,case rate,
Amputate leg at thigh,27591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,18560.03,case rate,
Amputate leg at thigh,27592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,18560.03,case rate,
Amputation follow-up surgery,27594,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation follow-up surgery,27596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Amputate lower leg at knee,27598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,13107.45,case rate,
Unlisted px femur/knee,27599,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Decompression of lower leg,27600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompression of lower leg,27601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompression of lower leg,27602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Drain lower leg lesion,27603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Drain lower leg bursa,27604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of achilles tendon,27605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incision of achilles tendon,27606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat lower leg bone lesion,27607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Explore/treat ankle joint,27610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exploration of ankle joint,27612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy lower leg soft tissue,27613,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy lower leg soft tissue,27614,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect leg/ankle tum < 5 cm,27615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect leg/ankle tum 5 cm/>,27616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc leg/ankle tum < 3 cm,27618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc leg/ankle tum deep <5 cm,27619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Explore/treat ankle joint,27620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove ankle joint lining,27625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove ankle joint lining,27626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of tendon lesion,27630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exc leg/ankle les sc 3 cm/>,27632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc leg/ankle tum dep 5 cm/>,27634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Remove lower leg bone lesion,27635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove/graft leg bone lesion,27637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove/graft leg bone lesion,27638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Partial removal of tibia,27640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of fibula,27641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect tibia tumor,27645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Resect fibula tumor,27646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Resect talus/calcaneus tum,27647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair achilles tendon,27650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair/graft achilles tendon,27652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of achilles tendon,27654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair leg fascia defect,27656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of leg tendon each,27658,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of leg tendon each,27659,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of leg tendon each,27664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of leg tendon each,27665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair lower leg tendons,27675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair lower leg tendons,27676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Release of lower leg tendon,27680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release of lower leg tendons,27681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of lower leg tendon,27685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise lower leg tendons,27686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of calf tendon,27687,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revise lower leg tendon,27690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revise lower leg tendon,27691,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of ankle ligament,27695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of ankle ligaments,27696,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of ankle ligament,27698,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of ankle joint,27700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Reconstruct ankle joint,27702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,7530.35,82992.02,case rate,
Reconstruction ankle joint,27703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6380.51,49452.22,case rate,
Removal of ankle implant,27704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of tibia,27705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of fibula,27707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of tibia & fibula,27709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Realignment of lower leg,27712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,13107.45,case rate,
Revision of lower leg,27715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,785.39,11281.54,case rate,
Repair of tibia,27720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft of tibia,27722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair/graft of tibia,27724,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Repair of lower leg,27725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Repair fibula nonunion,27726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of lower leg,27727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Repair of tibia epiphysis,27730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of fibula epiphysis,27732,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair lower leg epiphyses,27734,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of leg epiphyses,27740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of leg epiphyses,27742,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Reinforce tibia,27745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of tibia fracture,27750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of tibia fracture,27752,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of tibia fracture,27756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of tibia fracture,27758,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treatment of tibia fracture,27759,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Cltx medial ankle fx,27760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx med ankle fx w/mnpj,27762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx medial ankle fx,27766,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cltx post ankle fx,27767,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Cltx post ankle fx w/mnpj,27768,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Optx post ankle fx,27769,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of fibula fracture,27780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of fibula fracture,27781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of fibula fracture,27784,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of ankle fracture,27786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of ankle fracture,27788,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of ankle fracture,27792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of ankle fracture,27808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of ankle fracture,27810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of ankle fracture,27814,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of ankle fracture,27816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of ankle fracture,27818,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of ankle fracture,27822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of ankle fracture,27823,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat lower leg fracture,27824,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat lower leg fracture,27825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat lower leg fracture,27826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat lower leg fracture,27827,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat lower leg fracture,27828,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treat lower leg joint,27829,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat lower leg dislocation,27830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat lower leg dislocation,27831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat lower leg dislocation,27832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat ankle dislocation,27840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat ankle dislocation,27842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat ankle dislocation,27846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat ankle dislocation,27848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fixation of ankle joint,27860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of ankle joint open,27870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Fusion of tibiofibular joint,27871,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Amputation of lower leg,27880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,18560.03,case rate,
Amputation of lower leg,27881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Amputation of lower leg,27882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,11281.54,case rate,
Amputation follow-up surgery,27884,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation follow-up surgery,27886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Amputation of foot at ankle,27888,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1455.59,13107.45,case rate,
Amputation of foot at ankle,27889,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Decompression of leg,27892,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Decompression of leg,27893,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Decompression of leg,27894,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Unlisted px leg/ankle,27899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Drainage of bursa of foot,28001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Treatment of foot infection,28002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of foot infection,28003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat foot bone lesion,28005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of foot fascia,28008,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of toe tendon,28010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incision of toe tendons,28011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Exploration of foot joint,28020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exploration of foot joint,28022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Exploration of toe joint,28024,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Decompression of tibia nerve,28035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Exc foot/toe tum sc 1.5 cm/>,28039,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc foot/toe tum dep 1.5cm/>,28041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Exc foot/toe tum sc < 1.5 cm,28043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Exc foot/toe tum deep <1.5cm,28045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect foot/toe tumor < 3 cm,28046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Resect foot/toe tumor 3 cm/>,28047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Biopsy of foot joint lining,28050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy of foot joint lining,28052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Biopsy of toe joint lining,28054,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Neurectomy foot,28055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Partial removal foot fascia,28060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of foot fascia,28062,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of foot joint lining,28070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Removal of foot joint lining,28072,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of foot lesion,28080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Excise foot tendon sheath,28086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Excise foot tendon sheath,28088,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of foot lesion,28090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of toe lesions,28092,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of ankle/heel lesion,28100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove/graft foot lesion,28102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove/graft foot lesion,28103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Removal of foot lesion,28104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove/graft foot lesion,28106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove/graft foot lesion,28107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Removal of toe lesions,28108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Part removal of metatarsal,28110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Part removal of metatarsal,28111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Part removal of metatarsal,28112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Part removal of metatarsal,28113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of metatarsal heads,28114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of foot,28116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of heel bone,28118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of heel spur,28119,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Part removal of ankle/heel,28120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of foot bone,28122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of toe,28124,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of toe,28126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of ankle bone,28130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Removal of metatarsal,28140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of toe,28150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of toe,28153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of toe,28160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect tarsal tumor,28171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect metatarsal tumor,28173,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect phalanx of toe tumor,28175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Removal of foot foreign body,28190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Removal of foot foreign body,28192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Removal of foot foreign body,28193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Repair of foot tendon,28200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair/graft of foot tendon,28202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Repair of foot tendon,28208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair/graft of foot tendon,28210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Release of foot tendon,28220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Release of foot tendons,28222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release of foot tendon,28225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release of foot tendons,28226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of foot tendon(s),28230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incision of toe tendon,28232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Incision of foot tendon,28234,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Revision of foot tendon,28238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Release of big toe,28240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of foot fascia,28250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release of midfoot joint,28260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Revision of foot tendon,28261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Revision of foot and ankle,28262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Release of midfoot joint,28264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Release of foot contracture,28270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Release of toe joint each,28272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Fusion of toes,28280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of hammertoe,28285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of hammertoe,28286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial removal of foot bone,28288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Corrj halux rigdus w/o implt,28289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Corrj halux rigdus w/implt,28291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cor hlx vlgs rsc prx phlx bs,28292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Cor hlx vlgs prx mtar osteot,28295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Cor hlx vlgs dstl mtar osteo,28296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Cor hlx vlgs jt arthrd,28297,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cor hlx vlgs prx phlx osteot,28298,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cor hlx vlgs double osteot,28299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Incision of heel bone,28300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of ankle bone,28302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of midfoot bones,28304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incise/graft midfoot bones,28305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of metatarsal,28306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Incision of metatarsal,28307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Incision of metatarsal,28308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Incision of metatarsals,28309,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Revision of big toe,28310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Revision of toe,28312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair deformity of toe,28313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Removal of sesamoid bone,28315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of foot bones,28320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Repair of metatarsals,28322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Resect enlarged toe tissue,28340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Resect enlarged toe,28341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair extra toe(s),28344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair webbed toe(s),28345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Reconstruct cleft foot,28360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treatment of heel fracture,28400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of heel fracture,28405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of heel fracture,28406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat heel fracture,28415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat/graft heel fracture,28420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Treatment of ankle fracture,28430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of ankle fracture,28435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treatment of ankle fracture,28436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat ankle fracture,28445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Osteochondral talus autogrft,28446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat midfoot fracture each,28450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat midfoot fracture each,28455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat midfoot fracture,28456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat midfoot fracture each,28465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat metatarsal fracture,28470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat metatarsal fracture,28475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat metatarsal fracture,28476,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat metatarsal fracture,28485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat big toe fracture,28490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat big toe fracture,28495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat big toe fracture,28496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat big toe fracture,28505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treatment of toe fracture,28510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treatment of toe fracture,28515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat toe fracture,28525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat sesamoid bone fracture,28530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat sesamoid bone fracture,28531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat foot dislocation,28540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat foot dislocation,28545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat foot dislocation,28546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Repair foot dislocation,28555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat foot dislocation,28570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat foot dislocation,28575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat foot dislocation,28576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Repair foot dislocation,28585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat foot dislocation,28600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat foot dislocation,28605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat foot dislocation,28606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair foot dislocation,28615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Treat toe dislocation,28630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat toe dislocation,28635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Treat toe dislocation,28636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair toe dislocation,28645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Treat toe dislocation,28660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Treat toe dislocation,28665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Treat toe dislocation,28666,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of toe dislocation,28675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Fusion of foot bones,28705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18881.2,,,,10707.94,82992.02,case rate,
Fusion of foot bones,28715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Fusion of foot bones,28725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Fusion of foot bones,28730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Fusion of foot bones,28735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Revision of foot bones,28737,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Fusion of foot bones,28740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of big toe joint,28750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of big toe joint,28755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Fusion of big toe joint,28760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Amputation of midfoot,28800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Amputation thru metatarsal,28805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation toe & metatarsal,28810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Amputation of toe,28820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Partial amputation of toe,28825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Hi enrgy eswt plantar fascia,28890,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Unlisted px foot/toes,28899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Application of body cast,29000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of body cast,29010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of body cast,29015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of body cast,29035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of body cast,29040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of body cast,29044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Application of body cast,29046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of figure eight,29049,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of shoulder cast,29055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of shoulder cast,29058,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of long arm cast,29065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of forearm cast,29075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Apply hand/wrist cast,29085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Apply finger cast,29086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Apply long arm splint,29105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Apply forearm splint,29125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Apply forearm splint,29126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Application of finger splint,29130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Application of finger splint,29131,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Strapping of chest,29200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Strapping of shoulder,29240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Strapping of elbow or wrist,29260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Strapping of hand or finger,29280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Application of hip cast,29305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of hip casts,29325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of long leg cast,29345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of long leg cast,29355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Apply long leg cast brace,29358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of long leg cast,29365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Apply short leg cast,29405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Apply short leg cast,29425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Apply short leg cast,29435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Addition of walker to cast,29440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Apply rigid leg cast,29445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Application of leg cast,29450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Application long leg splint,29505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Application lower leg splint,29515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Strapping of hip,29520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Strapping of knee,29530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Strapping of ankle and/or ft,29540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Strapping of toes,29550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Application of paste boot,29580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Apply multlay comprs lwr leg,29581,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Appl multlay comprs arm/hand,29584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Removal/revision of cast,29700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Removal/revision of cast,29705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Removal/revision of cast,29710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Repair of body cast,29720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Windowing of cast,29730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Wedging of cast,29740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Wedging of clubfoot cast,29750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.09,,,,117.32,909.26,fee schedule,
Unlisted px casting/strpg,29799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.64,,,,71.28,552.43,fee schedule,
Jaw arthroscopy/surgery,29800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Jaw arthroscopy/surgery,29804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs dx +- synovial bx,29805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs srg capsulorraphy,29806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Sho arthrs srg rpr slap les,29807,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Sho arthrs srg rmvl loose/fb,29819,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs srg prtl synvct,29820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Sho arthrs srg compl synvct,29821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs srg lmtd dbrdmt,29822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs srg xtnsv dbrdmt,29823,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs srg dstl claviclc,29824,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs srg lss&rescj ads,29825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sho arthrs srg rt8tr cuf rpr,29827,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Sho arthrs srg bicp tenodsis,29828,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Elbow arthroscopy,29830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Elbow arthroscopy/surgery,29834,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Elbow arthroscopy/surgery,29835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Elbow arthroscopy/surgery,29836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Elbow arthroscopy/surgery,29837,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Elbow arthroscopy/surgery,29838,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Wrist arthroscopy,29840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Wrist arthroscopy/surgery,29843,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Wrist arthroscopy/surgery,29844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Wrist arthroscopy/surgery,29845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Wrist arthroscopy/surgery,29846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Wrist arthroscopy/surgery,29847,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Wrist endoscopy/surgery,29848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Knee arthroscopy/surgery,29850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Knee arthroscopy/surgery,29851,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Tibial arthroscopy/surgery,29855,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Tibial arthroscopy/surgery,29856,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Hip arthroscopy dx,29860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hip arthro w/fb removal,29861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Hip arthr0 w/debridement,29862,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hip arthr0 w/synovectomy,29863,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Autgrft implnt knee w/scope,29866,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Allgrft implnt knee w/scope,29867,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Meniscal trnspl knee w/scpe,29868,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Knee arthroscopy dx,29870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/drainage,29871,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29873,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29874,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29876,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29877,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29879,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29883,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29884,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Knee arthroscopy/surgery,29886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Knee arthroscopy/surgery,29887,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Knee arthroscopy/surgery,29888,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Knee arthroscopy/surgery,29889,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Ankle arthroscopy/surgery,29891,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Ankle arthroscopy/surgery,29892,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Scope plantar fasciotomy,29893,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Ankle arthroscopy/surgery,29894,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Ankle arthroscopy/surgery,29895,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Ankle arthroscopy/surgery,29897,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Ankle arthroscopy/surgery,29898,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Ankle arthroscopy/surgery,29899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Mcp joint arthroscopy dx,29900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Mcp joint arthroscopy surg,29901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Mcp joint arthroscopy surg,29902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1628.34,,,,701.48,5436.83,case rate,
Subtalar arthro w/fb rmvl,29904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Subtalar arthro w/exc,29905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Subtalar arthro w/deb,29906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Subtalar arthro w/fusion,29907,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Hip arthro w/femoroplasty,29914,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hip arthro acetabuloplasty,29915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hip arthro w/labral repair,29916,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Unlisted px arthroscopy,29999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.92,,,,101.23,784.57,fee schedule,
Drainage of nose lesion,30000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of nose lesion,30020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Intranasal biopsy,30100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Removal of nose polyp(s),30110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Removal of nose polyp(s),30115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of intranasal lesion,30117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of intranasal lesion,30118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Revision of nose,30120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of nose lesion,30124,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Removal of nose lesion,30125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise inferior turbinate,30130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Resect inferior turbinate,30140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Partial removal of nose,30150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of nose,30160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Injection treatment of nose,30200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Nasal sinus therapy,30210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Insert nasal septal button,30220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Remove nasal foreign body,30300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Remove nasal foreign body,30310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Remove nasal foreign body,30320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Reconstruction of nose,30400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of nose,30410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of nose,30420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of nose,30430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of nose,30435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of nose,30450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of nose,30460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of nose,30462,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair nasal stenosis,30465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rpr nsl vlv collapse w/implt,30468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rpr nsl vlv collapse w/rmdlg,30469,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair of nasal septum,30520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Rpr choanal atresia ntranasl,30540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rpr choanal atresia trsnpltn,30545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lysis intranasal synechia,30560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Repair upper jaw fistula,30580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair mouth/nose fistula,30600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Intranasal reconstruction,30620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair nasal septum defect,30630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Ablate inf turbinate superf,30801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Ablate inf turbinate submuc,30802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Control of nosebleed,30901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Control of nosebleed,30903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,fee schedule,
Control of nosebleed,30905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,fee schedule,
Repeat control of nosebleed,30906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Ligation nasal sinus artery,30915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligation upper jaw artery,30920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ther fx nasal inf turbinate,30930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Unlisted procedure nose,30999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Irrigation maxillary sinus,31000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Irrigation sphenoid sinus,31002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Exploration maxillary sinus,31020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Exploration maxillary sinus,31030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Explore sinus remove polyps,31032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Exploration behind upper jaw,31040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Exploration sphenoid sinus,31050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Sphenoid sinus surgery,31051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Exploration of frontal sinus,31070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Exploration of frontal sinus,31075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of frontal sinus,31080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of frontal sinus,31081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of frontal sinus,31084,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of frontal sinus,31085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of frontal sinus,31086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of frontal sinus,31087,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Exploration of sinuses,31090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of ethmoid sinus,31200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of ethmoid sinus,31201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Removal of ethmoid sinus,31205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of upper jaw,31225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,678.8,8759.27,case rate,
Removal of upper jaw,31230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Nasal endoscopy dx,31231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200.68,,,,87.41,677.46,fee schedule,
Nsl/sins ndsc dx max sinusc,31233,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Nsl/sins ndsc dx sphn sinusc,31235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Nsl/sins ndsc surg bx polypc,31237,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Nsl/sins ndsc srg nsl hemrrg,31238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Nsl/sinus endoscopy surg dcr,31239,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Nsl/sns ndsc cnch bull rescj,31240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Nsl/sns ndsc lig sphnptn art,31241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Nsl/sinus ndsc rf abltj pnn,31242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,5645.99,5933.2,case rate,
Nsl/sinus ndsc cryoabltj pnn,31243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,5645.99,5933.2,case rate,
Nsl/sins ndsc total,31253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc w/prtl ethmdct,31254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc w/tot ethmdct,31255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Exploration maxillary sinus,31256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Nsl/sins ndsc tot w/sphendt,31257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc sphn tiss rmvl,31259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Endoscopy maxillary sinus,31267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc frnt tiss rmvl,31276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nasal/sinus endoscopy surg,31287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nasal/sinus endoscopy surg,31288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nasal/sinus endoscopy surg,31290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,781.7,8759.27,case rate,
Nasal/sinus endoscopy surg,31291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,781.7,8759.27,case rate,
Nsl/sins ndsc med/inf dcmprn,31292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc med&inf dcmprn,31293,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc surg on dcmprn,31294,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc surg max sins,31295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc surg frnt sins,31296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc surg sphn sins,31297,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Nsl/sins ndsc surg frnt&sphn,31298,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Unlisted px accessory sinus,31299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Removal of larynx lesion,31300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of larynx,31360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of larynx,31365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1887.95,8759.27,case rate,
Partial removal of larynx,31367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Partial removal of larynx,31368,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1801.67,8759.27,case rate,
Partial removal of larynx,31370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Partial removal of larynx,31375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Partial removal of larynx,31380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Partial removal of larynx,31382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of larynx & pharynx,31390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2086.44,8759.27,case rate,
Reconstruct larynx & pharynx,31395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2192.94,8759.27,case rate,
Revision of larynx,31400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of epiglottis,31420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Insert emergency airway,31500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Change of windpipe airway,31502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Diagnostic laryngoscopy,31505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200.68,,,,87.41,677.46,fee schedule,
Laryngoscopy with biopsy,31510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Remove foreign body larynx,31511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200.68,,,,87.41,677.46,fee schedule,
Removal of larynx lesion,31512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Injection into vocal cord,31513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Laryngoscopy for aspiration,31515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Dx laryngoscopy newborn,31520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Dx laryngoscopy excl nb,31525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Dx laryngoscopy w/oper scope,31526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Laryngoscopy for treatment,31527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscopy and dilation,31528,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscopy and dilation,31529,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscopy w/fb removal,31530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Laryngoscopy w/fb & op scope,31531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscopy w/biopsy,31535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscopy w/bx & op scope,31536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscopy w/exc of tumor,31540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Larynscop w/tumr exc + scope,31541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Remove vc lesion w/scope,31545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Remove vc lesion scope/graft,31546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Laryngoplasty laryngeal sten,31551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Laryngoplasty laryngeal sten,31552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Laryngoplasty laryngeal sten,31553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Laryngoplasty laryngeal sten,31554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Laryngoscop w/arytenoidectom,31560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Larynscop remve cart + scop,31561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Laryngoscope w/vc inj,31570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscop w/vc inj + scope,31571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Largsc w/laser dstrj les,31572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Largsc w/ther injection,31573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Largsc w/njx augmentation,31574,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Diagnostic laryngoscopy,31575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200.68,,,,87.41,677.46,fee schedule,
Laryngoscopy with biopsy,31576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Largsc w/rmvl foreign bdy(s),31577,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Largsc w/removal lesion,31578,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Laryngoscopy telescopic,31579,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Laryngoplasty laryngeal web,31580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Laryngoplasty fx rdctj fixj,31584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Laryngoplasty cricoid split,31587,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reinnervate larynx,31590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Laryngoplasty medialization,31591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Cricotracheal resection,31592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Unlisted procedure larynx,31599,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Incision of windpipe,31600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Incision of windpipe,31601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Incision of windpipe,31603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Incision of windpipe,31605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Incision of windpipe,31610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Surgery/speech prosthesis,31611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Puncture/clear windpipe,31612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair windpipe opening,31613,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair windpipe opening,31614,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Visualization of windpipe,31615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Dx bronchoscope/wash,31622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Dx bronchoscope/brush,31623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Dx bronchoscope/lavage,31624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Bronchoscopy w/biopsy(s),31625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Bronchoscopy w/markers,31626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronchoscopy/lung bx each,31628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Bronchoscopy/needle bx each,31629,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Bronchoscopy dilate/fx repr,31630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Bronchoscopy dilate w/stent,31631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronch w/balloon occlusion,31634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronchoscopy w/fb removal,31635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Bronchoscopy bronch stents,31636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronchoscopy revise stent,31638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronchoscopy w/tumor excise,31640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Bronchoscopy treat blockage,31641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Diag bronchoscope/catheter,31643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Brnchsc w/ther aspir 1st,31645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Brnchsc w/ther aspir sbsq,31646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Bronchial valve init insert,31647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronchial valve remov init,31648,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Bronchial valve remov addl,31649,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Bronch ebus samplng 1/2 node,31652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Bronch ebus samplng 3/> node,31653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3794.1,,,,1630.15,12634.53,case rate,
Bronch thermoplsty 1 lobe,31660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronch thermoplsty 2/> lobes,31661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6934.32,,,,3025.48,23449.03,case rate,
Bronchial brush biopsy,31717,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,413.7,,,,184.42,1429.36,fee schedule,
Clearance of airways,31720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.1,,,,93.64,725.79,case rate,
Clearance of airways,31725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,57.52,8759.27,case rate,
Intro windpipe wire/tube,31730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,781.7,6058.54,case rate,
Repair of windpipe,31750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair of windpipe,31755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair of windpipe,31760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,957.45,8759.27,case rate,
Reconstruction of windpipe,31766,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1225.64,8759.27,case rate,
Repair/graft of bronchus,31770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,918.32,8759.27,case rate,
Reconstruct bronchus,31775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,968.34,9790.52,case rate,
Reconstruct windpipe,31780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Reconstruct windpipe,31781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1059.03,9790.52,case rate,
Remove windpipe lesion,31785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove windpipe lesion,31786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,997.35,8759.27,case rate,
Repair of windpipe injury,31800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Repair of windpipe injury,31805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,573.69,8759.27,case rate,
Closure of windpipe lesion,31820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair of windpipe defect,31825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Revise windpipe scar,31830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Unlisted px trachea bronchi,31899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200.68,,,,87.41,677.46,fee schedule,
Thoracostomy w/rib resection,32035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,520.31,9790.52,case rate,
Thoracostomy w/flap drainage,32036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,560.73,9790.52,case rate,
Open wedge/bx lung infiltr,32096,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,557.11,8759.27,case rate,
Open wedge/bx lung nodule,32097,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,558.67,9790.52,case rate,
Open biopsy of lung pleura,32098,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,530.67,9790.52,case rate,
Exploration of chest,32100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,565.39,9790.52,case rate,
Explore/repair chest,32110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1027.93,9790.52,case rate,
Re-exploration of chest,32120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,611.78,9790.52,case rate,
Explore chest free adhesions,32124,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,646.76,8759.27,case rate,
Removal of lung lesion(s),32140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,691.07,8759.27,case rate,
Remove/treat lung lesions,32141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1054.1,9790.52,case rate,
Removal of lung lesion(s),32150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,708.95,9790.52,case rate,
Remove lung foreign body,32151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,700.92,8759.27,case rate,
Open chest heart massage,32160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,561.77,8759.27,case rate,
Drain open lung lesion,32200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,798.34,9790.52,case rate,
Treat chest lining,32215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,563.07,8759.27,case rate,
Release of lung,32220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1117.33,8759.27,case rate,
Partial release of lung,32225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,697.28,8759.27,case rate,
Removal of chest lining,32310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,643.13,8759.27,case rate,
Free/remove chest lining,32320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1120.18,8759.27,case rate,
Needle biopsy chest lining,32400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Core ndl bx lng/med perq,32408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Remove lung pneumonectomy,32440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1088.05,8759.27,case rate,
Sleeve pneumonectomy,32442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2092.4,8759.27,case rate,
Removal of lung extrapleural,32445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2427.45,8759.27,case rate,
Partial removal of lung,32480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1027.15,9790.52,case rate,
Bilobectomy,32482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1098.16,8759.27,case rate,
Segmentectomy,32484,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,991.91,9790.52,case rate,
Sleeve lobectomy,32486,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1607.07,8759.27,case rate,
Completion pneumonectomy,32488,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1646.71,8759.27,case rate,
Lung volume reduction,32491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1023.79,8759.27,case rate,
Repair bronchus add-on,32501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,165.06,8759.27,case rate,
Resect apical lung tumor,32503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1240.41,8759.27,case rate,
Resect apical lung tum/chest,32504,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1409.87,8759.27,case rate,
Wedge resect of lung initial,32505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,650.64,9790.52,case rate,
Wedge resect of lung add-on,32506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,106.49,9790.52,case rate,
Wedge resect of lung diag,32507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,106.49,8759.27,case rate,
Removal of lung lesion,32540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1198.69,8759.27,case rate,
Insert pleural cath,32550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Insertion of chest tube,32551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Remove lung catheter,32552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,case rate,
Ins mark thor for rt perq,32553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1403.85,,,,655.59,5081.14,fee schedule,
Aspirate pleura w/o imaging,32554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Aspirate pleura w/ imaging,32555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Insert cath pleura w/o image,32556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Insert cath pleura w/ image,32557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Treat pleurodesis w/agent,32560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Lyse chest fibrin init day,32561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Lyse chest fibrin subq day,32562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Thoracoscopy diagnostic,32601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Thoracoscopy wbx sac,32604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Thoracoscopy w/bx med space,32606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Thoracoscopy w/bx infiltrate,32607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Thoracoscopy w/bx nodule,32608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Thoracoscopy w/bx pleura,32609,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Thoracoscopy w/pleurodesis,32650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,470.3,9790.52,case rate,
Thoracoscopy remove cortex,32651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,761.82,9790.52,case rate,
Thoracoscopy rem totl cortex,32652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1152.05,8759.27,case rate,
Thoracoscopy remov fb/fibrin,32653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Thoracoscopy contrl bleeding,32654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,822.7,9790.52,case rate,
Thoracoscopy resect bullae,32655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,667.74,9790.52,case rate,
Thoracoscopy w/pleurectomy,32656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Thoracoscopy w/sac fb remove,32658,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,500.88,9790.52,case rate,
Thoracoscopy w/sac drainage,32659,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,515.13,9790.52,case rate,
Thoracoscopy w/pericard exc,32661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,557.88,9790.52,case rate,
Thoracoscopy w/mediast exc,32662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,624.22,9790.52,case rate,
Thoracoscopy w/lobectomy,32663,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,967.55,9790.52,case rate,
Thoracoscopy w/ th nrv exc,32664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,591.31,9790.52,case rate,
Thoracoscop w/esoph musc exc,32665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,853.02,9790.52,case rate,
Thoracoscopy w/wedge resect,32666,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,607.89,9790.52,case rate,
Thoracoscopy w/w resect addl,32667,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,106.49,9790.52,case rate,
Thoracoscopy w/w resect diag,32668,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,106.49,9790.52,case rate,
Thoracoscopy remove segment,32669,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,929.46,9790.52,case rate,
Thoracoscopy bilobectomy,32670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1109.04,8759.27,case rate,
Thoracoscopy pneumonectomy,32671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1220.45,8759.27,case rate,
Thoracoscopy for lvrs,32672,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1045.04,8759.27,case rate,
Thoracoscopy w/thymus resect,32673,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,842.4,9790.52,case rate,
Thoracoscopy lymph node exc,32674,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,145.87,9790.52,case rate,
Repair lung hernia,32800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,664.38,9790.52,case rate,
Close chest after drainage,32810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,630.44,9790.52,case rate,
Close bronchial fistula,32815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1938.74,8759.27,case rate,
Reconstruct injured chest,32820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,928.43,9790.52,case rate,
Donor pneumonectomy,32850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1485,8759.27,case rate,
Lung transplant single,32851,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2249.69,8759.27,case rate,
Lung transplant with bypass,32852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2438.85,8759.27,case rate,
Lung transplant double,32853,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3135.62,9229.31,case rate,
Lung transplant with bypass,32854,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3321.41,9773.99,case rate,
Prepare donor lung single,32855,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,203.66,8759.27,case rate,
Prepare donor lung double,32856,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6.5,8759.27,case rate,
Removal of rib(s),32900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1002.28,9790.52,case rate,
Revise & repair chest wall,32905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,924.8,8759.27,case rate,
Revise & repair chest wall,32906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1137.28,9790.52,case rate,
Revision of lung,32940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,856.14,8759.27,case rate,
Therapeutic pneumothorax,32960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Ablate pulm tumor perq crybl,32994,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Total lung lavage,32997,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,246.94,8759.27,case rate,
Ablate pulm tumor perq rf,32998,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted px lungs & pleura,32999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Pericardiocentesis w/imaging,33016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Prcrd drg 6yr+ w/o cgen car,33017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,162.65,8759.27,case rate,
Prcrd drg 0-5yr or w/anomly,33018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,162.65,8759.27,case rate,
Perq prcrd drg insj cath ct,33019,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,152.1,8759.27,case rate,
Incision of heart sac,33020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,574.47,8759.27,case rate,
Incision of heart sac,33025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,536.64,8759.27,case rate,
Partial removal of heart sac,33030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1378.78,8759.27,case rate,
Partial removal of heart sac,33031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1702.93,8759.27,case rate,
Resect heart sac lesion,33050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.43,8759.27,case rate,
Removal of heart lesion,33120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1437.08,8759.27,case rate,
Removal of heart lesion,33130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,948.64,8759.27,case rate,
Heart revascularize (tmr),33140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1074.83,8759.27,case rate,
Heart tmr w/other procedure,33141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,89.39,8759.27,case rate,
Insert epicard eltrd open,33202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,537.67,8759.27,case rate,
Insert epicard eltrd endo,33203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,561.51,12700.02,case rate,
Insert heart pm atrial,33206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Insert heart pm ventricular,33207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Insrt heart pm atrial & vent,33208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Insert electrd/pm cath sngl,33210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Insert card electrodes dual,33211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Insert pulse gen sngl lead,33212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Insert pulse gen dual leads,33213,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Upgrade of pacemaker system,33214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Reposition pacing-defib lead,33215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insert 1 electrode pm-defib,33216,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Insert 2 electrode pm-defib,33217,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Repair lead pace-defib one,33218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,fee schedule,
Repair lead pace-defib dual,33220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,fee schedule,
Insert pulse gen mult leads,33221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,9130.61,70766.92,case rate,
Relocation pocket pacemaker,33222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Relocate pocket for defib,33223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Insert pacing lead & connect,33224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Reposition l ventric lead,33226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Remove&replace pm gen singl,33227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Remv&replc pm gen dual lead,33228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10818.72,,,,5050.77,39146.04,case rate,
Remv&replc pm gen mult leads,33229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,9130.61,70766.92,case rate,
Insrt pulse gen w/dual leads,33230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Insrt pulse gen w/mult leads,33231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33331.84,,,,15685.33,121569.29,case rate,
Removal of pm generator,33233,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Removal of pacemaker system,33234,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Removal pacemaker electrode,33235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Remove electrode/thoracotomy,33236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,552.71,8759.27,case rate,
Remove electrode/thoracotomy,33237,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,591.83,8759.27,case rate,
Remove electrode/thoracotomy,33238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,667.23,8759.27,case rate,
Insrt pulse gen w/singl lead,33240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Remove pulse generator,33241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Remove eltrd/thoracotomy,33243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,957.19,8759.27,case rate,
Remove elctrd transvenously,33244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Insj/rplcmt defib w/lead(s),33249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33331.84,,,,15685.33,121569.29,case rate,
Ablate heart dysrhythm focus,33250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1009.28,8759.27,case rate,
Ablate heart dysrhythm focus,33251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1123.81,8759.27,case rate,
Ablate atria lmtd,33254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,942.69,8759.27,case rate,
Ablate atria w/o bypass ext,33255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1125.88,8759.27,case rate,
Ablate atria w/bypass exten,33256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1331.36,8759.27,case rate,
Ablate atria lmtd add-on,33257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,407.6,8759.27,case rate,
Ablate atria x10sv add-on,33258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,454.23,8759.27,case rate,
Ablate atria w/bypass add-on,33259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,591.83,8759.27,case rate,
Ablate heart dysrhythm focus,33261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1115.26,8759.27,case rate,
Rmvl& replc pulse gen 1 lead,33262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Rmvl & rplcmt dfb gen 2 lead,33263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23881.48,,,,11158.16,86481.43,case rate,
Rmvl & rplcmt dfb gen mlt ld,33264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33331.84,,,,15685.33,121569.29,case rate,
Ablate atria lmtd endo,33265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,944.75,8759.27,case rate,
Ablate atria x10sv endo,33266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1272.27,8759.27,case rate,
Excl laa open any method,33267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,724.49,8759.27,case rate,
Excl laa opn oth px any meth,33268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,89.39,8759.27,case rate,
Excl laa thrscp any method,33269,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,574.73,65103.1,case rate,
Ins/rep subq defibrillator,33270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33331.84,,,,15685.33,121569.29,case rate,
Insj subq impltbl dfb elctrd,33271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Rmvl of subq defibrillator,33272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Repos prev impltbl subq dfb,33273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,fee schedule,
Tcat insj/rpl perm ldls pm,33274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19741.52,,,,8399.85,65103.1,case rate,
Tcat rmvl perm ldls pm w/img,33275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insj phrnc nrv stim sys,33276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47851.42,,,,45535.1,47851.42,fee schedule,
Rmvl phrnc nrv stim sys,33278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Rmvl phrnc nrv stim transvns,33279,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Rmvl phrnc nrv stim pg only,33280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Reposg phrnc nrv stim trnsvn,33281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Insj subq car rhythm mntr,33285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8607.42,,,,3991.59,30936.9,case rate,
Rmvl subq car rhythm mntr,33286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,case rate,
Rmv&rplcmt phrnc nrv stim pg,33287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31460.67,,,,29937.77,31460.67,case rate,
Rmv&rplcmt phrnc nrv stim ld,33288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,13133.14,13801.21,case rate,
Tcat impl wrls p-art prs snr,33289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29446.87,,,,13352.23,103486.59,case rate,
Repair of heart wound,33300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1673.14,8759.27,case rate,
Repair of heart wound,33305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2797.99,8759.27,case rate,
Exploratory heart surgery,33310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,814.4,8759.27,case rate,
Exploratory heart surgery,33315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1318.66,8759.27,case rate,
Repair major blood vessel(s),33320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,741.86,8759.27,case rate,
Repair major vessel,33321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,826.34,8759.27,case rate,
Repair major blood vessel(s),33322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,963.68,8759.27,case rate,
Insert major vessel graft,33330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,987.76,8759.27,case rate,
Insert major vessel graft,33335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1290.42,8759.27,case rate,
Perq clsr tcat l atr apndge,33340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,543.37,65103.1,case rate,
Replace aortic valve perq,33361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,829.7,65103.1,case rate,
Replace aortic valve open,33362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,904.08,65103.1,case rate,
Replace aortic valve open,33363,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,936.2,65103.1,case rate,
Replace aortic valve open,33364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,935.16,65103.1,case rate,
Replace aortic valve open,33365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,978.44,65103.1,case rate,
Trcath replace aortic valve,33366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1077.41,65103.1,case rate,
Replace aortic valve w/byp,33367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,416.41,65103.1,case rate,
Replace aortic valve w/byp,33368,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,504.51,65103.1,case rate,
Replace aortic valve w/byp,33369,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,665.94,65103.1,case rate,
Valvuloplasty aortic valve,33390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1327.99,8759.27,case rate,
Valvuloplasty aortic valve,33391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1574.16,8759.27,case rate,
Prepare heart-aorta conduit,33404,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1209.84,8759.27,case rate,
Replacement aortic valve opn,33405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1563.53,8759.27,case rate,
Replacement aortic valve opn,33406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1977.09,8759.27,case rate,
Replacement aortic valve opn,33410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1748.54,8759.27,case rate,
Replacement of aortic valve,33411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2302.54,8759.27,case rate,
Replacement of aortic valve,33412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2158.48,8759.27,case rate,
Replacement of aortic valve,33413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2214.45,8759.27,case rate,
Repair of aortic valve,33414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1472.85,8759.27,case rate,
Revision subvalvular tissue,33415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1395.11,8759.27,case rate,
Revise ventricle muscle,33416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1395.62,8759.27,case rate,
Repair of aortic valve,33417,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1154.12,8759.27,case rate,
Repair tcat mitral valve,33418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1241.96,65103.1,case rate,
Revision of mitral valve,33420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1005.9,8759.27,case rate,
Revision of mitral valve,33422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1152.31,8759.27,case rate,
Repair of mitral valve,33425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1876.55,8759.27,case rate,
Repair of mitral valve,33426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1640.49,8759.27,case rate,
Repair of mitral valve,33427,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1680.92,8759.27,case rate,
Replacement of mitral valve,33430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1929.68,8759.27,case rate,
Rplcmt a-valve tlcj autol pv,33440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2333.64,8759.27,case rate,
Revision of tricuspid valve,33460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1648.27,8759.27,case rate,
Valvuloplasty tricuspid,33463,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2125.05,8759.27,case rate,
Valvuloplasty tricuspid,33464,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1679.88,8759.27,case rate,
Replace tricuspid valve,33465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1893.13,8759.27,case rate,
Revision of tricuspid valve,33468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1679.11,8759.27,case rate,
Vlvt pv clsd hrt via p-art,33471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,919.1,8759.27,case rate,
Revision of pulmonary valve,33474,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1498.76,8759.27,case rate,
Replacement pulmonary valve,33475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1602.92,8759.27,case rate,
Revision of heart chamber,33476,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1055.91,8759.27,case rate,
Implant tcat pulm vlv perq,33477,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,928.95,65103.1,case rate,
Revision of heart chamber,33478,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1090.38,8759.27,case rate,
Repair prosth valve clot,33496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1152.56,8759.27,case rate,
Repair heart vessel fistula,33500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1080.8,8759.27,case rate,
Repair heart vessel fistula,33501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,776.58,8759.27,case rate,
Coronary artery correction,33502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,889.04,8759.27,case rate,
Coronary artery graft,33503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,924.8,8759.27,case rate,
Coronary artery graft,33504,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1017.3,8759.27,case rate,
Repair artery w/tunnel,33505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1408.32,8759.27,case rate,
Repair artery translocation,33506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1405.46,8759.27,case rate,
Repair art intramural,33507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1181.59,8759.27,case rate,
Ndsc hrv uxtr art 1 sgm cab,33509,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,117.9,8759.27,case rate,
Cabg vein single,33510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1333.7,8759.27,case rate,
Cabg vein two,33511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1464.03,8759.27,case rate,
Cabg vein three,33512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1668.22,8759.27,case rate,
Cabg vein four,33513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1704.49,8759.27,case rate,
Cabg vein five,33514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1795.71,8759.27,case rate,
Cabg vein six or more,33516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1858.93,8759.27,case rate,
Cabg artery-vein single,33517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,127.22,8759.27,case rate,
Cabg artery-vein two,33518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,279.59,8759.27,case rate,
Cabg artery-vein three,33519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,369.76,8759.27,case rate,
Cabg artery-vein four,33521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,443.61,8759.27,case rate,
Cabg artery-vein five,33522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,498.03,8759.27,case rate,
Cabg art-vein six or more,33523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,563.84,8759.27,case rate,
Coronary artery bypass/reop,33530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,357.06,8759.27,case rate,
Cabg arterial single,33533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1291.2,8759.27,case rate,
Cabg arterial two,33534,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1515.33,8759.27,case rate,
Cabg arterial three,33535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1684.29,8759.27,case rate,
Cabg arterial four or more,33536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1811.77,8759.27,case rate,
Removal of heart lesion,33542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1802.96,8759.27,case rate,
Repair of heart damage,33545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2107.18,8759.27,case rate,
Restore/remodel ventricle,33548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2031.77,8759.27,case rate,
Open coronary endarterectomy,33572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,156.51,8759.27,case rate,
Closure of valve,33600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1188.59,8759.27,case rate,
Closure of valve,33602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1154.39,8759.27,case rate,
Anastomosis/artery-aorta,33606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1228.22,8759.27,case rate,
Repair anomaly w/conduit,33608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1244.04,8759.27,case rate,
Repair by enlargement,33610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1227.2,8759.27,case rate,
Repair double ventricle,33611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1338.36,8759.27,case rate,
Repair double ventricle,33612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1374.12,8759.27,case rate,
Repair modified fontan,33615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1375.67,8759.27,case rate,
Repair single ventricle,33617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1488.38,8759.27,case rate,
Repair single ventricle,33619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1894.69,8759.27,case rate,
Apply r&l pulm art bands,33620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1132.1,8759.27,case rate,
Transthor cath for stent,33621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,643.92,8759.27,case rate,
Redo compl cardiac anomaly,33622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2342.97,8759.27,case rate,
Repair heart septum defect,33641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1126.91,8759.27,case rate,
Revision of heart veins,33645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1190.4,8759.27,case rate,
Repair heart septum defects,33647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1247.66,8759.27,case rate,
Repair of heart defects,33660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1206.72,8759.27,case rate,
Repair of heart defects,33665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1312.96,8759.27,case rate,
Repair of heart chambers,33670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1347.95,8759.27,case rate,
Close mult vsd,33675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1352.36,8759.27,case rate,
Close mult vsd w/resection,33676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1387.85,8759.27,case rate,
Cl mult vsd w/rem pul band,33677,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1440.71,8759.27,case rate,
Repair heart septum defect,33681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1276.16,8759.27,case rate,
Repair heart septum defect,33684,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1296.12,8759.27,case rate,
Repair heart septum defect,33688,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1289.12,8759.27,case rate,
Reinforce pulmonary artery,33690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,837.48,8759.27,case rate,
Repair of heart defects,33692,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1338.36,8759.27,case rate,
Repair of heart defects,33694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1338.36,8759.27,case rate,
Repair of heart defects,33697,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1409.35,8759.27,case rate,
Repair of heart defects,33702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1070.16,8759.27,case rate,
Repair of heart defects,33710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1407.02,8759.27,case rate,
Repair of heart defect,33720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1070.95,8759.27,case rate,
Repair venous anomaly,33724,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1058.51,8759.27,case rate,
Repair pul venous stenosis,33726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1393.81,8759.27,case rate,
Repair heart-vein defect(s),33730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1381.11,8759.27,case rate,
Repair heart-vein defect,33732,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1140.91,8759.27,case rate,
Revision of heart chamber,33735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,902.25,8759.27,case rate,
Revision of heart chamber,33736,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,977.15,8759.27,case rate,
Revision of heart chamber,33737,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,901.74,8759.27,case rate,
Tas congenital car anomal,33741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,515.39,65103.1,case rate,
Tis cgen car anomal 1st shnt,33745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,736.16,65103.1,case rate,
Tis cgen car anomal ea addl,33746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,294.36,65103.1,case rate,
Major vessel shunt,33750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,873.75,8759.27,case rate,
Major vessel shunt,33755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,916.25,8759.27,case rate,
Major vessel shunt,33762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,887.22,8759.27,case rate,
Major vessel shunt & graft,33764,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,916.25,8759.27,case rate,
Major vessel shunt,33766,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,921.69,8759.27,case rate,
Major vessel shunt,33767,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,982.32,8759.27,case rate,
Cavopulmonary shunting,33768,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.45,8759.27,case rate,
Repair great vessels defect,33770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1448.73,8759.27,case rate,
Repair great vessels defect,33771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1487.08,8759.27,case rate,
Repair great vessels defect,33774,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1244.82,8759.27,case rate,
Repair great vessels defect,33775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1279.79,8759.27,case rate,
Repair great vessels defect,33776,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1353.64,8759.27,case rate,
Repair great vessels defect,33777,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1301.56,8759.27,case rate,
Repair great vessels defect,33778,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1614.58,8759.27,case rate,
Repair great vessels defect,33779,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1588.41,8759.27,case rate,
Repair great vessels defect,33780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1619.24,8759.27,case rate,
Repair great vessels defect,33781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1578.56,8759.27,case rate,
Nikaidoh proc,33782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,6503.14,8759.27,case rate,
Nikaidoh proc w/ostia implt,33783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7027.16,8759.27,case rate,
Repair arterial trunk,33786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1560.42,8759.27,case rate,
Revision of pulmonary artery,33788,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1057.21,8759.27,case rate,
Aortic suspension,33800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,682.52,8759.27,case rate,
Repair vessel defect,33802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,756.89,8759.27,case rate,
Repair vessel defect,33803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,796.28,8759.27,case rate,
Repair septal defect,33813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,862.6,8759.27,case rate,
Repair septal defect,33814,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1056.69,8759.27,case rate,
Revise major vessel,33820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,671.89,8759.27,case rate,
Revise major vessel,33822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,707.92,8759.27,case rate,
Revise major vessel,33824,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,822.19,8759.27,case rate,
Remove aorta constriction,33840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,861.83,8759.27,case rate,
Remove aorta constriction,33845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,927.9,8759.27,case rate,
Remove aorta constriction,33851,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,884.38,8759.27,case rate,
Repair septal defect,33852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,970.14,8759.27,case rate,
Repair septal defect,33853,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1266.32,8759.27,case rate,
As-aort grf f/aortic dsj,33858,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2324.82,8759.27,case rate,
As-aort grf f/ds oth/thn dsj,33859,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1672.62,8759.27,case rate,
Ascending aortic graft,33863,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2153.81,8759.27,case rate,
Ascending aortic graft,33864,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2200.45,8759.27,case rate,
Transvrs a-arch grf hypthrm,33871,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2229.21,8759.27,case rate,
Thoracic aortic graft,33875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1880.44,8759.27,case rate,
Thoracoabdominal graft,33877,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2452.06,8759.27,case rate,
Endovasc taa repr incl subcl,33880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1216.31,19766.37,case rate,
Endovasc taa repr w/o subcl,33881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1042.95,19766.37,case rate,
Insert endovasc prosth taa,33883,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,759.22,19766.37,case rate,
Endovasc prosth taa add-on,33884,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,263,19766.37,case rate,
Endovasc prosth delayed,33886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,655.57,19766.37,case rate,
Artery transpose/endovas taa,33889,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,534.3,8759.27,case rate,
Car-car bp grft/endovas taa,33891,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,642.09,19479.69,case rate,
Evasc st rpr thrc/aa acrs br,33894,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,672.67,19766.37,case rate,
Evasc st rpr thrc/aa x crsg,33895,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,535.34,19766.37,case rate,
Perq trluml angp nt/recr coa,33897,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,398.01,19766.37,case rate,
Perq p-art revsc 1 nm nt uni,33900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Perq p-art revsc 1 nm nt bi,33901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Perq p-art revsc 1 abnor uni,33902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Perq p-art revsc 1 abnor bi,33903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Remove lung artery emboli,33910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1813.85,8759.27,case rate,
Remove lung artery emboli,33915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,951.24,8759.27,case rate,
Surgery of great vessel,33916,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2856.54,8759.27,case rate,
Repair pulmonary artery,33917,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1011.86,8759.27,case rate,
Repair pulmonary atresia,33920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1245.07,8759.27,case rate,
Transect pulmonary artery,33922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,963.41,8759.27,case rate,
Remove pulmonary shunt,33924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,193.56,65103.1,case rate,
Rpr pul art unifocal w/o cpb,33925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1178.22,8759.27,case rate,
Repr pul art unifocal w/cpb,33926,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1652.41,8759.27,case rate,
Impltj tot rplcmt hrt sys,33927,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1730.41,8759.27,case rate,
Rmvl & rplcmt tot hrt sys,33928,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1890.54,8759.27,case rate,
Rmvl rplcmt hrt sys f/trnspl,33929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1218.39,8759.27,case rate,
Removal of donor heart/lung,33930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Prepare donor heart/lung,33933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,291.25,8759.27,case rate,
Transplantation heart/lung,33935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3385.67,9915.15,case rate,
Removal of donor heart,33940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Prepare donor heart,33944,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,241.76,8759.27,case rate,
Transplantation of heart,33945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3342.4,9807.04,case rate,
Ecmo/ecls initiation venous,33946,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,213.51,8759.27,case rate,
Ecmo/ecls initiation artery,33947,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,236.05,8759.27,case rate,
Ecmo/ecls daily mgmt-venous,33948,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,167.12,8759.27,case rate,
Ecmo/ecls daily mgmt artery,33949,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,162.46,8759.27,case rate,
Ecmo/ecls insj prph cannula,33951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,288.66,8759.27,case rate,
Ecmo/ecls insj prph cannula,33952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,293.32,8759.27,case rate,
Ecmo/ecls insj prph cannula,33953,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,322.07,8759.27,case rate,
Ecmo/ecls insj prph cannula,33954,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,324.42,8759.27,case rate,
Ecmo/ecls insj ctr cannula,33955,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,563.58,8759.27,case rate,
Ecmo/ecls insj ctr cannula,33956,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,569.02,8759.27,case rate,
Ecmo/ecls repos perph cnula,33957,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,125.67,8759.27,case rate,
Ecmo/ecls repos perph cnula,33958,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,125.67,8759.27,case rate,
Ecmo/ecls repos perph cnula,33959,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,159.35,8759.27,case rate,
Ecmo/ecls repos perph cnula,33962,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,159.35,8759.27,case rate,
Ecmo/ecls repos perph cnula,33963,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,318.2,8759.27,case rate,
Ecmo/ecls repos perph cnula,33964,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,335.81,8759.27,case rate,
Ecmo/ecls rmvl perph cannula,33965,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,125.67,8759.27,case rate,
Ecmo/ecls rmvl prph cannula,33966,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,162.2,8759.27,case rate,
Insert i-aort percut device,33967,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,177.24,12700.02,case rate,
Remove aortic assist device,33968,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,23.06,11290.3,case rate,
Ecmo/ecls rmvl perph cannula,33969,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,185.79,8759.27,case rate,
Aortic circulation assist,33970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,242.27,8759.27,case rate,
Aortic circulation assist,33971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,494.14,8759.27,case rate,
Insert balloon device,33973,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,341.78,8759.27,case rate,
Remove intra-aortic balloon,33974,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,623.71,8759.27,case rate,
Implant ventricular device,33975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,885.94,8759.27,case rate,
Implant ventricular device,33976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1077.94,8759.27,case rate,
Remove ventricular device,33977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,770.62,8759.27,case rate,
Remove ventricular device,33978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,910.8,8759.27,case rate,
Insert intracorporeal device,33979,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1323.32,8759.27,case rate,
Remove intracorporeal device,33980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1215.79,8759.27,case rate,
Replace vad pump ext,33981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,564.62,8759.27,case rate,
Replace vad intra w/o bp,33982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1327.21,8759.27,case rate,
Replace vad intra w/bp,33983,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1574.16,8759.27,case rate,
Ecmo/ecls rmvl prph cannula,33984,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,193.04,8759.27,case rate,
Ecmo/ecls rmvl ctr cannula,33985,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,349.81,8759.27,case rate,
Ecmo/ecls rmvl ctr cannula,33986,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,357.06,8759.27,case rate,
Artery expos/graft artery,33987,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,141.21,8759.27,case rate,
Insertion of left heart vent,33988,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,528.61,8759.27,case rate,
Removal of left heart vent,33989,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,335.81,8759.27,case rate,
Insj perq vad l hrt arterial,33990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,247.72,12700.02,case rate,
Insj perq vad l hrt artl&ven,33991,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,309.9,12700.02,case rate,
Rmvl perq left heart vad,33992,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,128.26,11290.3,case rate,
Reposg perq r/l hrt vad,33993,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,114.78,11290.3,case rate,
Insj perq vad r hrt venous,33995,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,247.46,12700.02,case rate,
Rmvl perq right heart vad,33997,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,108.57,11290.3,case rate,
Unlisted px cardiac surgery,33999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Removal of artery clot,34001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,618.52,11290.3,case rate,
Removal of artery clot,34051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,694.44,19766.37,case rate,
Removal of artery clot,34101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Removal of arm artery clot,34111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Removal of artery clot,34151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,947.34,8759.27,case rate,
Removal of artery clot,34201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Removal of leg artery clot,34203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Removal of vein clot,34401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1029.74,8759.27,case rate,
Removal of vein clot,34421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Removal of vein clot,34451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,967.55,8759.27,case rate,
Removal of vein clot,34471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Removal of vein clot,34490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Repair valve femoral vein,34501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Reconstruct vena cava,34502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1064.2,8759.27,case rate,
Transposition of vein valve,34510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Cross-over vein graft,34520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Leg vein fusion,34530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Evasc rpr a-ao ndgft,34701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,841.62,19766.37,case rate,
Evasc rpr a-ao ndgft rpt,34702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1250.77,19766.37,case rate,
Evasc rpr a-unilac ndgft,34703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,933.09,19766.37,case rate,
Evasc rpr a-unilac ndgft rpt,34704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1549.8,19766.37,case rate,
Evac rpr a-biiliac ndgft,34705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1035.7,19766.37,case rate,
Evasc rpr a-biiliac rpt,34706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1536.07,19766.37,case rate,
Evasc rpr ilio-iliac ndgft,34707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,793.68,19766.37,case rate,
Evasc rpr ilio-iliac rpt,34708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1220.97,19766.37,case rate,
Plmt xtn prosth evasc rpr,34709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,216.89,19766.37,case rate,
Dlyd plmt xtn prosth 1st vsl,34710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,541.57,19766.37,case rate,
Dlyd plmt xtn prosth ea addl,34711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,197.7,19766.37,case rate,
Tcat dlvr enhncd fixj dev,34712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,449.83,19766.37,case rate,
Evasc rpr a-iliac ndgft,34717,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,297.72,19766.37,case rate,
Evasc rpr n/a a-iliac ndgft,34718,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,837.22,19766.37,case rate,
Endovas iliac a device addon,34808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,135.77,19766.37,case rate,
Opn fem art expos,34812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,138.36,8759.27,case rate,
Femoral endovas graft add-on,34813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,158.05,19766.37,case rate,
Opn iliac art expos,34820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,224.65,19766.37,case rate,
Open aortic tube prosth repr,34830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1185.74,8759.27,case rate,
Open aortoiliac prosth repr,34831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1299.24,8759.27,case rate,
Open aortofemor prosth repr,34832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1273.84,8759.27,case rate,
Opn ilac art expos cndt crtj,34833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,261.7,19766.37,case rate,
Opn brach art expos,34834,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,86.54,8759.27,case rate,
Endovasc visc aorta 1 graft,34841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1103.59,19766.37,case rate,
Endovasc visc aorta 2 graft,34842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1208.27,19766.37,case rate,
Endovasc visc aorta 3 graft,34843,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1325.66,19766.37,case rate,
Endovasc visc aorta 4 graft,34844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1416.87,19766.37,case rate,
Visc & infraren abd 1 prosth,34845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1343.8,19766.37,case rate,
Visc & infraren abd 2 prosth,34846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1423.35,19766.37,case rate,
Visc & infraren abd 3 prosth,34847,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1506.53,19766.37,case rate,
Visc & infraren abd 4+ prost,34848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1614.84,19766.37,case rate,
Repair defect of artery,35001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,767.77,11290.3,case rate,
Repair artery rupture neck,35002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,769.59,11290.3,case rate,
Repair defect of artery,35005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,675.01,11290.3,case rate,
Repair defect of artery,35011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair artery rupture arm,35013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Repair defect of artery,35021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,876.08,8759.27,case rate,
Repair artery rupture chest,35022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,999.43,8759.27,case rate,
Repair defect of arm artery,35045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair defect of artery,35081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1170.97,8759.27,case rate,
Repair artery rupture aorta,35082,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1462.47,8759.27,case rate,
Repair defect of artery,35091,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1199.99,8759.27,case rate,
Repair artery rupture aorta,35092,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1743.37,8759.27,case rate,
Repair defect of artery,35102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1267.61,8759.27,case rate,
Repair artery rupture aorta,35103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1500.05,8759.27,case rate,
Repair defect of artery,35111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,895.78,8759.27,case rate,
Repair artery rupture spleen,35112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1100.23,8759.27,case rate,
Repair defect of artery,35121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1063.95,8759.27,case rate,
Repair artery rupture belly,35122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1270.99,8759.27,case rate,
Repair defect of artery,35131,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,934.13,8759.27,case rate,
Repair artery rupture groin,35132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1100.23,8759.27,case rate,
Repair defect of artery,35141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Repair artery rupture thigh,35142,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Repair defect of artery,35151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Repair ruptd popliteal art,35152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Repair blood vessel lesion,35180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,694.71,5638.95,case rate,
Repair blood vessel lesion,35182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1237.81,8759.27,case rate,
Repair blood vessel lesion,35184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Repair blood vessel lesion,35188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair blood vessel lesion,35189,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1016.78,8759.27,case rate,
Repair blood vessel lesion,35190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair blood vessel lesion,35201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair blood vessel lesion,35206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Repair blood vessel lesion,35207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Repair blood vessel lesion,35211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,961.33,8759.27,case rate,
Repair blood vessel lesion,35216,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1465.32,8759.27,case rate,
Repair blood vessel lesion,35221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1017.04,8759.27,case rate,
Repair blood vessel lesion,35226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Repair blood vessel lesion,35231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Repair blood vessel lesion,35236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair blood vessel lesion,35241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,995.79,8759.27,case rate,
Repair blood vessel lesion,35246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1081.05,8759.27,case rate,
Repair blood vessel lesion,35251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1204.14,8759.27,case rate,
Repair blood vessel lesion,35256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair blood vessel lesion,35261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Repair blood vessel lesion,35266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Repair blood vessel lesion,35271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,958.49,8759.27,case rate,
Repair blood vessel lesion,35276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1011.86,8759.27,case rate,
Repair blood vessel lesion,35281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1108.51,8759.27,case rate,
Repair blood vessel lesion,35286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Rechanneling of artery,35301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,767.51,11290.3,case rate,
Rechanneling of artery,35302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Rechanneling of artery,35303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Rechanneling of artery,35304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Rechanneling of artery,35305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Rechanneling of artery,35306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Rechanneling of artery,35311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1071.99,8759.27,case rate,
Rechanneling of artery,35321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Rechanneling of artery,35331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,992.43,8759.27,case rate,
Rechanneling of artery,35341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,938.54,8759.27,case rate,
Rechanneling of artery,35351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,871.15,8759.27,case rate,
Rechanneling of artery,35355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Rechanneling of artery,35361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1025.34,8759.27,case rate,
Rechanneling of artery,35363,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1092.71,8759.27,case rate,
Rechanneling of artery,35371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Rechanneling of artery,35372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Reoperation carotid add-on,35390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,106.75,11290.3,case rate,
Angioscopy,35400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,98.71,8759.27,case rate,
Art byp grft ipsilat carotid,35501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,981.81,11290.3,case rate,
Art byp grft subclav-carotid,35506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,857.68,11290.3,case rate,
Art byp grft carotid-vertbrl,35508,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,896.55,11290.3,case rate,
Art byp grft contral carotid,35509,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,950.19,11290.3,case rate,
Art byp grft carotid-brchial,35510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,828.14,11290.3,case rate,
Art byp grft subclav-subclav,35511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,754.82,8759.27,case rate,
Art byp grft subclav-brchial,35512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,811.83,19479.69,case rate,
Art byp grft subclav-vertbrl,35515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,896.55,8759.27,case rate,
Art byp grft subclav-axilary,35516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,821.68,19479.69,case rate,
Art byp grft axillary-axilry,35518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,769.59,19479.69,case rate,
Art byp grft axill-femoral,35521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,828.93,8759.27,case rate,
Art byp grft axill-brachial,35522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,788.24,19479.69,case rate,
Art byp grft brchl-ulnr-rdl,35523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,860.8,19479.69,case rate,
Art byp grft brachial-brchl,35525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,767.51,19479.69,case rate,
Art byp grft aor/carot/innom,35526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1193.76,8759.27,case rate,
Art byp grft aorcel/aormesen,35531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1309.85,8759.27,case rate,
Art byp grft axill/fem/fem,35533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Art byp grft hepatorenal,35535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1279.02,8759.27,case rate,
Art byp grft splenorenal,35536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1137.28,8759.27,case rate,
Art byp grft aortoiliac,35537,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1399.77,8759.27,case rate,
Art byp grft aortobi-iliac,35538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1568.21,8759.27,case rate,
Art byp grft aortofemoral,35539,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1471.28,8759.27,case rate,
Art byp grft aortbifemoral,35540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1639.46,8759.27,case rate,
Art byp grft fem-popliteal,35556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,944.49,19479.69,case rate,
Art byp grft fem-femoral,35558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,837.74,19479.69,case rate,
Art byp grft aortorenal,35560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1146.86,8759.27,case rate,
Art byp grft ilioiliac,35563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,892.93,8759.27,case rate,
Art byp grft iliofemoral,35565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,888,8759.27,case rate,
Art byp fem-ant-post tib/prl,35566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1123.55,19479.69,case rate,
Art byp tibial-tib/peroneal,35570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,992.69,19479.69,case rate,
Art byp pop-tibl-prl-other,35571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,895.26,19479.69,case rate,
Vein byp grft fem-popliteal,35583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,976.36,19479.69,case rate,
Vein byp fem-tibial peroneal,35585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1128.47,19479.69,case rate,
Vein byp pop-tibl peroneal,35587,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,925.06,19479.69,case rate,
Open hrv uxtr art 1 sgm cab,35600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,126.19,8759.27,case rate,
Art byp common ipsi carotid,35601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,949.15,11290.3,case rate,
Art byp carotid-subclavian,35606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,796.53,11290.3,case rate,
Art byp subclav-subclavian,35612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,706.88,8759.27,case rate,
Art byp subclav-axillary,35616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,742.38,19479.69,case rate,
Art byp axillary-femoral,35621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,743.94,19479.69,case rate,
Art byp axillary-pop-tibial,35623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,886.71,19479.69,case rate,
Art byp aorsubcl/carot/innom,35626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1091.68,8759.27,case rate,
Art byp aor-celiac-msn-renal,35631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1248.96,8759.27,case rate,
Art byp ilio-celiac,35632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1214.76,8759.27,case rate,
Art byp ilio-mesenteric,35633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1335.51,8759.27,case rate,
Art byp iliorenal,35634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1189.1,8759.27,case rate,
Art byp spenorenal,35636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1073.53,8759.27,case rate,
Art byp aortoiliac,35637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1116.03,8759.27,case rate,
Art byp aortobi-iliac,35638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1173.81,8759.27,case rate,
Art byp carotid-vertebral,35642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,670.61,11290.3,case rate,
Art byp subclav-vertebrl,35645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,640.81,8759.27,case rate,
Art byp aortobifemoral,35646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1154.12,8759.27,case rate,
Art byp aortofemoral,35647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1051.25,19479.69,case rate,
Art byp axillary-axillary,35650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,689.26,19479.69,case rate,
Art byp axill-fem-femoral,35654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,923.24,8759.27,case rate,
Art byp femoral-popliteal,35656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,729.17,19479.69,case rate,
Art byp femoral-femoral,35661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,737.19,19479.69,case rate,
Art byp ilioiliac,35663,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,822.44,8759.27,case rate,
Art byp iliofemoral,35665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,797.05,19479.69,case rate,
Art byp fem-ant-post tib/prl,35666,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,879.72,19479.69,case rate,
Art byp pop-tibl-prl-other,35671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,775.8,8759.27,case rate,
Composite byp grft pros&vein,35681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,53.64,19479.69,case rate,
Composite byp grft 2 veins,35682,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,235.54,19479.69,case rate,
Composite byp grft 3/> segmt,35683,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,272.85,19479.69,case rate,
Art trnsposj vertbrl carotid,35691,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,640.29,11290.3,case rate,
Art trnsposj subclavian,35693,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,569.02,8759.27,case rate,
Art trnsposj subclav carotid,35694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,668.27,11290.3,case rate,
Art trnsposj carotid subclav,35695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,693.41,11290.3,case rate,
Reimplant artery each,35697,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,98.2,8759.27,case rate,
Reoperation bypass graft,35700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.57,8759.27,case rate,
Expl n/flwd surg neck art,35701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.93,11290.3,case rate,
Expl n/flwd surg uxtr art,35702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Expl n/flwd surg lxtr art,35703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Explore neck vessels,35800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Explore chest vessels,35820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Explore abdominal vessels,35840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,851.73,19766.37,case rate,
Explore limb vessels,35860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Repair vessel graft defect,35870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,842.4,8759.27,case rate,
Removal of clot in graft,35875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Removal of clot in graft,35876,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Revise graft w/vein,35879,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Revise graft w/vein,35881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Revj fem anast nonautog grf,35883,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Revj fem anast autog vn grf,35884,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Excision graft neck,35901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Excision graft extremity,35903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Excision graft thorax,35905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1130.54,8759.27,case rate,
Excision graft abdomen,35907,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1283.42,8759.27,case rate,
Pseudoaneurysm injection trt,36002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Place cath thoracic aorta,36221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Place cath carotid/inom art,36222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Place cath carotid/inom art,36223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Place cath carotd art,36224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Place cath subclavian art,36225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Place cath vertebral art,36226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Ins cath ren art 1st unilat,36251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ins cath ren art 1st bilat,36252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ins cath ren art 2nd+ unilat,36253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Ins cath ren art 2nd+ bilat,36254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insertion of infusion pump,36260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Revision of infusion pump,36261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,fee schedule,
Removal of infusion pump,36262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3978.66,,,,1638.6,12700.02,case rate,
Routine venipuncture,36415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.83,,,,3,14.57,fee schedule,
Venipuncture cutdown < 1 yr,36420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Venipuncture cutdown 1 yr/>,36425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Transfusion bld/bld compnt,36430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Bld push tfuj 2 yr/<,36440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Bld exchange truj newborn,36450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Bld exchange truj oth thn nb,36455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Prtl exchange transfuse nb,36456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Intrauterine transfusion ftl,36460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Njx noncmpnd sclrsnt 1 vein,36465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Njx noncmpnd sclrsnt mlt vn,36466,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Njx sclrsnt spider veins,36468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Njx sclrsnt 1 incmptnt vein,36470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Njx sclrsnt mlt incmptnt vn,36471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Endovenous mchnchem 1st vein,36473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Endovenous rf 1st vein,36475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Endovenous laser 1st vein,36478,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Endoven ther chem adhes 1st,36482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Apheresis wbc,36511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Apheresis rbc,36512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Apheresis platelets,36513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Apheresis plasma,36514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Apheresis immunoads slctv,36516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4688.68,,,,2034.24,15766.4,fee schedule,
Photopheresis,36522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4688.68,,,,2034.24,15766.4,fee schedule,
Insert non-tunnel cv cath,36555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Insert non-tunnel cv cath,36556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Insert tunneled cv cath,36557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Insert tunneled cv cath,36558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insert tunneled cv cath,36560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insert tunneled cv cath,36561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insert tunneled cv cath,36563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Insert tunneled cv cath,36565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insert tunneled cv cath,36566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Insj picc <5 yr w/o imaging,36568,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,694.71,5638.95,case rate,
Insj picc 5 yr+ w/o imaging,36569,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Insert picvad cath,36570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insert picvad cath,36571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insj picc rs&i <5 yr,36572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Insj picc rs&i 5 yr+,36573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Repair tunneled cv cath,36575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Repair tunneled cv cath,36576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Replace tunneled cv cath,36578,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Replace cvad cath,36580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Replace tunneled cv cath,36581,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Replace tunneled cv cath,36582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Replace tunneled cv cath,36583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Compl rplcmt picc rs&i,36584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Replace picvad cath,36585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Removal tunneled cv cath,36589,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,case rate,
Removal tunneled cv cath,36590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,694.71,5638.95,case rate,
Draw blood off venous device,36591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Collect blood from picc,36592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Declot vascular device,36593,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Mech remov tunneled cv cath,36595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Mech remov tunneled cv cath,36596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Reposition venous catheter,36597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Inj w/fluor eval cv device,36598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Withdrawal of arterial blood,36600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Insertion catheter artery,36640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insertion catheter artery,36660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,50.52,8759.27,case rate,
Insert needle bone cavity,36680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Insertion of cannula,36800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Insertion of cannula,36810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insertion of cannula,36815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Av fuse uppr arm cephalic,36818,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Av fuse uppr arm basilic,36819,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Av fusion/forearm vein,36820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Av fusion direct any site,36821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Insertion of cannula(s),36823,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Artery-vein autograft,36825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Artery-vein nonautograft,36830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Open thrombect av fistula,36831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Av fistula revision open,36832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Av fistula revision,36833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Artery to vein shunt,36835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Prq av fstl crtj uxtr 1 acs,36836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Prq av fstl crt uxtr sep acs,36837,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Dist revas ligation hemo,36838,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
External cannula declotting,36860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,694.71,5638.95,case rate,
Cannula declotting,36861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Intro cath dialysis circuit,36901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Intro cath dialysis circuit,36902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Intro cath dialysis circuit,36903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Thrmbc/nfs dialysis circuit,36904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Thrmbc/nfs dialysis circuit,36905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Thrmbc/nfs dialysis circuit,36906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Revision of circulation,37140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1622.36,8759.27,case rate,
Revision of circulation,37145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,282.89,8759.27,case rate,
Revision of circulation,37160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1546.7,8759.27,case rate,
Revision of circulation,37180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1486.32,8759.27,case rate,
Splice spleen/kidney veins,37181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1622.36,8759.27,case rate,
Insert hepatic shunt (tips),37182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,5190.89,40232.02,case rate,
Revision tips,37183,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Prim art m-thrmbc 1st vsl,37184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,5190.89,40232.02,case rate,
Venous mech thrombectomy,37187,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Ven mechnl thrmbc repeat tx,37188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ins endovas vena cava filtr,37191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Redo endovas vena cava filtr,37192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Rem endovas vena cava filter,37193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Thrombolytic therapy stroke,37195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Remove intrvas foreign body,37197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Transcatheter biopsy,37200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Thrombolytic art therapy,37211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Thrombolytic venous therapy,37212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Thromblytic art/ven therapy,37213,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Cessj therapy cath removal,37214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Transcath stent cca w/eps,37215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,677.59,40232.02,case rate,
Stent placemt retro carotid,37217,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,5190.89,40232.02,case rate,
Stent placemt ante carotid,37218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,567.73,40232.02,case rate,
Iliac revasc,37220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Iliac revasc w/stent,37221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Fem/popl revas w/tla,37224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Fem/popl revas w/ather,37225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,5190.89,40232.02,case rate,
Fem/popl revasc w/stent,37226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Fem/popl revasc stnt & ather,37227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Tib/per revasc w/tla,37228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Tib/per revasc w/ather,37229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Tib/per revasc w/stent,37230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Tib/per revasc stent & ather,37231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Open/perq place stent 1st,37236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Open/perq place stent same,37238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Vasc embolize/occlude venous,37241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Vasc embolize/occlude artery,37242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,5190.89,40232.02,case rate,
Vasc embolize/occlude organ,37243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Vasc embolize/occlude bleed,37244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Trluml balo angiop 1st art,37246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Trluml balo angiop 1st vein,37248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Endoscopy ligate perf veins,37500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Unlisted vasc endoscopy px,37501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Ligation of neck vein,37565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Ligation of neck artery,37600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligation of neck artery,37605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligation of neck artery,37606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligation of a-v fistula,37607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Temporal artery procedure,37609,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Ligation of neck artery,37615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Ligation of chest artery,37616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,774.25,8759.27,case rate,
Ligation of abdomen artery,37617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2681.41,8759.27,case rate,
Ligation of extremity artery,37618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,277.52,8759.27,case rate,
Ligation of inf vena cava,37619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Revision of major vein,37650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Revision of major vein,37660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,922.47,8759.27,case rate,
Revise leg vein,37700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligate/strip short leg vein,37718,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligate/strip long leg vein,37722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Removal of leg veins/lesion,37735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligate leg veins radical,37760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ligate leg veins open,37761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Stab phleb veins xtr 10-20,37765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Phleb veins - extrem 20+,37766,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Revision of leg vein,37780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Ligate/divide/excise vein,37785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Revascularization penis,37788,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,918.58,8759.27,case rate,
Penile venous occlusion,37790,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Unlisted px vascular surgery,37799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,fee schedule,
Removal of spleen total,38100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,813.63,11290.3,case rate,
Removal of spleen partial,38101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,819.59,11290.3,case rate,
Removal of spleen total,38102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,182.94,11290.3,case rate,
Repair of ruptured spleen,38115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.44,11290.3,case rate,
Laparoscopy splenectomy,38120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Unlisted laps px spleen,38129,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Harvest auto stem cells,38206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Cryopreserve stem cells,38207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Thaw preserved stem cells,38208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Wash harvest stem cells,38209,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
T-cell depletion of harvest,38210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Tumor cell deplete of harvst,38211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Rbc depletion of harvest,38212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Platelet deplete of harvest,38213,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Volume deplete of harvest,38214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Harvest stem cell concentrte,38215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Dx bone marrow aspirations,38220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Dx bone marrow biopsies,38221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Dx bone marrow bx & aspir,38222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Bone marrow harvest allogen,38230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Bone marrow harvest autolog,38232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4688.68,,,,2034.24,15766.4,fee schedule,
Transplt allo hct/donor,38240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55364.72,,,,20652.13,160064.59,case rate,
Transplt autol hct/donor,38241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Transplt allo lymphocytes,38242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Transplj hematopoietic boost,38243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.51,,,,664.96,5153.79,fee schedule,
Drainage lymph node lesion,38300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Drainage lymph node lesion,38305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Incision of lymph channels,38308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Thoracic duct procedure,38380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,199.39,8759.27,case rate,
Thoracic duct procedure,38381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,564.88,9790.52,case rate,
Thoracic duct procedure,38382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,484.82,11290.3,case rate,
Biopsy/removal lymph nodes,38500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Needle biopsy lymph nodes,38505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy/removal lymph nodes,38510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Biopsy/removal lymph nodes,38520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Biopsy/removal lymph nodes,38525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Biopsy/removal lymph nodes,38530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Open bx/exc inguinofem nodes,38531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Explore deep node(s) neck,38542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Removal neck/armpit lesion,38550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3861.87,,,,1681.08,13029.26,case rate,
Removal neck/armpit lesion,38555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Removal pelvic lymph nodes,38562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Removal abdomen lymph nodes,38564,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,503.98,11290.3,case rate,
Laparoscopy lymph node biop,38570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy lymphadenectomy,38571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparoscopy lymphadenectomy,38572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laps pelvic lymphadec,38573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Unlisted laps px lymphtc sys,38589,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Removal of lymph nodes neck,38700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Removal of lymph nodes neck,38720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,4306.01,33373.75,case rate,
Removal of lymph nodes neck,38724,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,199.39,8759.27,case rate,
Remove armpit lymph nodes,38740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Remove armpit lymph nodes,38745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Remove thoracic lymph nodes,38746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,145.61,9790.52,case rate,
Remove abdominal lymph nodes,38747,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,184.75,11290.3,case rate,
Remove groin lymph nodes,38760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6606.86,,,,2906.2,22524.54,case rate,
Remove groin lymph nodes,38765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,199.39,8759.27,case rate,
Remove pelvis lymph nodes,38770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,586.12,11290.3,case rate,
Remove abdomen lymph nodes,38780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,753.26,11290.3,case rate,
Ra tracer id of sentinl node,38792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,case rate,
Unlistd px hemic/lymphtc sys,38999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.82,,,,199.39,1545.37,fee schedule,
Exploration of chest,39000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.63,8759.27,case rate,
Exploration of chest,39010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,553.48,9790.52,case rate,
Resect mediastinal cyst,39200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,604.78,8759.27,case rate,
Resect mediastinal tumor,39220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,798.34,9790.52,case rate,
Mediastinoscpy w/medstnl bx,39401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Mediastinoscpy w/lmph nod bx,39402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted px mediastinum,39499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,162.65,8759.27,case rate,
Repair diaphragm laceration,39501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,602.19,34440.87,case rate,
Repair of diaphragm hernia,39503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3979.84,34440.87,case rate,
Repair of diaphragm hernia,39540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,609.71,34440.87,case rate,
Repair of diaphragm hernia,39541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,657.39,34440.87,case rate,
Revision of diaphragm,39545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,630.18,34440.87,case rate,
Resect diaphragm simple,39560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,572.13,34440.87,case rate,
Resect diaphragm complex,39561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,886.45,34440.87,case rate,
Unlisted px diaphragm,39599,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,4443.69,34440.87,case rate,
Biopsy of lip,40490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Partial excision of lip,40500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Partial excision of lip,40510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Partial excision of lip,40520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Reconstruct lip with flap,40525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Reconstruct lip with flap,40527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Partial removal of lip,40530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Rpr lip fth vermilion only,40650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Rpr lip fth<half ver height,40652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Rpr lip fth>1half ver ht/cpx,40654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Repair cleft lip/nasal,40700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair cleft lip/nasal,40701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair cleft lip/nasal,40702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair cleft lip/nasal,40720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair cleft lip/nasal,40761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Unlisted procedure lips,40799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of mouth lesion,40800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Drainage of mouth lesion,40801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Removal foreign body mouth,40804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,case rate,
Removal foreign body mouth,40805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Incision of lip fold,40806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Biopsy of mouth lesion,40808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Excision of mouth lesion,40810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excise/repair mouth lesion,40812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Excise/repair mouth lesion,40814,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of mouth lesion,40816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excise oral mucosa for graft,40818,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Excise lip or cheek fold,40819,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Treatment of mouth lesion,40820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair mouth laceration,40830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Repair mouth laceration,40831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Reconstruction of mouth,40840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of mouth,40842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of mouth,40843,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of mouth,40844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction of mouth,40845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Unlisted px vestibule mouth,40899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of mouth lesion,41000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Drainage of mouth lesion,41005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of mouth lesion,41006,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Drainage of mouth lesion,41007,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Drainage of mouth lesion,41008,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Drainage of mouth lesion,41009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Incision of tongue fold,41010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Drainage of mouth lesion,41015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Drainage of mouth lesion,41016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Drainage of mouth lesion,41017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Drainage of mouth lesion,41018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Place needles h&n for rt,41019,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Biopsy of tongue,41100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Biopsy of tongue,41105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Biopsy of floor of mouth,41108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Excision of tongue lesion,41110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of tongue lesion,41112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of tongue lesion,41113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of tongue lesion,41114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of tongue fold,41115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Excision of mouth lesion,41116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Partial removal of tongue,41120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Partial removal of tongue,41130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,678.8,8759.27,case rate,
Tongue and neck surgery,41135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of tongue,41140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Tongue removal neck surgery,41145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Tongue mouth jaw surgery,41150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Tongue mouth neck surgery,41153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Tongue jaw & neck surgery,41155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Repair tongue laceration,41250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,119.31,1430.99,case rate,
Repair tongue laceration,41251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Repair tongue laceration,41252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Tongue to lip surgery,41510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Tongue suspension,41512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruction tongue fold,41520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Tongue base vol reduction,41530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Unlisted px tongue flr mouth,41599,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of gum lesion,41800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Removal foreign body gum,41805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Removal foreign body jawbone,41806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Excision gum each quadrant,41820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of gum flap,41821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Excision of gum lesion,41822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Excision of gum lesion,41823,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excision of gum lesion,41825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of gum lesion,41826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of gum lesion,41827,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excision of gum lesion,41828,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Removal of gum tissue,41830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Treatment of gum lesion,41850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Gum graft,41870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Repair gum,41872,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair tooth socket,41874,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Unlisted px dentalvlr strux,41899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage mouth roof lesion,42000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Biopsy roof of mouth,42100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Excision lesion mouth roof,42104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision lesion mouth roof,42106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision lesion mouth roof,42107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove palate/lesion,42120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excision of uvula,42140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair palate pharynx/uvula,42145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Treatment mouth roof lesion,42160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair lac palate<2 cm,42180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Repair palate,42182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct cleft palate,42200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct cleft palate,42205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Reconstruct cleft palate,42210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct cleft palate,42215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct cleft palate,42220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Reconstruct cleft palate,42225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lengthening of palate,42226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Lengthening of palate,42227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair palate,42235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair nose to lip fistula,42260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Preparation palate mold,42280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Insertion palate prosthesis,42281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Unlisted px palate uvula,42299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of salivary gland,42300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Drainage of salivary gland,42305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Drainage of salivary gland,42310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Drainage of salivary gland,42320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Removal of salivary stone,42330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of salivary stone,42335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of salivary stone,42340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Biopsy of salivary gland,42400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Biopsy of salivary gland,42405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Excision of salivary cyst,42408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Drainage of salivary cyst,42409,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excise parotid gland/lesion,42410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise parotid gland/lesion,42415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise parotid gland/lesion,42420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise parotid gland/lesion,42425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise parotid gland/lesion,42426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,994.76,10782.66,case rate,
Excise submaxillary gland,42440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Excise sublingual gland,42450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair salivary duct,42500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair salivary duct,42505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Parotid duct diversion,42507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Parotid duct diversion,42509,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Parotid duct diversion,42510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Closure of salivary fistula,42600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Dilation of salivary duct,42650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Dilation of salivary duct,42660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Ligation of salivary duct,42665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Unlisted px salivry glnd/dux,42699,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of tonsil abscess,42700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Drainage of throat abscess,42720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Drainage of throat abscess,42725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Biopsy of throat,42800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Biopsy of upper nose/throat,42804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Biopsy of upper nose/throat,42806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excise pharynx lesion,42808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Remove pharynx foreign body,42809,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Excision of neck cyst,42810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of neck cyst,42815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove tonsils and adenoids,42820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove tonsils and adenoids,42821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of tonsils,42825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of tonsils,42826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of adenoids,42830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of adenoids,42831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of adenoids,42835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Removal of adenoids,42836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Extensive surgery of throat,42842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Extensive surgery of throat,42844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Extensive surgery of throat,42845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Excision of tonsil tags,42860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Excision of lingual tonsil,42870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Partial removal of pharynx,42890,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of pharyngeal walls,42892,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revision of pharyngeal walls,42894,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Repair throat wound,42900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Reconstruction of throat,42950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair throat esophagus,42953,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,678.8,8759.27,case rate,
Surgical opening of throat,42955,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Control throat bleeding,42960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Control throat bleeding,42961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,223.38,8759.27,case rate,
Control throat bleeding,42962,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Control nose/throat bleeding,42970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Control nose/throat bleeding,42971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,339.96,8759.27,case rate,
Control nose/throat bleeding,42972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Dise eval slp do brth flx dx,42975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1719.59,,,,87.41,1719.59,case rate,
Unlisted px phrnx adnd/tnsl,42999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Incision of esophagus,43020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Throat muscle surgery,43030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Incision of esophagus,43045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,912.36,9790.52,case rate,
Excision of esophagus lesion,43100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Excision of esophagus lesion,43101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of esophagus,43107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of esophagus,43108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Esphg tot w/thrcm,43112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of esophagus,43113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of esophagus,43116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of esophagus,43117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of esophagus,43118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of esophagus,43121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of esophagus,43122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of esophagus,43123,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of esophagus,43124,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of esophagus pouch,43130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of esophagus pouch,43135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Esophagoscopy rigid trnso,43180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Esophagoscopy rigid trnso dx,43191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscp rig trnso inject,43192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscp rig trnso biopsy,43193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscp rig trnso rem fb,43194,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy rigid balloon,43195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Esophagoscp guide wire dilat,43196,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,1594.48,12358.02,case rate,
Esophagoscopy flex dx brush,43197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Esophagosc flex trnsn biopsy,43198,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Esophagoscopy flexible brush,43200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Esoph scope w/submucous inj,43201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy flex biopsy,43202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esoph scope w/sclerosis inj,43204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagus endoscopy/ligation,43205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esoph optical endomicroscopy,43206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd esophagogastrc fndoplsty,43210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Esophagoscop mucosal resect,43211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscop stent placement,43212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Esophagoscopy retro balloon,43213,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagosc dilate balloon 30,43214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy flex remove fb,43215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy lesion removal,43216,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy snare les remv,43217,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy balloon <30mm,43220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esoph endoscopy dilation,43226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy control bleed,43227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy lesion ablate,43229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Esophagoscop ultrasound exam,43231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Esophagoscopy w/us needle bx,43232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd balloon dil esoph30 mm/>,43233,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd diagnostic brush wash,43235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Uppr gi scope w/submuc inj,43236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Endoscopic us exam esoph,43237,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd us fine needle bx/aspir,43238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd biopsy single/multiple,43239,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Egd w/transmural drain cyst,43240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Egd tube/cath insertion,43241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd us fine needle bx/aspir,43242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd injection varices,43243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd varices ligation,43244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd dilate stricture,43245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd place gastrostomy tube,43246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd remove foreign body,43247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Egd guide wire insertion,43248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Esoph egd dilation <30 mm,43249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd cautery tumor polyp,43250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd remove lesion snare,43251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd optical endomicroscopy,43252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,1594.48,12358.02,case rate,
Egd us transmural injxn/mark,43253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd endo mucosal resection,43254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd control bleeding any,43255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd w/thrml txmnt gerd,43257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Egd us exam duodenum/jejunum,43259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Ercp w/specimen collection,43260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Endo cholangiopancreatograph,43261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Endo cholangiopancreatograph,43262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Ercp sphincter pressure meas,43263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,1594.48,12358.02,case rate,
Ercp remove duct calculi,43264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Ercp lithotripsy calculi,43265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Egd endoscopic stent place,43266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Egd lesion ablation,43270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Ercp duct stent placement,43274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Ercp remove forgn body duct,43275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,1594.48,12358.02,case rate,
Ercp stent exchange w/dilate,43276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Ercp ea duct/ampulla dilate,43277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Ercp lesion ablate w/dilate,43278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Lap myotomy heller,43279,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,900.7,12329.02,case rate,
Laparoscopy fundoplasty,43280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Lap paraesophag hern repair,43281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Lap paraesoph her rpr w/mesh,43282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Lap esoph lengthening,43283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,108.31,34440.87,case rate,
Laps esophgl sphnctr agmntj,43284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Rmvl esophgl sphnctr dev,43285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Esphg tot w/laps moblj,43286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Esphg dstl 2/3 w/laps moblj,43287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Esphg thrsc moblj,43288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Unlisted laps px esoph,43289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Egd flx trnsorl dplmnt balo,43290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Egd flx trnsorl rmvl balo,43291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Repair of esophagus,43300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair esophagus and fistula,43305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair of esophagus,43310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1027.15,12329.02,case rate,
Repair esophagus and fistula,43312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1091.68,12329.02,case rate,
Esophagoplasty congenital,43313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1590.74,12329.02,case rate,
Tracheo-esophagoplasty cong,43314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1590.74,12329.02,case rate,
Fuse esophagus & stomach,43320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Revise esophagus & stomach,43325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,958.49,12329.02,case rate,
Esoph fundoplasty lap,43327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,581.19,12329.02,case rate,
Esoph fundoplasty thor,43328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,778.4,12329.02,case rate,
Esophagomyotomy abdominal,43330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,942.94,12329.02,case rate,
Esophagomyotomy thoracic,43331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,933.61,12329.02,case rate,
Transab esoph hiat hern rpr,43332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,806.38,34440.87,case rate,
Transab esoph hiat hern rpr,43333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,882.3,34440.87,case rate,
Transthor diaphrag hern rpr,43334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,861.05,34440.87,case rate,
Transthor diaphrag hern rpr,43335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,921.43,34440.87,case rate,
Thorabd diaphr hern repair,43336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1002.54,34440.87,case rate,
Thorabd diaphr hern repair,43337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1067.58,34440.87,case rate,
Esoph lengthening,43338,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,77.99,12329.02,case rate,
Fuse esophagus & intestine,43340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Fuse esophagus & intestine,43341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Surgical opening esophagus,43351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Surgical opening esophagus,43352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Gastrointestinal repair,43360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Gastrointestinal repair,43361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Ligate esophagus veins,43400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Ligate/staple esophagus,43405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair esophagus wound,43410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair esophagus wound,43415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair esophagus opening,43420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair esophagus opening,43425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Dilate esophagus 1/mult pass,43450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Dilate esophagus,43453,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Pressure treatment esophagus,43460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,154.69,8759.27,case rate,
Free jejunum flap microvasc,43496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Transorl lwr esophgl myotomy,43497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,1594.48,12358.02,case rate,
Unlisted procedure esophagus,43499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Surgical opening of stomach,43500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Surgical repair of stomach,43501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Surgical repair of stomach,43502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Surgical opening of stomach,43510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Incision of pyloric muscle,43520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Biopsy of stomach,43605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Excision of stomach lesion,43610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Excision of stomach lesion,43611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach,43620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach,43621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach,43622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach partial,43631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach partial,43632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach partial,43633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach partial,43634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of stomach partial,43635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,77.99,8759.27,case rate,
Vagotomy & pylorus repair,43640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Vagotomy & pylorus repair,43641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Lap gastric bypass/roux-en-y,43644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1222.27,12329.02,case rate,
Lap gastr bypass incl smll i,43645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1299.49,12329.02,case rate,
Lap impl electrode antrum,43647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Lap revise/remv eltrd antrum,43648,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Laparoscopy vagus nerve,43651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy vagus nerve,43652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy gastrostomy,43653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted laps px stomach,43659,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Nasal/orogastric w/tube plmt,43752,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Tx gastro intub w/asp,43753,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Dx gastr intub w/asp spec,43754,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Dx gastr intub w/asp specs,43755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Dx duod intub w/asp spec,43756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,case rate,
Dx duod intub w/asp specs,43757,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Reposition gastrostomy tube,43761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Rplc gtube no revj trc,43762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Rplc gtube revj gstrst trc,43763,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Lap place gastr adj device,43770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Lap revise gastr adj device,43771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,905.88,12329.02,case rate,
Lap rmvl gastr adj device,43772,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Lap replace gastr adj device,43773,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Lap rmvl gastr adj all parts,43774,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Lap sleeve gastrectomy,43775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Reconstruction of pylorus,43800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Fusion of stomach and bowel,43810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Fusion of stomach and bowel,43820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Fusion of stomach and bowel,43825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Place gastrostomy tube,43830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Place gastrostomy tube,43831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Place gastrostomy tube,43832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair of stomach lesion,43840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Gastroplasty w/o v-band,43843,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.44,12329.02,case rate,
Gastroplasty duodenal switch,43845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1379.55,12329.02,case rate,
Gastric bypass for obesity,43846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1165.79,12329.02,case rate,
Gastric bypass incl small i,43847,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1274.36,12329.02,case rate,
Revision gastroplasty,43848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1362.97,12329.02,case rate,
Revise stomach-bowel fusion,43860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Revise stomach-bowel fusion,43865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair stomach opening,43870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Repair stomach-bowel fistula,43880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Impl/redo electrd antrum,43881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Revise/remove electrd antrum,43882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Revise gastric port open,43886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Remove gastric port open,43887,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,case rate,
Change gastric port open,43888,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Unlisted procedure stomach,43999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Freeing of bowel adhesion,44005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,771.92,13423.91,case rate,
Incision of small bowel,44010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Insert needle cath bowel,44015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,97.94,13423.91,case rate,
Explore small intestine,44020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,689.77,13423.91,case rate,
Decompress small bowel,44021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Incision of large bowel,44025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Reduce bowel obstruction,44050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,663.61,13423.91,case rate,
Correct malrotation of bowel,44055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1046.08,13423.91,case rate,
Biopsy of bowel,44100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Excise intestine lesion(s),44110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Excision of bowel lesion(s),44111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of small intestine,44120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,862.35,13423.91,case rate,
Removal of small intestine,44121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,167.39,13423.91,case rate,
Removal of small intestine,44125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,833.85,13423.91,case rate,
Enterectomy w/o taper cong,44126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1730.93,13423.91,case rate,
Enterectomy w/taper cong,44127,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Enterectomy cong add-on,44128,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,167.65,13423.91,case rate,
Bowel to bowel fusion,44130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Enterectomy cadaver donor,44132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Enterectomy live donor,44133,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Intestine transplnt cadaver,44135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Intestine transplant live,44136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,7530.35,8759.27,case rate,
Remove intestinal allograft,44137,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,858.98,8759.27,case rate,
Mobilization of colon,44139,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,83.95,13423.91,case rate,
Partial removal of colon,44140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of colon,44141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1286.01,13423.91,case rate,
Partial removal of colon,44143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1170.71,13423.91,case rate,
Partial removal of colon,44144,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Partial removal of colon,44145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1171.74,13423.91,case rate,
Partial removal of colon,44146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1493.57,13423.91,case rate,
Partial removal of colon,44147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Removal of colon,44150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1322.04,13423.91,case rate,
Removal of colon/ileostomy,44151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1517.67,13423.91,case rate,
Removal of colon/ileostomy,44155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1477.77,13423.91,case rate,
Removal of colon/ileostomy,44156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1622.61,13423.91,case rate,
Colectomy w/ileoanal anast,44157,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1540.73,13423.91,case rate,
Colectomy w/neo-rectum pouch,44158,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1578.56,13423.91,case rate,
Removal of colon,44160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Lap enterolysis,44180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Lap jejunostomy,44186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Lap ileo/jejuno-stomy,44187,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Lap colostomy,44188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,871.42,13423.91,case rate,
Lap enterectomy,44202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,982.06,13423.91,case rate,
Lap resect s/intestine addl,44203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,167.65,13423.91,case rate,
Laparo partial colectomy,44204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1090.64,13423.91,case rate,
Lap colectomy part w/ileum,44205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Lap part colectomy w/stoma,44206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1235.75,13423.91,case rate,
L colectomy/coloproctostomy,44207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1288.86,13423.91,case rate,
L colectomy/coloproctostomy,44208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1406.51,13423.91,case rate,
Laparo total proctocolectomy,44210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1273.06,13423.91,case rate,
Lap colectomy w/proctectomy,44211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1543.58,13423.91,case rate,
Laparo total proctocolectomy,44212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1461.7,13423.91,case rate,
Lap mobil splenic fl add-on,44213,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,130.6,13423.91,case rate,
Lap close enterostomy,44227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1175.11,13423.91,case rate,
Unlisted laps px intestine,44238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Open bowel to skin,44300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Ileostomy/jejunostomy,44310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Revision of ileostomy,44312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Revision of ileostomy,44314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Devise bowel pouch,44316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Colostomy,44320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,854.84,13423.91,case rate,
Colostomy with biopsies,44322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Revision of colostomy,44340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3634.82,,,,1590.74,12329.02,fee schedule,
Revision of colostomy,44345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Revision of colostomy,44346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,844.47,13423.91,case rate,
Small bowel endoscopy,44360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy/biopsy,44361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44363,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44369,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy/stent,44370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Small bowel endoscopy,44372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44373,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44376,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy/biopsy,44377,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44378,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
S bowel endoscope w/stent,44379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Small bowel endoscopy br/wa,44380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Small bowel endoscopy br/wa,44381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Small bowel endoscopy,44382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Small bowel endoscopy,44384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,1594.48,12358.02,case rate,
Endoscopy of bowel pouch,44385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Endoscopy bowel pouch/biop,44386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Colonoscopy thru stoma spx,44388,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Colonoscopy with biopsy,44389,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy for foreign body,44390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Colonoscopy for bleeding,44391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy & polypectomy,44392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/snare,44394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy with ablation,44401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/stent plcmt,44402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Colonoscopy w/resection,44403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/injection,44404,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/dilation,44405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/ultrasound,44406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/ndl aspir/bx,44407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/decompression,44408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Intro gastrointestinal tube,44500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Suture small intestine,44602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Suture small intestine,44603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Suture large intestine,44604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,746,13423.91,case rate,
Repair of bowel lesion,44605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Intestinal stricturoplasty,44615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,760,13423.91,case rate,
Repair bowel opening,44620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair bowel opening,44625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair bowel opening,44626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1125.1,13423.91,case rate,
Repair bowel-skin fistula,44640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,987.24,13423.91,case rate,
Repair bowel fistula,44650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair bowel-bladder fistula,44660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair bowel-bladder fistula,44661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Surgical revision intestine,44680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Suspend bowel w/prosthesis,44700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Prepare donor intestine,44715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,264.82,8759.27,case rate,
Prep donor intestine/venous,44720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,188.89,8759.27,case rate,
Prep donor intestine/artery,44721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,264.3,8759.27,case rate,
Unlisted px small intestine,44799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Excision of bowel pouch,44800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Excision of mesentery lesion,44820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Repair of mesentery,44850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Unlisted px meckels dvrtclm,44899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Drain appendix abscess open,44900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,403.67,8759.27,case rate,
Appendectomy,44950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7665.09,,,,1732,13423.91,case rate,
Appendectomy,44960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,621.63,13423.91,case rate,
Laparoscopy appendectomy,44970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted laps px appendix,44979,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Drainage of pelvic abscess,45000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Drainage of rectal abscess,45005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Drainage of rectal abscess,45020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Biopsy of rectum,45100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Removal of anorectal lesion,45108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Removal of rectum,45110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Partial removal of rectum,45111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Removal of rectum,45112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Partial proctectomy,45113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Partial removal of rectum,45114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Partial removal of rectum,45116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Remove rectum w/reservoir,45119,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Removal of rectum,45120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Removal of rectum and colon,45121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Partial proctectomy,45123,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Pelvic exenteration,45126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Excision of rectal prolapse,45130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Excision of rectal prolapse,45135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Excise ileoanal reservior,45136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Excision of rectal stricture,45150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Excision of rectal lesion,45160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Exc rect tum transanal part,45171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Exc rect tum transanal full,45172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Destruction rectal tumor,45190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Proctosigmoidoscopy dx,45300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Proctosigmoidoscopy dilate,45303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Proctosigmoidoscopy w/bx,45305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Proctosigmoidoscopy fb,45307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Proctosigmoidoscopy removal,45308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Proctosigmoidoscopy removal,45309,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Proctosigmoidoscopy removal,45315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Proctosigmoidoscopy bleed,45317,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Proctosigmoidoscopy ablate,45320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Proctosigmoidoscopy volvul,45321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Proctosigmoidoscopy w/stent,45327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Diagnostic sigmoidoscopy,45330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Sigmoidoscopy and biopsy,45331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Sigmoidoscopy w/fb removal,45332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Sigmoidoscopy & polypectomy,45333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Sigmoidoscopy for bleeding,45334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Sigmoidoscopy w/submuc inj,45335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Sigmoidoscopy & decompress,45337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Sigmoidoscopy w/tumr remove,45338,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Sig w/tndsc balloon dilation,45340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Sigmoidoscopy w/ultrasound,45341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Sigmoidoscopy w/us guide bx,45342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Sigmoidoscopy w/ablation,45346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Sigmoidoscopy w/plcmt stent,45347,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Sigmoidoscopy w/resection,45349,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1097.84,9738.29,case rate,
Sgmdsc w/band ligation,45350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Diagnostic colonoscopy,45378,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Colonoscopy w/fb removal,45379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy and biopsy,45380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy submucous njx,45381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/control bleed,45382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/lesion removal,45384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/lesion removal,45385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/balloon dilat,45386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/ablation,45388,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/stent plcmt,45389,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5774.21,,,,2562.71,19862.33,case rate,
Colonoscopy w/resection,45390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1097.84,9738.29,case rate,
Colonoscopy w/endoscope us,45391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/endoscopic fnb,45392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Colonoscopy w/decompression,45393,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Lap removal of rectum,45395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Lap remove rectum w/pouch,45397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Colonoscopy w/band ligation,45398,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Unlisted procedure colon,45399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Laparoscopic proc,45400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Lap proctopexy w/sig resect,45402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Laparoscope proc rectum,45499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Repair of rectum,45500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair of rectum,45505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Treatment of rectal prolapse,45520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,case rate,
Correct rectal prolapse,45540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Correct rectal prolapse,45541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair rectum/remove sigmoid,45550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair of rectocele,45560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Exploration/repair of rectum,45562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Exploration/repair of rectum,45563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair rect/bladder fistula,45800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair fistula w/colostomy,45805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair rectourethral fistula,45820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair fistula w/colostomy,45825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Reduction of rectal prolapse,45900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Dilation of anal sphincter,45905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Dilation of rectal narrowing,45910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Remove rectal obstruction,45915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Surg dx exam anorectal,45990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Unlisted procedure rectum,45999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Placement of seton,46020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Removal of rectal marker,46030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Incision of rectal abscess,46040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Incision of rectal abscess,46045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Incision of anal abscess,46050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Incision of rectal abscess,46060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Incision of anal septum,46070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Incision of anal sphincter,46080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Incise external hemorrhoid,46083,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Removal of anal fissure,46200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Excise anal ext tag/papilla,46220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Ligation of hemorrhoid(s),46221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Removal of anal tags,46230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove ext hem groups 2+,46250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove int/ext hem 1 group,46255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove in/ex hem grp & fiss,46257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove in/ex hem grp w/fistu,46258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove in/ex hem groups 2+,46260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove in/ex hem grps & fiss,46261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove in/ex hem grps w/fist,46262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove anal fist subq,46270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove anal fist inter,46275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove anal fist complex,46280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Remove anal fist 2 stage,46285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair anal fistula,46288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Removal of hemorrhoid clot,46320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Injection into hemorrhoid(s),46500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Chemodenervation anal musc,46505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Diagnostic anoscopy spx,46600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Diagnostic anoscopy,46601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Anoscopy and dilation,46604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Anoscopy and biopsy,46606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Diagnostic anoscopy & biopsy,46607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Anoscopy remove for body,46608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Anoscopy remove lesion,46610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Anoscopy,46611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Anoscopy remove lesions,46612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Anoscopy control bleeding,46614,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Anoscopy,46615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair of anal stricture,46700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair of anal stricture,46705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,417.17,8759.27,case rate,
Repr of anal fistula w/glue,46706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair anorectal fist w/plug,46707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repr per/vag pouch sngl proc,46710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repr per/vag pouch dbl proc,46712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Rep perf anoper fistu,46715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,402.93,8759.27,case rate,
Rep perf anoper/vestib fistu,46716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Construction of absent anus,46730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Construction of absent anus,46735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Construction of absent anus,46740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair of imperforated anus,46742,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair of cloacal anomaly,46744,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair of cloacal anomaly,46746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair of cloacal anomaly,46748,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Repair of anal sphincter,46750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair of anal sphincter,46751,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,484.82,8759.27,case rate,
Reconstruction of anus,46753,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Removal of suture from anus,46754,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair of anal sphincter,46760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Repair of anal sphincter,46761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Destruction anal lesion(s),46900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Destruction anal lesion(s),46910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Cryosurgery anal lesion(s),46916,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Laser surgery anal lesions,46917,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Excision of anal lesion(s),46922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Destruction anal lesion(s),46924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Destroy internal hemorrhoids,46930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Treatment of anal fissure,46940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Treatment of anal fissure,46942,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Int hrhc lig 1 hroid w/o img,46945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Int hrhc lig 2+hroid w/o img,46946,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Hemorrhoidopexy by stapling,46947,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Int hrhc tranal dartlzj 2+,46948,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,1256.47,9738.29,case rate,
Unlisted procedure anus,46999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Needle biopsy of liver,47000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Open drainage liver lesion,47010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,863.13,13423.91,case rate,
Inject/aspirate liver cyst,47015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,827.89,13423.91,case rate,
Wedge biopsy of liver,47100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,608.67,13423.91,case rate,
Partial removal of liver,47120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1649.31,13423.91,case rate,
Extensive removal of liver,47122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Partial removal of liver,47125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Partial removal of liver,47130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Removal of donor liver,47133,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,4095.48,8759.27,case rate,
Transplantation of liver,47135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3792.5,11047.9,case rate,
Partial removal donor liver,47140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2510.88,8759.27,case rate,
Partial removal donor liver,47141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2997.77,8759.27,case rate,
Partial removal donor liver,47142,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,3292.91,9605.28,case rate,
Prep donor liver whole,47143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,265.6,8759.27,case rate,
Prep donor liver 3-segment,47144,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,338.92,8759.27,case rate,
Prep donor liver lobe split,47145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,348.25,8759.27,case rate,
Prep donor liver/venous,47146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,226.47,8759.27,case rate,
Prep donor liver/arterial,47147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,264.05,8759.27,case rate,
Surgery for liver lesion,47300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,809.23,13423.91,case rate,
Repair liver wound,47350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Repair liver wound,47360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Repair liver wound,47361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Repair liver wound,47362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Laparo ablate liver tumor rf,47370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparo ablate liver cryosurg,47371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Unlisted laps px liver,47379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Open ablate liver tumor rf,47380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1021.96,13423.91,case rate,
Open ablate liver tumor cryo,47381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Percut ablate liver rf,47382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Perq abltj lvr cryoablation,47383,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Unlisted procedure liver,47399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Incision of liver duct,47400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Incision of bile duct,47420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,944.23,13423.91,case rate,
Incision of bile duct,47425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,967.3,19754.05,case rate,
Incise bile duct sphincter,47460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Incision of gallbladder,47480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,630.44,13423.91,case rate,
Incision of gallbladder,47490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Injection for cholangiogram,47531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Injection for cholangiogram,47532,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Plmt biliary drainage cath,47533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Plmt biliary drainage cath,47534,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Conversion ext bil drg cath,47535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Exchange biliary drg cath,47536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Removal biliary drg cath,47537,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,case rate,
Perq plmt bile duct stent,47538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Perq plmt bile duct stent,47539,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Perq plmt bile duct stent,47540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Plmt access bil tree sm bwl,47541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7665.09,,,,1732,13423.91,case rate,
Biliary endo perq dx w/speci,47552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7665.09,,,,1732,13423.91,case rate,
Biliary endoscopy thru skin,47553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7665.09,,,,1732,13423.91,case rate,
Biliary endoscopy thru skin,47554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Biliary endoscopy thru skin,47555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Biliary endoscopy thru skin,47556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Laparoscopic cholecystectomy,47562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparo cholecystectomy/graph,47563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparo cholecystectomy/explr,47564,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Laparo cholecystoenterostomy,47570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,550.88,19754.05,case rate,
Unlisted laps px biliary trc,47579,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Removal of gallbladder,47600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,760,13423.91,case rate,
Removal of gallbladder,47605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,799.9,13423.91,case rate,
Removal of gallbladder,47610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,885.68,13423.91,case rate,
Removal of gallbladder,47612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,898.37,19754.05,case rate,
Removal of gallbladder,47620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,969.1,19754.05,case rate,
Exploration of bile ducts,47700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Bile duct revision,47701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Excision of bile duct tumor,47711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Excision of bile duct tumor,47712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Excision of bile duct cyst,47715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Fuse gallbladder & bowel,47720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,821.93,19754.05,case rate,
Fuse upper gi structures,47721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,959.79,19754.05,case rate,
Fuse gallbladder & bowel,47740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,931.02,19754.05,case rate,
Fuse gallbladder & bowel,47741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1043.74,19754.05,case rate,
Fuse bile ducts and bowel,47760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1586.6,13423.91,case rate,
Fuse liver ducts & bowel,47765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Fuse bile ducts and bowel,47780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Fuse bile ducts and bowel,47785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Reconstruction of bile ducts,47800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Placement bile duct support,47801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,793.94,13423.91,case rate,
Fuse liver duct & intestine,47802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Suture bile duct injury,47900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Unlisted px biliary tract,47999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Drainage of abdomen,48000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1322.3,13423.91,case rate,
Placement of drain pancreas,48001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1615.11,13423.91,case rate,
Removal of pancreatic stone,48020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Biopsy of pancreas open,48100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,631.48,13423.91,case rate,
Needle biopsy pancreas,48102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Resect/debride pancreas,48105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Removal of pancreas lesion,48120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,787.73,13423.91,case rate,
Partial removal of pancreas,48140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1106.45,13423.91,case rate,
Partial removal of pancreas,48145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1149.99,13423.91,case rate,
Pancreatectomy,48146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1332.91,13423.91,case rate,
Removal of pancreatic duct,48148,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Partial removal of pancreas,48150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Pancreatectomy,48152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Pancreatectomy,48153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Pancreatectomy,48154,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Removal of pancreas,48155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1294.56,13423.91,case rate,
Injection intraop add-on,48400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,73.85,8759.27,case rate,
Surgery of pancreatic cyst,48500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Drain pancreatic pseudocyst,48510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,781.5,13423.91,case rate,
Fuse pancreas cyst and bowel,48520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Fuse pancreas cyst and bowel,48540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Pancreatorrhaphy,48545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Duodenal exclusion,48547,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Fuse pancreas and bowel,48548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Prep donor pancreas,48551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,182.67,8759.27,case rate,
Prep donor pancreas/venous,48552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,162.46,8759.27,case rate,
Transpl allograft pancreas,48554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1875,8759.27,case rate,
Removal allograft pancreas,48556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,317.35,8759.27,case rate,
Unlisted procedure pancreas,48999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Exploration of abdomen,49000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,548.03,11290.3,case rate,
Reopening of abdomen,49002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,737.72,11290.3,case rate,
Exploration behind abdomen,49010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Prpertl pel pack hemrrg trma,49013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,315.08,11290.3,case rate,
Reexploration pelvic wound,49014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,263.78,11290.3,case rate,
Drainage abdom abscess open,49020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1130.8,11290.3,case rate,
Drain open abdom abscess,49040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,715.43,34440.87,case rate,
Drain open retroperi abscess,49060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,779.43,11290.3,case rate,
Drain to peritoneal cavity,49062,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,546.73,11290.3,case rate,
Abd paracentesis,49082,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Abd paracentesis w/imaging,49083,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Peritoneal lavage,49084,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Biopsy abdominal mass,49180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Sclerotx fluid collection,49185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,649.14,5683.29,case rate,
Exc abd tum 5 cm or less,49203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,852.75,11290.3,case rate,
Exc abd tum over 5 cm,49204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1084.94,11290.3,case rate,
Exc abd tum over 10 cm,49205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1243.79,11290.3,case rate,
Excise sacral spine tumor,49215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Excision of umbilicus,49250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Removal of omentum,49255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Diag laparo separate proc,49320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy biopsy,49321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy aspiration,49322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparo drain lymphocele,49323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Lap insert tunnel ip cath,49324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Lap revision perm ip cath,49325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlstd laps px abd pertm&omn,49329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Remove foreign body adbomen,49402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Image cath fluid colxn visc,49405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Image cath fluid peri/retro,49406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Image cath fluid trns/vgnl,49407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Ins mark abd/pel for rt perq,49411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1403.85,,,,655.59,5081.14,fee schedule,
Ins device for rt guide open,49412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,56.75,17567.07,case rate,
Insert tun ip cath perc,49418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Insert tun ip cath w/port,49419,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Ins tun ip cath for dial opn,49421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Remove tunneled ip cath,49422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Exchange drainage catheter,49423,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Insert abdomen-venous drain,49425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,556.58,11290.3,case rate,
Revise abdomen-venous shunt,49426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Ligation of shunt,49428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,306.27,11290.3,case rate,
Removal of shunt,49429,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Embedded ip cath exit-site,49436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Place gastrostomy tube perc,49440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Place duod/jej tube perc,49441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Place cecostomy tube perc,49442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1195.59,,,,529.54,4104.23,fee schedule,
Change g-tube to g-j perc,49446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1927.85,,,,851.64,6600.63,case rate,
Replace g/c tube perc,49450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Replace duod/jej tube perc,49451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Replace g-j tube perc,49452,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Fix g/colon tube w/device,49460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Fluoro exam of g/colon tube,49465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Rpr hern preemie reduc,49491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Rpr ing hern premie blocked,49492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr ing hernia baby reduc,49495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr ing hernia baby blocked,49496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr ing hernia init reduce,49500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7665.09,,,,1732,13423.91,case rate,
Rpr ing hernia init blocked,49501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Prp i/hern init reduc >5 yr,49505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Prp i/hern init block >5 yr,49507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rerepair ing hernia reduce,49520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rerepair ing hernia blocked,49521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7665.09,,,,1732,13423.91,case rate,
Repair ing hernia sliding,49525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Repair lumbar hernia,49540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Rpr rem hernia init reduce,49550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr fem hernia init blocked,49553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rerepair fem hernia reduce,49555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rerepair fem hernia blocked,49557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr aa hrn 1st < 3 cm rdc,49591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr aa hrn 1st < 3 ncr/strn,49592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Rpr aa hrn 1st 3-10 rdc,49593,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr aa hrn 1st 3-10 ncr/strn,49594,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Rpr aa hrn 1st > 10 rdc,49595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr aa hrn 1st > 10 ncr/strn,49596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,716.73,13423.91,case rate,
Repair umbilical lesion,49600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Repair umbilical lesion,49605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Repair umbilical lesion,49606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,801.45,13423.91,case rate,
Repair umbilical lesion,49610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,495.43,13423.91,case rate,
Repair umbilical lesion,49611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,438.17,13423.91,case rate,
Rpr aa hrn rcr < 3 rdc,49613,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr aa hrn rcr < 3 ncr/strn,49614,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Rpr aa hrn rcr 3-10 rdc,49615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Rpr aa hrn rcr 3-10 ncr/strn,49616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,600.64,13423.91,case rate,
Rpr aa hrn rcr > 10 rdc,49617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,620.59,13423.91,case rate,
Rpr aa hrn rcr > 10 ncr/strn,49618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,867.79,13423.91,case rate,
Rpr parastomal hernia rdc,49621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,524.21,13423.91,case rate,
Rpr parastomal hrna ncr/strn,49622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,647.02,13423.91,case rate,
Lap ing hernia repair init,49650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Lap ing hernia repair recur,49651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlstd laps px hrnap hrnrphy,49659,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Repair of abdominal wall,49900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,591.04,11290.3,case rate,
Omental flap extra-abdom,49904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,997.35,11290.3,case rate,
Omental flap intra-abdom,49905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,245.9,11290.3,case rate,
Free omental flap microvasc,49906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Unlisted px abd pertm&omn,49999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Exploration of kidney,50010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,538.44,8759.27,case rate,
Renal abscess open drain,50020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Nfros nfrot w/drg,50040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,675.52,8759.27,case rate,
Nephrotomy w/exploration,50045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,680.44,8759.27,case rate,
Nl removal calculus,50060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,829.19,8759.27,case rate,
Nl sec surg operj calculus,50065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.42,8759.27,case rate,
Nl comp cgen kdn abnormality,50070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,861.83,8759.27,case rate,
Nl rmvl lg staghorn calculus,50075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Perq nl/pl lithotrp smpl<2cm,50080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Perq nl/pl lithotrp cplx>2cm,50081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Trnsxj/repos abrrnt rnl vsls,50100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,766.99,8759.27,case rate,
Pyelotomy w/exploration,50120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,692.63,8759.27,case rate,
Pyelotomy w/drg pyelostomy,50125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,716.47,8759.27,case rate,
Pyelotomy w/removal calculus,50130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,752.74,12147.4,case rate,
Pyelotomy complicated,50135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,816.49,8759.27,case rate,
Renal biopsy perq,50200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Renal bx surg exposure kdn,50205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,537.41,8759.27,case rate,
Remove kidney open,50220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,761.04,8759.27,case rate,
Removal kidney open complex,50225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,870.12,8759.27,case rate,
Removal kidney open radical,50230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Removal of kidney & ureter,50234,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Removal of kidney & ureter,50236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1064.98,8759.27,case rate,
Partial removal of kidney,50240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Cryoablate renal mass open,50250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,886.19,8759.27,case rate,
Removal of kidney lesion,50280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,698.07,8759.27,case rate,
Removal of kidney lesion,50290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,656.61,8759.27,case rate,
Remove cadaver donor kidney,50300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,860.05,8759.27,case rate,
Remove kidney living donor,50320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1088.83,8759.27,case rate,
Prep cadaver renal allograft,50323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,146.74,8759.27,case rate,
Prep donor renal graft,50325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,140.16,8759.27,case rate,
Prep renal graft/venous,50327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,150.02,8759.27,case rate,
Prep renal graft/arterial,50328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,131.37,8759.27,case rate,
Prep renal graft/ureteral,50329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,125.15,8759.27,case rate,
Removal of kidney,50340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,687.97,8759.27,case rate,
Transplantation of kidney,50360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Transplantation of kidney,50365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2061.83,8759.27,case rate,
Remove transplanted kidney,50370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,869.6,8759.27,case rate,
Reimplantation of kidney,50380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1458.85,8759.27,case rate,
Change ureter stent percut,50382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Remove ureter stent percut,50384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Change stent via transureth,50385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Remove stent via transureth,50386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Change nephroureteral cath,50387,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Remove renal tube w/fluoro,50389,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Drainage of kidney lesion,50390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Instll rx agnt into rnal tub,50391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Measure kidney pressure,50396,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Revision of kidney/ureter,50400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,840.84,8759.27,case rate,
Revision of kidney/ureter,50405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Njx px nfrosgrm &/urtrgrm,50430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Njx px nfrosgrm &/urtrgrm,50431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Plmt nephrostomy catheter,50432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Plmt nephroureteral catheter,50433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Convert nephrostomy catheter,50434,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Exchange nephrostomy cath,50435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Dilat xst trc ndurlgc px,50436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Dilat xst trc new access rcs,50437,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair of kidney wound,50500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,890.08,8759.27,case rate,
Close kidney-skin fistula,50520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,821.42,8759.27,case rate,
Close nephrovisceral fistula,50525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1038.04,8759.27,case rate,
Close nephrovisceral fistula,50526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1110.85,8759.27,case rate,
Revision of horseshoe kidney,50540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,834.63,8759.27,case rate,
Laparo ablate renal cyst,50541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Laparo ablate renal mass,50542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparo partial nephrectomy,50543,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparoscopy pyeloplasty,50544,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparo radical nephrectomy,50545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Laparoscopic nephrectomy,50546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,873.24,8759.27,case rate,
Laparo removal donor kidney,50547,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Laparo remove w/ureter,50548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,907.04,8759.27,case rate,
Unlisted laps px renal,50549,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Kidney endoscopy,50551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Kidney endoscopy,50553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Kidney endoscopy & biopsy,50555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Kidney endoscopy & treatment,50557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Kidney endoscopy & treatment,50561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Renal scope w/tumor resect,50562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Kidney endoscopy,50570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Kidney endoscopy,50572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Kidney endoscopy & biopsy,50574,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Kidney endoscopy,50575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Kidney endoscopy & treatment,50576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Kidney endoscopy & treatment,50580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Fragmenting of kidney stone,50590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Perc rf ablate renal tumor,50592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Perc cryo ablate renal tum,50593,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Exploration of ureter,50600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,683.3,12147.4,case rate,
Insert ureteral support,50605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,715.68,12147.4,case rate,
Removal of ureter stone,50610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,688.23,12147.4,case rate,
Removal of ureter stone,50620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,658.68,12147.4,case rate,
Removal of ureter stone,50630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,650.91,12147.4,case rate,
Removal of ureter,50650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,754.82,12147.4,case rate,
Removal of ureter,50660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,831.77,8759.27,case rate,
Measure ureter pressure,50686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Change of ureter tube/stent,50688,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Plmt ureteral stent prq,50693,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Plmt ureteral stent prq,50694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Plmt ureteral stent prq,50695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revision of ureter,50700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,675.78,8759.27,case rate,
Release of ureter,50715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,871.94,12147.4,case rate,
Release of ureter,50722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,742.64,8759.27,case rate,
Release/revise ureter,50725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,802.49,8759.27,case rate,
Revise ureter,50727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revise ureter,50728,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,513.57,12147.4,case rate,
Fusion of ureter & kidney,50740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,866.23,8759.27,case rate,
Fusion of ureter & kidney,50750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,839.04,8759.27,case rate,
Fusion of ureters,50760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,816.75,8759.27,case rate,
Splicing of ureters,50770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,839.04,8759.27,case rate,
Reimplant ureter in bladder,50780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,804.05,12147.4,case rate,
Reimplant ureter in bladder,50782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,782.8,8759.27,case rate,
Reimplant ureter in bladder,50783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,820.38,8759.27,case rate,
Reimplant ureter in bladder,50785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,881.79,12147.4,case rate,
Implant ureter in bowel,50800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,676.04,8759.27,case rate,
Fusion of ureter & bowel,50810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,996.84,8759.27,case rate,
Urine shunt to intestine,50815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,892.4,8759.27,case rate,
Construct bowel bladder,50820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,954.08,12147.4,case rate,
Construct bowel bladder,50825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1195.59,8759.27,case rate,
Revise urine flow,50830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1306.74,8759.27,case rate,
Replace ureter by bowel,50840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,897.33,8759.27,case rate,
Appendico-vesicostomy,50845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,915.73,12147.4,case rate,
Transplant ureter to skin,50860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,689.77,8759.27,case rate,
Repair of ureter,50900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,616.71,8759.27,case rate,
Closure ureter/skin fistula,50920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,644.69,8759.27,case rate,
Closure ureter/bowel fistula,50930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,802.23,8759.27,case rate,
Release of ureter,50940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,649.09,8759.27,case rate,
Laparoscopy ureterolithotomy,50945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparo new ureter/bladder,50947,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Laparo new ureter/bladder,50948,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Unlisted laps px ureter,50949,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Endoscopy of ureter,50951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Endoscopy of ureter,50953,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Ureter endoscopy & biopsy,50955,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Ureter endoscopy & treatment,50957,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Ureter endoscopy & treatment,50961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Ureter endoscopy,50970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Ureter endoscopy & catheter,50972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Ureter endoscopy & biopsy,50974,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Ureter endoscopy & treatment,50976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Ureter endoscopy & treatment,50980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Incise & treat bladder,51020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Incise & treat bladder,51030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Incise & drain bladder,51040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Incise bladder/drain ureter,51045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Removal of bladder stone,51050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Removal of ureter stone,51060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Remove ureter calculus,51065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Drainage of bladder abscess,51080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Drain bladder by needle,51100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Drain bladder by trocar/cath,51101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Drain bl w/cath insertion,51102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Removal of bladder cyst,51500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Removal of bladder lesion,51520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of bladder lesion,51525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,627.59,12147.4,case rate,
Removal of bladder lesion,51530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,563.84,12147.4,case rate,
Repair of ureter lesion,51535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Partial removal of bladder,51550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,699.37,12147.4,case rate,
Partial removal of bladder,51555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,915.21,12147.4,case rate,
Revise bladder & ureter(s),51565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,938.01,8759.27,case rate,
Removal of bladder,51570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1068.35,12147.4,case rate,
Removal of bladder & nodes,51575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1319.17,12147.4,case rate,
Remove bladder/revise tract,51580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1375.67,8759.27,case rate,
Removal of bladder & nodes,51585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1529.6,8759.27,case rate,
Remove bladder/revise tract,51590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1397.7,12147.4,case rate,
Remove bladder/revise tract,51595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1567.3,12147.4,case rate,
Remove bladder/create pouch,51596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1706.57,8759.27,case rate,
Removal of pelvic structures,51597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1662.78,8759.27,case rate,
Irrigation of bladder,51700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Insert bladder catheter,51701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Insert temp bladder cath,51702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Insert bladder cath complex,51703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Change of bladder tube,51705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Change of bladder tube,51710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Endoscopic injection/implant,51715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Treatment of bladder lesion,51720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,259.3,2370.04,case rate,
Simple cystometrogram,51725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Complex cystometrogram,51726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Cystometrogram w/up,51727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Cystometrogram w/vp,51728,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Cystometrogram w/vp&up,51729,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Urine flow measurement,51736,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Electro-uroflowmetry first,51741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,71.12,551.18,case rate,
Anal/urinary muscle study,51784,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Anal/urinary muscle study,51785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Urinary reflex study,51792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Us urine capacity measure,51798,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Revision of bladder/urethra,51800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,756.89,12147.4,case rate,
Revision of urinary tract,51820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,792.13,8759.27,case rate,
Attach bladder/urethra,51840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1567.3,12147.4,case rate,
Attach bladder/urethra,51841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,593.64,12147.4,case rate,
Repair bladder neck,51845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair of bladder wound,51860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Repair of bladder wound,51865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,653.24,12147.4,case rate,
Repair of bladder opening,51880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair bladder/vagina lesion,51900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,603.23,10716,case rate,
Close bladder-uterus fistula,51920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,559.69,8759.27,case rate,
Hysterectomy/bladder repair,51925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,793.42,8759.27,case rate,
Correction of bladder defect,51940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1190.91,8759.27,case rate,
Revision of bladder & bowel,51960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1007.46,12147.4,case rate,
Construct bladder opening,51980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,523.17,12147.4,case rate,
Laparo urethral suspension,51990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparo sling operation,51992,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted laps px bladder,51999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Cystoscopy,52000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Cystoscopy removal of clots,52001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy & ureter catheter,52005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and biopsy,52007,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy & duct catheter,52010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Cystoscopy w/biopsy(s),52204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and treatment,52214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52234,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystoscopy and radiotracer,52250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and treatment,52265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy & revise urethra,52270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy & revise urethra,52275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and treatment,52276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and treatment,52277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy implant stent,52282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cysto rx balo cath urtl strx,52284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,4988.65,5242.42,case rate,
Cystoscopy and treatment,52285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Cystoscopy chemodenervation,52287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and treatment,52290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and treatment,52300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystoscopy and treatment,52310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Cystoscopy and treatment,52315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Remove bladder stone,52317,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Remove bladder stone,52318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy stone removal,52325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystoscopy inject material,52327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystoscopy and treatment,52330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystoscopy and treatment,52332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Create passage to kidney,52334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cysto w/ureter stricture tx,52341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cysto w/up stricture tx,52342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cysto w/renal stricture tx,52343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cysto/uretero stricture tx,52344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cysto/uretero w/up stricture,52345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystouretero w/renal strict,52346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystouretero & or pyeloscope,52351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystouretero w/stone remove,52352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystouretero w/lithotripsy,52353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystouretero w/biopsy,52354,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystouretero w/excise tumor,52355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cysto/uretero w/lithotripsy,52356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cystouretero w/congen repr,52400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Cystourethro cut ejacul duct,52402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Incision of prostate,52450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revision of bladder neck,52500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Prostatectomy (turp),52601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Remove prostate regrowth,52630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Relieve bladder contracture,52640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Laser surgery of prostate,52647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Laser surgery of prostate,52648,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Prostate laser enucleation,52649,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Drainage of prostate abscess,52700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Incision of urethra,53000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Incision of urethra,53010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Incision of urethra,53020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Incision of urethra,53025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Drainage of urethra abscess,53040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Drainage of urethra abscess,53060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Drainage of urinary leakage,53080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Drainage of urinary leakage,53085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Biopsy of urethra,53200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Removal of urethra,53210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of urethra,53215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Treatment of urethra lesion,53220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of urethra lesion,53230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Removal of urethra lesion,53235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Surgery for urethra pouch,53240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of urethra gland,53250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Treatment of urethra lesion,53260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Treatment of urethra lesion,53265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Removal of urethra gland,53270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair of urethra defect,53275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revise urethra stage 1,53400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Revise urethra stage 2,53405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Reconstruction of urethra,53410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Reconstruction of urethra,53415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,822.7,17821.26,case rate,
Reconstruct urethra stage 1,53420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Reconstruct urethra stage 2,53425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Reconstruction of urethra,53430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Reconstruct urethra/bladder,53431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Male sling procedure,53440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13005.69,,,,5881.73,45586.39,case rate,
Remove/revise male sling,53442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Insert tandem cuff,53444,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Insert uro/ves nck sphincter,53445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Remove uro sphincter,53446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Remove/replace ur sphincter,53447,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Remov/replc ur sphinctr comp,53448,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,929.2,17821.26,case rate,
Repair uro sphincter,53449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Revision of urethra,53450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Tprnl balo cntnc dev bi,53451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13005.69,,,,5881.73,45586.39,case rate,
Tprnl balo cntnc dev uni,53452,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Tprnl balo cntnc dev rmvl ea,53453,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Tprnl balo cntnc dev adjmt,53454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Revision of urethra,53460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Urethrlys transvag w/ scope,53500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair of urethra injury,53502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair of urethra injury,53505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Repair of urethra injury,53510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Repair of urethra injury,53515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Repair of urethra defect,53520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Dilate urethra stricture,53600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Dilate urethra stricture,53601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Dilate urethra stricture,53605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Dilate urethra stricture,53620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Dilate urethra stricture,53621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Dilation of urethra,53660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Dilation of urethra,53661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Dilation of urethra,53665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Prostatic microwave thermotx,53850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Prostatic rf thermotx,53852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Trurl dstrj prst8 tiss rf wv,53854,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Insert prost urethral stent,53855,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Transurethral rf treatment,53860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Unlisted px urinary system,53899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Slitting of prepuce,54000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Slitting of prepuce,54001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Drain penis lesion,54015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Destruction penis lesion(s),54050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Destruction penis lesion(s),54055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Cryosurgery penis lesion(s),54056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Laser surg penis lesion(s),54057,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Excision of penis lesion(s),54060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Destruction penis lesion(s),54065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Biopsy of penis,54100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Biopsy of penis,54105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Treatment of penis lesion,54110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Treat penis lesion graft,54111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Treat penis lesion graft,54112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Treatment of penis lesion,54115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Partial removal of penis,54120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of penis,54125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,602.97,12147.4,case rate,
Remove penis & nodes,54130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,869.35,12147.4,case rate,
Remove penis & nodes,54135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1097.11,8759.27,case rate,
Circumcision w/regionl block,54150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Circumcision neonate,54160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.09,,,,305.79,2370.04,case rate,
Circum 28 days or older,54161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Lysis penil circumic lesion,54162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Repair of circumcision,54163,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Frenulotomy of penis,54164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Treatment of penis lesion,54200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Treatment of penis lesion,54205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Treatment of penis lesion,54220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Dynamic cavernosometry,54231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Penile injection,54235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Penis study,54240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Penis study,54250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Revision of penis,54300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revision of penis,54304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Reconstruction of urethra,54308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Reconstruction of urethra,54312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Reconstruction of urethra,54316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Reconstruction of urethra,54318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Reconstruction of urethra,54322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Reconstruction of urethra,54324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Reconstruction of urethra,54326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revise penis/urethra,54328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revise penis/urethra,54332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revise penis/urethra,54336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Rpr hypspad comp simple,54340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Rrp hypspad comp moblj&urtp,54344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Rpr hypspad comp dsj & urtp,54348,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Revj prior hypspad repair,54352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Penis plastic surgery,54360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair penis,54380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Repair penis,54385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Repair penis and bladder,54390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,904.58,12147.4,case rate,
Insert semi-rigid prosthesis,54400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13005.69,,,,5881.73,45586.39,case rate,
Insert self-contd prosthesis,54401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Insert multi-comp penis pros,54405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Remove muti-comp penis pros,54406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair multi-comp penis pros,54408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Remove/replace penis prosth,54410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Remov/replc penis pros comp,54411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Remove self-contd penis pros,54415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Remv/repl penis contain pros,54416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20437.12,,,,9428.76,73077.68,case rate,
Remv/replc penis pros compl,54417,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13005.69,,,,5881.73,45586.39,case rate,
Revision of penis,54420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revision of penis,54430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,105.07,8759.27,case rate,
Revision of penis,54435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Repair corporeal tear,54437,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Replantation of penis,54438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,973.51,8759.27,case rate,
Repair of penis,54440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Preputial stretching,54450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Biopsy of testis,54500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Biopsy of testis,54505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Excise lesion testis,54512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of testis,54520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Orchiectomy partial,54522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of testis,54530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Extensive testis surgery,54535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Exploration for testis,54550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Exploration for testis,54560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Reduce testis torsion,54600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Suspension of testis,54620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Orchiopexy ingun/scrot appr,54640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Orchiopexy (fowler-stephens),54650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Revision of testis,54660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Repair testis injury,54670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Relocation of testis(es),54680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Laparoscopy orchiectomy,54690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy orchiopexy,54692,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted laps px testis,54699,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Drainage of scrotum,54700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Biopsy of epididymis,54800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Remove epididymis lesion,54830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Remove epididymis lesion,54840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Removal of epididymis,54860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of epididymis,54861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Explore epididymis,54865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Fusion of spermatic ducts,54900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Fusion of spermatic ducts,54901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Drainage of hydrocele,55000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Removal of hydrocele,55040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Removal of hydroceles,55041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Repair of hydrocele,55060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Drainage of scrotum abscess,55100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Explore scrotum,55110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of scrotum lesion,55120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Removal of scrotum,55150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revision of scrotum,55175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revision of scrotum,55180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Incision of sperm duct,55200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of sperm duct(s),55250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Repair of sperm duct,55400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of hydrocele,55500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of sperm cord lesion,55520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revise spermatic cord veins,55530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Revise spermatic cord veins,55535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7665.09,,,,1732,13423.91,case rate,
Revise hernia & sperm veins,55540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3505.17,,,,1732,13423.91,case rate,
Laparo ligate spermatic vein,55550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlstd laps px sprmatic cord,55559,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Incise sperm duct pouch,55600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Incise sperm duct pouch,55605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,105.07,8759.27,case rate,
Remove sperm duct pouch,55650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,105.07,8759.27,case rate,
Remove sperm pouch lesion,55680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Biopsy of prostate,55700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Biopsy of prostate,55705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Prostate saturation sampling,55706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Drainage of prostate abscess,55720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Drainage of prostate abscess,55725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
Removal of prostate,55801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,799.64,12147.4,case rate,
Extensive prostate surgery,55810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,950.19,12147.4,case rate,
Extensive prostate surgery,55812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1168.11,8759.27,case rate,
Extensive prostate surgery,55815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1278.25,12147.4,case rate,
Removal of prostate,55821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,613.08,12147.4,case rate,
Removal of prostate,55831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,628.62,12147.4,case rate,
Extensive prostate surgery,55840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,851.73,12147.4,case rate,
Extensive prostate surgery,55842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,851.73,12147.4,case rate,
Extensive prostate surgery,55845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,989.33,12147.4,case rate,
Surgical exposure prostate,55860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Extensive prostate surgery,55862,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,798.34,8759.27,case rate,
Extensive prostate surgery,55865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,971.44,8759.27,case rate,
Laps surg prst8ect rpbic rad,55866,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laps surg prst8ect smpl stot,55867,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Electroejaculation,55870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Cryoablate prostate,55873,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Tprnl plmt biodegrdabl matrl,55874,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Transperi needle place pros,55875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Place rt device/marker pros,55876,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1403.85,,,,655.59,5081.14,fee schedule,
Abltj mal prst8 tiss hifu,55880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Unlisted px male genital sys,55899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.4,,,,105.07,814.36,fee schedule,
Place needles pelvic for rt,55920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Sex transformation m to f,55970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Sex transformation f to m,55980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3532.01,,,,1567.3,12147.4,case rate,
I & d of vulva/perineum,56405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Drainage of gland abscess,56420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Surgery for vulva lesion,56440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Lysis of labial lesion(s),56441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Hymenotomy,56442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Destroy vulva lesions sim,56501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Destroy vulva lesion/s compl,56515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Biopsy of vulva/perineum,56605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Partial removal of vulva,56620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Complete removal of vulva,56625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Extensive vulva surgery,56630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1382.62,10716,case rate,
Extensive vulva surgery,56631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,871.94,10716,case rate,
Extensive vulva surgery,56632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1060.05,10716,case rate,
Extensive vulva surgery,56633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,906.93,10716,case rate,
Extensive vulva surgery,56634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,950.98,10716,case rate,
Extensive vulva surgery,56637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1111.88,10716,case rate,
Extensive vulva surgery,56640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1119.15,10716,case rate,
Partial removal of hymen,56700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Remove vagina gland lesion,56740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Repair of vagina,56800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Repair clitoris,56805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Repair of perineum,56810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Exam of vulva w/scope,56820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Exam/biopsy of vulva w/scope,56821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Exploration of vagina,57000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Drainage of pelvic abscess,57010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Drainage of pelvic fluid,57020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
I & d vaginal hematoma pp,57022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
I & d vag hematoma non-ob,57023,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Destroy vag lesions simple,57061,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Destroy vag lesions complex,57065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Biopsy of vagina,57100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Biopsy of vagina,57105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Remove vagina wall partial,57106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Remove vagina tissue part,57107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Vaginectomy partial w/nodes,57109,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Remove vagina wall complete,57110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,663.61,10716,case rate,
Remove vagina tissue compl,57111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1267.1,10716,case rate,
Closure of vagina,57120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Remove vagina lesion,57130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Remove vagina lesion,57135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Treat vagina infection,57150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Insert uteri tandem/ovoids,57155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Ins vag brachytx device,57156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Insert pessary/other device,57160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Fitting of diaphragm/cap,57170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Treat vaginal bleeding,57180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Repair of vagina,57200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Repair vagina/perineum,57210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Revision of urethra,57220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair of urethral lesion,57230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Anterior colporrhaphy,57240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair rectum & vagina,57250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Cmbn ant pst colprhy,57260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Cmbn ap colprhy w/ntrcl rpr,57265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair of bowel bulge,57268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair of bowel pouch,57270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,88.3,8759.27,case rate,
Suspension of vagina,57280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,708.69,10716,case rate,
Colpopexy extraperitoneal,57282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Colpopexy intraperitoneal,57283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Repair paravag defect open,57284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair paravag defect vag,57285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Revise/remove sling repair,57287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Repair bladder defect,57288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair bladder & vagina,57289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Construction of vagina,57291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Construct vagina with graft,57292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Revise vag graft via vagina,57295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Revise vag graft open abd,57296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,702.21,10716,case rate,
Repair rectum-vagina fistula,57300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Repair rectum-vagina fistula,57305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,529.54,8759.27,case rate,
Fistula repair & colostomy,57307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,805.6,8759.27,case rate,
Fistula repair transperine,57308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,494.14,8759.27,case rate,
Repair urethrovaginal lesion,57310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Repair urethrovaginal lesion,57311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,413.3,10716,case rate,
Repair bladder-vagina lesion,57320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Repair bladder-vagina lesion,57330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Repair vagina,57335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Dilation of vagina,57400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Pelvic examination,57410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Remove vaginal foreign body,57415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Exam of vagina w/scope,57420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Exam/biopsy of vag w/scope,57421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Repair paravag defect lap,57423,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparoscopy surg colpopexy,57425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Revise prosth vag graft lap,57426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Exam of cervix w/scope,57452,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Bx/curett of cervix w/scope,57454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Biopsy of cervix w/scope,57455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Endocerv curettage w/scope,57456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Bx of cervix w/scope leep,57460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Conz of cervix w/scope leep,57461,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Biopsy of cervix,57500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Endocervical curettage,57505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Cauterization of cervix,57510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Cryocautery of cervix,57511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Laser surgery of cervix,57513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Conization of cervix,57520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Conization of cervix,57522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Removal of cervix,57530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Removal of cervix radical,57531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1275.14,17567.07,case rate,
Removal of residual cervix,57540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,582.24,17567.07,case rate,
Remove cervix/repair pelvis,57545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,612.56,17567.07,case rate,
Removal of residual cervix,57550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Remove cervix/repair vagina,57555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Remove cervix repair bowel,57556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
D&c of cervical stump,57558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Revision of cervix,57700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Revision of cervix,57720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Dilation of cervical canal,57800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Biopsy of uterus lining,58100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Dilation and curettage,58120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Myomectomy abdom method,58140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,683.57,17567.07,case rate,
Myomectomy vag method,58145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Myomectomy abdom complex,58146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,844.2,17567.07,case rate,
Total hysterectomy,58150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,741.34,17567.07,case rate,
Total hysterectomy,58152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,904.08,17567.07,case rate,
Partial hysterectomy,58180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,700.92,10716,case rate,
Extensive hysterectomy,58200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,982.06,17567.07,case rate,
Extensive hysterectomy,58210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1329.55,17567.07,case rate,
Removal of pelvis contents,58240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2140.6,17567.07,case rate,
Vaginal hysterectomy,58260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Vag hyst including t/o,58262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Vag hyst w/t/o & vag repair,58263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Vag hyst w/urinary repair,58267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,784.62,10716,case rate,
Vag hyst w/enterocele repair,58270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Hysterectomy/revise vagina,58275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,726.32,10716,case rate,
Hysterectomy/revise vagina,58280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,776.58,10716,case rate,
Extensive hysterectomy,58285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1040.89,10716,case rate,
Vag hyst complex,58290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Vag hyst incl t/o complex,58291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Vag hyst t/o & repair compl,58292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Vag hyst w/enterocele compl,58294,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Remove intrauterine device,58301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,case rate,
Artificial insemination,58321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Artificial insemination,58322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Sperm washing,58323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Reopen fallopian tube,58345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Insert heyman uteri capsule,58346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Reopen fallopian tube,58350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Endometr ablate thermal,58353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Endometrial cryoablation,58356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Suspension of uterus,58400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,345.15,10716,case rate,
Suspension of uterus,58410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,599.61,17567.07,case rate,
Repair of ruptured uterus,58520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,587.68,17567.07,case rate,
Revision of uterus,58540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,672.67,17567.07,case rate,
Lsh uterus 250 g or less,58541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Lsh w/t/o ut 250 g or less,58542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Lsh uterus above 250 g,58543,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Lsh w/t/o uterus above 250 g,58544,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparoscopic myomectomy,58545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparo-myomectomy complex,58546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Lap radical hyst,58548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1375.41,17567.07,case rate,
Laparo-asst vag hysterectomy,58550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparo-vag hyst incl t/o,58552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparo-vag hyst complex,58553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laparo-vag hyst w/t/o compl,58554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Hysteroscopy dx sep proc,58555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Hysteroscopy biopsy,58558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Hysteroscopy lysis,58559,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Hysteroscopy resect septum,58560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Hysteroscopy remove myoma,58561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Hysteroscopy remove fb,58562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Hysteroscopy ablation,58563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Hysteroscopy sterilization,58565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Tlh uterus 250 g or less,58570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Tlh w/t/o 250 g or less,58571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Tlh uterus over 250 g,58572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Tlh w/t/o uterus over 250 g,58573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Laps tot hyst resj mal,58575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1411.43,17567.07,case rate,
Unlisted laps px uterus,58578,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted hystsc px uterus,58579,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Transcrv abltj utrn fibrd rf,58580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,7285.33,7655.93,case rate,
Division of fallopian tube,58600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Division of fallopian tube,58605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,249.52,9790.52,case rate,
Ligate oviduct(s) add-on,58611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,54.4,9790.52,case rate,
Occlude fallopian tube(s),58615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Laparoscopy lysis,58660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy remove adnexa,58661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy excise lesions,58662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy tubal cautery,58670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy tubal block,58671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy fimbrioplasty,58672,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Laparoscopy salpingostomy,58673,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,2548.74,19754.05,case rate,
Laps abltj uterine fibroids,58674,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,4443.69,34440.87,case rate,
Unlisted laps px ovidct ovry,58679,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Removal of fallopian tube,58700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,585.61,17567.07,case rate,
Removal of ovary/tube(s),58720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,557.11,17567.07,case rate,
Adhesiolysis tube ovary,58740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,659.46,17567.07,case rate,
Repair oviduct,58750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2266.57,17567.07,case rate,
Revise ovarian tube(s),58752,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,665.16,8759.27,case rate,
Fimbrioplasty,58760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,603.23,8759.27,case rate,
Create new tubal opening,58770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Drainage of ovarian cyst(s),58800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Drainage of ovarian cyst(s),58805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Drain ovary abscess open,58820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Drain ovary abscess percut,58822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,526.53,8759.27,case rate,
Transposition ovary(s),58825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,522.38,17567.07,case rate,
Biopsy of ovary(s),58900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Partial removal of ovary(s),58920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7655.93,,,,3386.6,26247.87,case rate,
Removal of ovarian cyst(s),58925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Removal of ovary(s),58940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,409.92,10716,case rate,
Removal of ovary(s),58943,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,856.9,17567.07,case rate,
Resect ovarian malignancy,58950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,846.54,17567.07,case rate,
Resect ovarian malignancy,58951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1054.36,17567.07,case rate,
Resect ovarian malignancy,58952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1204.91,17567.07,case rate,
Tah rad dissect for debulk,58953,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1460.15,17567.07,case rate,
Tah rad debulk/lymph remove,58954,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1577.52,17567.07,case rate,
Bso omentectomy w/tah,58956,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,993.99,17567.07,case rate,
Resect recurrent gyn mal,58957,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1161.11,17567.07,case rate,
Resect recur gyn mal w/lym,58958,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1210.61,17567.07,case rate,
Exploration of abdomen,58960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,732.01,17567.07,case rate,
Retrieval of oocyte,58970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Transfer of embryo,58974,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Transfer of embryo,58976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Unlisted px fml genital sys,58999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Amniocentesis diagnostic,59000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Amniocentesis therapeutic,59001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Fetal cord puncture prenatal,59012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Chorion biopsy,59015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.49,,,,344,2666.15,fee schedule,
Fetal contract stress test,59020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Fetal non-stress test,59025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Fetal scalp blood sample,59030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Transabdom amnioinfus w/us,59070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Umbilical cord occlud w/us,59072,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Fetal fluid drainage w/us,59074,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Fetal shunt placement w/us,59076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Remove uterus lesion,59100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Treat ectopic pregnancy,59120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,576,10716,case rate,
Treat ectopic pregnancy,59121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,576,10716,case rate,
Treat ectopic pregnancy,59130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,666.72,10716,case rate,
Treat ectopic pregnancy,59136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,632.51,10716,case rate,
Treat ectopic pregnancy,59140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,298.36,10716,case rate,
Treat ectopic pregnancy,59150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Treat ectopic pregnancy,59151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
D & c after delivery,59160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Insert cervical dilator,59200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Episiotomy or vaginal repair,59300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Revision of cervix,59320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Revision of cervix,59325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,166.16,9790.52,case rate,
Repair of uterus,59350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,191.04,9790.52,case rate,
Obstetrical care,59409,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Antepartum manipulation,59412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Deliver placenta,59414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Cesarean delivery only,59514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,564.45,8759.27,case rate,
Remove uterus after cesarean,59525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,329.47,10716,case rate,
Vbac delivery only,59612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Attempted vbac delivery only,59620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,643.66,8759.27,case rate,
Treatment of miscarriage,59812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Care of miscarriage,59820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Treatment of miscarriage,59821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Treat uterus infection,59830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,142.77,8759.27,case rate,
Abortion,59840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Abortion,59841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Abortion,59850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,142.77,8759.27,case rate,
Abortion,59851,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,142.77,8759.27,case rate,
Abortion,59852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,142.77,8759.27,case rate,
Abortion,59855,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,142.77,8759.27,case rate,
Abortion,59856,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,142.77,8759.27,case rate,
Abortion,59857,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,142.77,8759.27,case rate,
Abortion (mpr),59866,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.03,,,,142.77,1106.53,fee schedule,
Evacuate mole of uterus,59870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Remove cerclage suture,59871,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3167.49,,,,1382.62,10716,case rate,
Unlisted fetal invas px w/us,59897,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Unlstd laps px mat care&dlvr,59898,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted px mat care&dlvr,59899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Drain thyroid/tongue cyst,60000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Biopsy of thyroid,60100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Remove thyroid lesion,60200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Partial thyroid excision,60210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Partial thyroid excision,60212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Partial removal of thyroid,60220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Partial removal of thyroid,60225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Removal of thyroid,60240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Removal of thyroid,60252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Extensive thyroid surgery,60254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1209.84,19754.05,case rate,
Repeat thyroid surgery,60260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of thyroid,60270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,979.48,19754.05,case rate,
Removal of thyroid,60271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove thyroid duct lesion,60280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Remove thyroid duct lesion,60281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Aspir/inj thyroid cyst,60300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Explore parathyroid glands,60500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Re-explore parathyroids,60502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Explore parathyroid glands,60505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1009.53,19754.05,case rate,
Removal of thymus gland,60520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Removal of thymus gland,60521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,787.22,9790.52,case rate,
Removal of thymus gland,60522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,952,8759.27,case rate,
Explore adrenal gland,60540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,770.37,11290.3,case rate,
Explore adrenal gland,60545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,887.74,11290.3,case rate,
Remove carotid body lesion,60600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,954.86,11290.3,case rate,
Remove carotid body lesion,60605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1117.33,11290.3,case rate,
Laparoscopy adrenalectomy,60650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,846.8,11290.3,case rate,
Unlisted laps px endoc sys,60659,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Unlisted px endocrine system,60699,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5845.88,,,,2548.74,19754.05,case rate,
Remove cranial cavity fluid,61000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Remove cranial cavity fluid,61001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Remove brain cavity fluid,61020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Injection into brain canal,61026,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Remove brain canal fluid,61050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Injection into brain canal,61055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Brain canal shunt procedure,61070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Twist drill hole,61105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,329.86,10782.66,case rate,
Drill skull for implantation,61107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,208.85,10782.66,case rate,
Drill skull for drainage,61108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,637.69,10782.66,case rate,
Burr hole for puncture,61120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,526.53,10782.66,case rate,
Pierce skull for biopsy,61140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,881.53,10782.66,case rate,
Pierce skull for drainage,61150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,931.54,10782.66,case rate,
Pierce skull for drainage,61151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,690.29,10782.66,case rate,
Pierce skull & remove clot,61154,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,889.04,10782.66,case rate,
Pierce skull for drainage,61156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,851.22,10782.66,case rate,
Pierce skull implant device,61210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,244.86,10782.66,case rate,
Insert brain-fluid device,61215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Pierce skull & explore,61250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,606.08,10782.66,case rate,
Pierce skull & explore,61253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,690.29,10782.66,case rate,
Open skull for exploration,61304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1127.7,10782.66,case rate,
Open skull for exploration,61305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1376.45,10782.66,case rate,
Open skull for drainage,61312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Open skull for drainage,61313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1364.53,10782.66,case rate,
Open skull for drainage,61314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1255.44,10782.66,case rate,
Open skull for drainage,61315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Implt cran bone flap to abdo,61316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,58.3,10782.66,case rate,
Open skull for drainage,61320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1297.67,10782.66,case rate,
Open skull for drainage,61321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Decompressive craniotomy,61322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Decompressive lobectomy,61323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Decompress eye socket,61330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Explore orbit/remove lesion,61333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1379.3,10782.66,case rate,
Subtemporal decompression,61340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,993.99,10782.66,case rate,
Incise skull (press relief),61343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Relieve cranial pressure,61345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Incise skull for surgery,61450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1315.04,10782.66,case rate,
Incise skull for brain wound,61458,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1383.96,10782.66,case rate,
Incise skull for surgery,61460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of skull lesion,61500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,924.03,10782.66,case rate,
Remove infected skull bone,61501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,808.98,10782.66,case rate,
Removal of brain lesion,61510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Remove brain lining lesion,61512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain abscess,61514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1317.89,10782.66,case rate,
Removal of brain lesion,61516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1287.84,10782.66,case rate,
Implt brain chemotx add-on,61517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,58.04,10782.66,case rate,
Removal of brain lesion,61518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Remove brain lining lesion,61519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain lesion,61520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain lesion,61521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain abscess,61522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain lesion,61524,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain lesion,61526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain lesion,61530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Implant brain electrodes,61531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,853.8,10782.66,case rate,
Implant brain electrodes,61533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1052.8,10782.66,case rate,
Removal of brain lesion,61534,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1140.39,10782.66,case rate,
Remove brain electrodes,61535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,703.25,10782.66,case rate,
Removal of brain lesion,61536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain tissue,61537,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain tissue,61538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain tissue,61539,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain tissue,61540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Incision of brain tissue,61541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain tissue,61543,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Remove & treat brain lesion,61544,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1300.79,10782.66,case rate,
Excision of brain tumor,61545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of pituitary gland,61546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of pituitary gland,61548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1092.19,10782.66,case rate,
Release of skull seams,61550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,837.48,10782.66,case rate,
Release of skull seams,61552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1030.26,10782.66,case rate,
Incise skull/sutures,61556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1177.18,10782.66,case rate,
Incise skull/sutures,61557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1166.56,10782.66,case rate,
Excision of skull/sutures,61558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1296.12,10782.66,case rate,
Excision of skull/sutures,61559,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Excision of skull tumor,61563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1360.12,10782.66,case rate,
Excision of skull tumor,61564,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Removal of brain tissue,61566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Incision of brain tissue,61567,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Remove foreign body brain,61570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1287.31,10782.66,case rate,
Incise skull for brain wound,61571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1367.64,10782.66,case rate,
Skull base/brainstem surgery,61575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Skull base/brainstem surgery,61576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Craniofacial approach skull,61580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Craniofacial approach skull,61581,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Craniofacial approach skull,61582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Craniofacial approach skull,61583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Orbitocranial approach/skull,61584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Orbitocranial approach/skull,61585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Resect nasopharynx skull,61586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Infratemporal approach/skull,61590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Infratemporal approach/skull,61591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Orbitocranial approach/skull,61592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Transtemporal approach/skull,61595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Transcochlear approach/skull,61596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Transcondylar approach/skull,61597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Transpetrosal approach/skull,61598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Resect/excise cranial lesion,61600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Resect/excise cranial lesion,61601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Resect/excise cranial lesion,61605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Resect/excise cranial lesion,61606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Resect/excise cranial lesion,61607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Resect/excise cranial lesion,61608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Transect artery sinus,61611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,311.46,11290.3,case rate,
Remove aneurysm sinus,61613,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Resect/excise lesion skull,61615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Resect/excise lesion skull,61616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Repair dura,61618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Repair dura,61619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Endovasc tempory vessel occl,61623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Transcath occlusion cns,61624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,5190.89,40232.02,case rate,
Transcath occlusion non-cns,61626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Intracranial angioplasty,61630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,950.45,40232.02,case rate,
Intracran angioplsty w/stent,61635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1028.19,40232.02,case rate,
Perq art m-thrombect &/nfs,61645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,5190.89,40232.02,case rate,
Evasc prlng admn rx agnt 1st,61650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,392.05,40232.02,case rate,
Evasc prlng admn rx agnt add,61651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,167.65,40232.02,case rate,
Intracranial vessel surgery,61680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Intracranial vessel surgery,61682,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Intracranial vessel surgery,61684,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Intracranial vessel surgery,61686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Intracranial vessel surgery,61690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Intracranial vessel surgery,61692,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Brain aneurysm repr complx,61697,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Brain aneurysm repr complx,61698,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Brain aneurysm repr simple,61700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Inner skull vessel surgery,61702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Clamp neck artery,61703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,941.13,11290.3,case rate,
Revise circulation to head,61705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Revise circulation to head,61708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Revise circulation to head,61710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Fusion of skull arteries,61711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1456.72,11290.3,case rate,
Incise skull/brain surgery,61720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Incise skull/brain surgery,61735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1101.26,10782.66,case rate,
Litt icr 1 traj 1 smpl les,61736,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,650.38,10782.66,case rate,
Litt icr mlt trj mlt/cplx ls,61737,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,773.48,10782.66,case rate,
Incise skull/brain biopsy,61750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,971.18,10782.66,case rate,
Brain biopsy w/ct/mr guide,61751,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,963.41,10782.66,case rate,
Implant brain electrodes,61760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1092.98,10782.66,case rate,
Incise skull for treatment,61770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Treat trigeminal nerve,61790,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Treat trigeminal tract,61791,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Implant neuroelectrodes,61850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,685.89,45300.32,case rate,
Implant neuroelectrodes,61860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1075.09,45300.32,case rate,
Implant neuroelectrode,61863,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1041.66,45300.32,case rate,
Implant neuroelectrde addl,61864,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,188.37,45300.32,case rate,
Implant neuroelectrode,61867,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1560.42,45300.32,case rate,
Implant neuroelectrde addl,61868,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,332.45,45300.32,case rate,
Revise/remove neuroelectrode,61880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Insrt/redo neurostim 1 array,61885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22163.29,,,,10521.01,81543.21,case rate,
Implant neurostim arrays,61886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31460.67,,,,14356.3,111268.64,case rate,
Revise/remove neuroreceiver,61888,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Ins sk-mnt crnl nstm pg/rcvr,61889,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,8335.27,8759.27,case rate,
Rev/rplcmt sk-mnt crnl nstm,61891,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22163.29,,,,21090.45,22163.29,case rate,
Rmv sk-mnt crnl nstm pg/rcvr,61892,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,3120.67,3279.42,case rate,
Treat skull fracture,62000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Treat skull fracture,62005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,880.49,10782.66,case rate,
Treatment of head injury,62010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1062.14,10782.66,case rate,
Repair brain fluid leakage,62100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1101.53,10782.66,case rate,
Reduction of skull defect,62115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1170.19,10782.66,case rate,
Reduction of skull defect,62117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1346.65,10782.66,case rate,
Repair skull cavity lesion,62120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Incise skull repair,62121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1126.65,10782.66,case rate,
Crnop skull defect<5 cm diam,62140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,719.32,10782.66,case rate,
Crnop skull defect>5 cm diam,62141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,798.6,10782.66,case rate,
Rmvl b1 flp/prostc plate skl,62142,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,626.29,10782.66,case rate,
Rpl b1 flp/prostc plate skl,62143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,728.9,10782.66,case rate,
Repair of skull & brain,62145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,977.65,10782.66,case rate,
Crnop w/autograft<5 cm diam,62146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,865.72,10782.66,case rate,
Crnop w/autograft>5 cm diam,62147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,986.46,10782.66,case rate,
Retr bone flap to fix skull,62148,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,83.7,10782.66,case rate,
Dissect brain w/scope,62161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1050.99,10782.66,case rate,
Remove colloid cyst w/scope,62162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1299.24,10782.66,case rate,
Remove brain tumor w/scope,62164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Remove pituit tumor w/scope,62165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1076.9,10782.66,case rate,
Establish brain cavity shunt,62180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1101.53,23417.08,case rate,
Establish brain cavity shunt,62190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,650.91,23417.08,case rate,
Establish brain cavity shunt,62192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,682.01,23417.08,case rate,
Replace/irrigate catheter,62194,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Establish brain cavity shunt,62200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,950.19,23417.08,case rate,
Brain cavity shunt w/scope,62201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,849.39,23417.08,case rate,
Establish brain cavity shunt,62220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,673.97,23417.08,case rate,
Establish brain cavity shunt,62223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,729.17,23417.08,case rate,
Replace/irrigate catheter,62225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Replace/revise brain shunt,62230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Csf shunt reprogram,62252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,fee schedule,
Remove brain cavity shunt,62256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,432.73,23417.08,case rate,
Replace brain cavity shunt,62258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,775.02,23417.08,case rate,
Epidural lysis mult sessions,62263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Epidural lysis on single day,62264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Interdiscal perq aspir dx,62267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Drain spinal cord cyst,62268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Needle biopsy spinal cord,62269,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Dx lmbr spi pnxr,62270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Ther spi pnxr drg csf,62272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Inject epidural patch,62273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Treat spinal cord lesion,62280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Treat spinal cord lesion,62281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Treat spinal canal lesion,62282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Dcmprn px perq 1/mlt lumbar,62287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Njx chemonucleolysis lmbr,62292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Injection into spinal artery,62294,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Myelography lumbar injection,62302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Myelography lumbar injection,62303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Myelography lumbar injection,62304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Myelography lumbar injection,62305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Njx interlaminar crv/thrc,62320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx interlaminar crv/thrc,62321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx interlaminar lmbr/sac,62322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx interlaminar lmbr/sac,62323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx interlaminar crv/thrc,62324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx interlaminar crv/thrc,62325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx interlaminar lmbr/sac,62326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx interlaminar lmbr/sac,62327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Dx lmbr spi pnxr w/fluor/ct,62328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Ther spi pnxr csf fluor/ct,62329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Implant spinal canal cath,62350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Implant spinal canal cath,62351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spinal canal catheter,62355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Insert spine infusion device,62360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18068.9,,,,8282.91,64196.76,case rate,
Implant spine infusion pump,62361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18068.9,,,,8282.91,64196.76,case rate,
Implant spine infusion pump,62362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18068.9,,,,8282.91,64196.76,case rate,
Remove spine infusion device,62365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Analyze spine infus pump,62367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,fee schedule,
Analyze sp inf pump w/reprog,62368,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,fee schedule,
Anal sp inf pmp w/reprg&fill,62369,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,fee schedule,
Anl sp inf pmp w/mdreprg&fil,62370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,fee schedule,
Ndsc dcmprn 1 ntrspc lumbar,62380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spine lamina 1/2 crvl,63001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spine lamina 1/2 thrc,63003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spine lamina 1/2 lmbr,63005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spine lamina 1/2 scrl,63011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove lamina/facets lumbar,63012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spine lamina >2 crvcl,63015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spine lamina >2 thrc,63016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Remove spine lamina >2 lmbr,63017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Neck spine disk surgery,63020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Low back disk surgery,63030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Laminotomy single cervical,63040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Laminotomy single lumbar,63042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Lam facetec & foramot crv,63045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Lam facetec & foramot thrc,63046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Lam facetec & foramot lumbar,63047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Cervical laminoplsty 2/> seg,63050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1048.66,25069.45,case rate,
C-laminoplasty w/graft/plate,63051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1196.89,25069.45,case rate,
Decompress spinal cord thrc,63055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Decompress spinal cord lmbr,63056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Decompress spinal cord thrc,63064,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Neck spine disk surgery,63075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Spine disk surgery thorax,63077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Spine disk surgery thorax,63078,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,137.85,25069.45,case rate,
Remove vert body dcmprn crvl,63081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1232.37,25069.45,case rate,
Remove vertebral body add-on,63082,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,181.64,82992.02,case rate,
Remove vert body dcmprn thrc,63085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1345.61,82992.02,case rate,
Remove vertebral body add-on,63086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,130.34,82992.02,case rate,
Remov vertbr dcmprn thrclmbr,63087,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1682.99,82992.02,case rate,
Remove vertebral body add-on,63088,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,176.45,82992.02,case rate,
Remove vert body dcmprn lmbr,63090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1374.12,82992.02,case rate,
Remove vertebral body add-on,63091,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,122.05,82992.02,case rate,
Remove vert body dcmprn thrc,63101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1614.84,82992.02,case rate,
Remove vert body dcmprn lmbr,63102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1601.88,82992.02,case rate,
Remove vertebral body add-on,63103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,201.07,82992.02,case rate,
Incise spinal cord tract(s),63170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1101,82992.02,case rate,
Drainage of spinal cyst,63172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Drainage of spinal cyst,63173,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1189.1,82992.02,case rate,
Incise spine nrv half segmnt,63185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incise spine nrv >2 segmnts,63190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Incise spine accessory nerve,63191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Lam w/cordotomy 1stg thrc,63197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1179.52,82992.02,case rate,
Release spinal cord lumbar,63200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1063.18,25069.45,case rate,
Revise spinal cord vsls crvl,63250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2017,82992.02,case rate,
Revise spinal cord vsls thrc,63251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2063.64,82992.02,case rate,
Revise spine cord vsl thrlmb,63252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2063.38,82992.02,case rate,
Excise intraspinl lesion crv,63265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Excise intrspinl lesion thrc,63266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Excise intrspinl lesion lmbr,63267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Excise intrspinl lesion scrl,63268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Excise intrspinl lesion crvl,63270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1425.68,25069.45,case rate,
Excise intrspinl lesion thrc,63271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1427.75,82992.02,case rate,
Excise intrspinl lesion lmbr,63272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1302.6,25069.45,case rate,
Excise intrspinl lesion scrl,63273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1285.75,25069.45,case rate,
Bx/exc xdrl spine lesn crvl,63275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1249.99,82992.02,case rate,
Bx/exc xdrl spine lesn thrc,63276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1238.34,82992.02,case rate,
Bx/exc xdrl spine lesn lmbr,63277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1092.45,82992.02,case rate,
Bx/exc xdrl spine lesn scrl,63278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1102.81,82992.02,case rate,
Bx/exc idrl spine lesn crvl,63280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1457.03,82992.02,case rate,
Bx/exc idrl spine lesn thrc,63281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1443.31,82992.02,case rate,
Bx/exc idrl spine lesn lmbr,63282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1365.82,25069.45,case rate,
Bx/exc idrl spine lesn scrl,63283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1311.66,82992.02,case rate,
Bx/exc idrl imed lesn cervl,63285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1786.64,82992.02,case rate,
Bx/exc idrl imed lesn thrc,63286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1768.76,82992.02,case rate,
Bx/exc idrl imed lesn thrlmb,63287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1871.63,82992.02,case rate,
Bx/exc xdrl/idrl lsn any lvl,63290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1902.98,82992.02,case rate,
Repair laminectomy defect,63295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Remove vert xdrl body crvcl,63300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1268.91,82992.02,case rate,
Remove vert xdrl body thrc,63301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1514.03,82992.02,case rate,
Remove vert xdrl body thrlmb,63302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1496.42,82992.02,case rate,
Remov vert xdrl bdy lmbr/sac,63303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1583.22,82992.02,case rate,
Remove vert idrl body crvcl,63304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1610.18,82992.02,case rate,
Remove vert idrl body thrc,63305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1710.21,82992.02,case rate,
Remov vert idrl bdy thrclmbr,63306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1681.43,82992.02,case rate,
Remov vert idrl bdy lmbr/sac,63307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1645.16,82992.02,case rate,
Remove vertebral body add-on,63308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,217.15,82992.02,case rate,
Remove spinal cord lesion,63600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Stimulation of spinal cord,63610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Implant neuroelectrodes,63650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6929.1,,,,3229.28,25028.59,case rate,
Implant neuroelectrodes,63655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22163.29,,,,10521.01,81543.21,case rate,
Remove spine eltrd perq aray,63661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove spine eltrd plate,63662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Revise spine eltrd perq aray,63663,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6929.1,,,,3229.28,25028.59,case rate,
Revise spine eltrd plate,63664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Ins/rplc spi npg/rcvr pocket,63685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31460.67,,,,14356.3,111268.64,case rate,
Rev/rmv imp sp npg/r dtch cn,63688,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Repair of spinal herniation,63700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Repair of spinal herniation,63702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Repair of spinal herniation,63704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Repair of spinal herniation,63706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Repair spinal fluid leakage,63707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,101.23,8759.27,case rate,
Repair spinal fluid leakage,63709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,790.58,25069.45,case rate,
Graft repair of spine defect,63710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,772.69,25069.45,case rate,
Install spinal shunt,63740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,692.63,23417.08,case rate,
Install spinal shunt,63741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Revision of spinal shunt,63744,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Removal of spinal shunt,63746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Njx aa&/strd trigeminal nrv,64400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Njx aa&/strd gr ocpl nrv,64405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Njx aa&/strd vagus nrv,64408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Njx aa&/strd brch plxs img,64415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd brch pl nfs img,64416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd ax nerve img,64417,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd sprscap nrv,64418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd ntrcost nrv 1,64420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd ntrcost nrv ea,64421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd ii ih nerves,64425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd pudendal nerve,64430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd paracrv nrv,64435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd sciatic nrv img,64445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd sc nrv nfs img,64446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd femoral nrv img,64447,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd fem nrv nfs img,64448,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd lmbr plex nfs,64449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd other pn/branch,64450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd nrv nrvtg si jt,64451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd gnclr nrv brnch,64454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd pltr com dg nrv,64455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Pvb thoracic single inj site,64461,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Pvb thoracic cont infusion,64463,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Njx aa&/strd tfrm epi c/t 1,64479,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Njx aa&/strd tfrm epi l/s 1,64483,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Inj paravert f jnt c/t 1 lev,64490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Inj paravert f jnt l/s 1 lev,64493,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
N block spenopalatine gangl,64505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
N block stellate ganglion,64510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
N block inj hypogas plxs,64517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
N block lumbar/thoracic,64520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
N block inj celiac pelus,64530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Implant neuroelectrodes,64553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Implant neuroelectrodes,64555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6929.1,,,,3229.28,25028.59,case rate,
Implant neuroelectrodes,64561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6929.1,,,,3229.28,25028.59,case rate,
Neuroeltrd stim post tibial,64566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Opn impltj crnl nrv nea&pg,64568,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31460.67,,,,14356.3,111268.64,case rate,
Revise/repl vagus n eltrd,64569,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Remove vagus n eltrd,64570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Opn impltj nea perph nerve,64575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Opn impltj nea neuromuscular,64580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22163.29,,,,10521.01,81543.21,case rate,
Opn impltj nea sacral nerve,64581,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6929.1,,,,3229.28,25028.59,case rate,
Opn mpltj hpglsl nstm ary pg,64582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31460.67,,,,14356.3,111268.64,case rate,
Rev/rplct hpglsl nstm ary pg,64583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,5844.82,45300.32,case rate,
Rmvl hpglsl nstim ary pg,64584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Rev/rmv perph nstim eltrd ra,64585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Ins/rpl prph sac/gstr npg/r,64590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22163.29,,,,10521.01,81543.21,case rate,
Rev/rmv prph sac/gstr npg/r,64595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,1588.12,12308.71,case rate,
Ins/rplcmt prq eltrd ra pn 1,64596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13801.21,,,,13133.14,13801.21,case rate,
Revj/rmvl nea pn w/int nstim,64598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3447.28,,,,3280.41,3447.28,case rate,
Injection treatment of nerve,64600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Injection treatment of nerve,64605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Injection treatment of nerve,64610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Chemodenerv saliv glands,64611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Destroy nerve face muscle,64612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Chemodenerv musc migraine,64615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Chemodenerv musc neck dyston,64616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Chemodener muscle larynx emg,64617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,277.29,2442.05,fee schedule,
Injection treatment of nerve,64620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Dstrj nulyt agt gnclr nrv,64624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Rf abltj nrv nrvtg si jt,64625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Trml dstrj ios bvn 1st 2 l/s,64628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Injection treatment of nerve,64630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
N block inj common digit,64632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Destroy cerv/thor facet jnt,64633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Destroy lumb/sac facet jnt,64635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Injection treatment of nerve,64640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Chemodenerv 1 extremity 1-4,64642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Chemodenerv 1 extrem 5/> mus,64644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Chemodenerv trunk musc 1-5,64646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Chemodenerv trunk musc 6/>,64647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Chemodenerv eccrine glands,64650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Chemodenerv eccrine glands,64653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Injection treatment of nerve,64680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Injection treatment of nerve,64681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,923.46,,,,416.72,3229.76,fee schedule,
Revise finger/toe nerve,64702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revise hand/foot nerve,64704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revise arm/leg nerve,64708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revision of sciatic nerve,64712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revision of arm nerve(s),64713,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revise low back nerve(s),64714,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revision of cranial nerve,64716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revise ulnar nerve at elbow,64718,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Revise ulnar nerve at wrist,64719,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Carpal tunnel surgery,64721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Relieve pressure on nerve(s),64722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Release foot/toe nerve,64726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of brow nerve,64732,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of cheek nerve,64734,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of chin nerve,64736,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of jaw nerve,64738,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of tongue nerve,64740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of facial nerve,64742,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incise nerve back of head,64744,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incise diaphragm nerve,64746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of stomach nerves,64755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,652.47,11290.3,case rate,
Incision of vagus nerve,64760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,375.2,11290.3,case rate,
Incise hip/thigh nerve,64763,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incise hip/thigh nerve,64766,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Sever cranial nerve,64771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Incision of spinal nerve,64772,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove skin nerve lesion,64774,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove digit nerve lesion,64776,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove limb nerve lesion,64782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove nerve lesion,64784,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove sciatic nerve lesion,64786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Remove skin nerve lesion,64788,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Removal of nerve lesion,64790,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Removal of nerve lesion,64792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Biopsy of nerve,64795,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Sympathectomy cervical,64802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove sympathetic nerves,64804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove sympathetic nerves,64809,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,757.66,8759.27,case rate,
Remove sympathetic nerves,64818,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,570.07,8759.27,case rate,
Sympathectomy digital artery,64820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Remove sympathetic nerves,64821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Remove sympathetic nerves,64822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Sympathectomy supfc palmar,64823,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Repair of digit nerve,64831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Repair of hand or foot nerve,64834,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair of hand or foot nerve,64835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair of hand or foot nerve,64836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair of leg nerve,64840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair/transpose nerve,64856,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair arm/leg nerve,64857,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair sciatic nerve,64858,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Repair of arm nerves,64861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
Repair of low back nerves,64862,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair of facial nerve,64864,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Repair of facial nerve,64865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Fusion of facial/other nerve,64866,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,878.99,8759.27,case rate,
Fusion of facial/other nerve,64868,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,743.42,8759.27,case rate,
Nerve graft head/neck <4 cm,64885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nerve graft head/neck >4 cm,64886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf 1strnd hnd/foot <4cm,64890,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf 1strnd hnd/foot >4cm,64891,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf 1strnd arm/leg <4cm,64892,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf 1strnd arm/leg >4 cm,64893,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf mltst hnd/foot <4 cm,64895,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf mltst hnd/foot >4 cm,64896,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf mltst arm/leg <4 cm,64897,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv grf mltst arm/leg >4 cm,64898,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nerve pedicle transfer,64905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nerve pedicle transfer,64907,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nerve repair w/allograft,64910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Neurorraphy w/vein autograft,64911,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Nrv rpr w/nrv algrft 1st,64912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6749.07,,,,3021.36,23417.08,case rate,
Unlisted px nervous system,64999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Revise eye,65091,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise eye with implant,65093,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Removal of eye,65101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Remove eye/insert implant,65103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Remove eye/attach implant,65105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Removal of eye,65110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Remove eye/revise socket,65112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Remove eye/revise socket,65114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise ocular implant,65125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Insert ocular implant,65130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Insert ocular implant,65135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Attach ocular implant,65140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise ocular implant,65150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Reinsert ocular implant,65155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Removal of ocular implant,65175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Remove foreign body from eye,65205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Remove foreign body from eye,65210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Remove foreign body from eye,65220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Remove foreign body from eye,65222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Remove foreign body from eye,65235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Remove foreign body from eye,65260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Remove foreign body from eye,65265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Repair of eye wound,65270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair of eye wound,65272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair of eye wound,65273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,285.29,8759.27,case rate,
Repair of eye wound,65275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Repair of eye wound,65280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Repair of eye wound,65285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Repair of eye wound,65286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Repair of eye socket wound,65290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Removal of eye lesion,65400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Biopsy of cornea,65410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Removal of eye lesion,65420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Removal of eye lesion,65426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Corneal smear,65430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Curette/treat cornea,65435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Curette/treat cornea,65436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Treatment of corneal lesion,65450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Revision of cornea,65600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Corneal transplant,65710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Corneal transplant,65730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Corneal transplant,65750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Corneal transplant,65755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Corneal trnspl endothelial,65756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Revise cornea with implant,65770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12560.25,,,,3529.38,27354.48,case rate,
Correction of astigmatism,65772,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Correction of astigmatism,65775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Cover eye w/membrane,65778,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,case rate,
Cover eye w/membrane suture,65779,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Ocular reconst transplant,65780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Ocular reconst transplant,65781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Ocular reconst transplant,65782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Impltj ntrstrml crnl rng seg,65785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Drainage of eye,65800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Drainage of eye,65810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Drainage of eye,65815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Relieve inner eye pressure,65820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Incision of eye,65850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Trabeculoplasty laser surg,65855,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Incise inner eye adhesions,65860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Incise inner eye adhesions,65865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Incise inner eye adhesions,65870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Incise inner eye adhesions,65875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Incise inner eye adhesions,65880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Remove eye lesion,65900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Remove implant of eye,65920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Remove blood clot from eye,65930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Injection treatment of eye,66020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Injection treatment of eye,66030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Remove eye lesion,66130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Glaucoma surgery,66150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Glaucoma surgery,66155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Glaucoma surgery,66160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Glaucoma surgery,66170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Incision of eye,66172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Trluml dil aq o/f can w/o st,66174,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Trluml dil aq o/f can w/st,66175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Aqueous shunt eye w/o graft,66179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Aqueous shunt eye w/graft,66180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Insert ant drainage device,66183,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Revision of aqueous shunt,66184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Revise aqueous shunt eye,66185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Repair/graft eye lesion,66225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Follow-up surgery of eye,66250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Incision of iris,66500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Incision of iris,66505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Remove iris and lesion,66600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Removal of iris,66605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Removal of iris,66625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Removal of iris,66630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Removal of iris,66635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Repair iris & ciliary body,66680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Repair iris & ciliary body,66682,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Destruction ciliary body,66700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Ciliary transsleral therapy,66710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Ecp ciliary body destruction,66711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Destruction ciliary body,66720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Destruction ciliary body,66740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revision of iris,66761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Revision of iris,66762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Removal of inner eye lesion,66770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Incision secondary cataract,66820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
After cataract laser surgery,66821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Reposition intraocular lens,66825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Removal of lens lesion,66830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Removal of lens material,66840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Removal of lens material,66850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Removal of lens material,66852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Extraction of lens,66920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Extraction of lens,66930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Extraction of lens,66940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Xcapsl ctrc rmvl cplx wo ecp,66982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Cataract surg w/iol 1 stage,66983,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Xcapsl ctrc rmvl w/o ecp,66984,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Insert lens prosthesis,66985,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Exchange lens prosthesis,66986,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Xcapsl ctrc rmvl cplx w/ecp,66987,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Xcapsl ctrc rmvl w/ecp,66988,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Xcpsl ctrc rmvl cplx insj 1+,66989,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,2078.49,16109.4,case rate,
Xcapsl ctrc rmvl insj 1+,66991,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,2078.49,16109.4,case rate,
Unlisted px ant segment eye,66999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Partial removal of eye fluid,67005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Partial removal of eye fluid,67010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Release of eye fluid,67015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Replace eye fluid,67025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Implant eye drug system,67027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15991.15,,,,7833.88,60716.56,case rate,
Injection eye drug,67028,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Incise inner eye strands,67030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Laser surgery eye strands,67031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Removal of inner eye fluid,67036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Laser treatment of retina,67039,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Laser treatment of retina,67040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Vit for macular pucker,67041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Vit for macular hole,67042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Vit for membrane dissect,67043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Repair detached retina crtx,67101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Repair detached retina pc,67105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Repair detached retina,67107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Repair detached retina,67108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Repair detached retina,67110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Repair retinal detach cplx,67113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5295.28,,,,1953.84,15143.25,case rate,
Release encircling material,67115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1953.84,15143.25,case rate,
Remove eye implant material,67120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Remove eye implant material,67121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Proph rta dtchmnt crtx dthrm,67141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Proph rta dtchmnt pc,67145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Treatment of retinal lesion,67208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Treatment of retinal lesion,67210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Treatment of retinal lesion,67218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Treatment of choroid lesion,67220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Ocular photodynamic ther,67221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Dstrj extensive retinopathy,67227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Treatment x10sv retinopathy,67228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Tr retinal les preterm inf,67229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Reinforce eye wall,67250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Reinforce/graft eye wall,67255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4119.32,,,,1055.97,8184.28,case rate,
Unlisted px posterior segmnt,67299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Revise eye muscle,67311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise two eye muscles,67312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise eye muscle,67314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise two eye muscles,67316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise eye muscle(s),67318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Release eye tissue,67343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Destroy nerve of eye muscle,67345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Biopsy eye muscle,67346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Unlisted px extraocular musc,67399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Explore/biopsy eye socket,67400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Explore/drain eye socket,67405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Explore/treat eye socket,67412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Explore/treat eye socket,67413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Explr/decompress eye socket,67414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Aspiration orbital contents,67415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Explore/treat eye socket,67420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Explore/treat eye socket,67430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Explore/drain eye socket,67440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Explr/decompress eye socket,67445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Explore/biopsy eye socket,67450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Inject/treat eye socket,67500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Inject/treat eye socket,67505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Inject/treat eye socket,67515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Sprchoroidal spc njx rx agt,67516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,326.51,343.12,fee schedule,
Insert eye socket implant,67550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise eye socket implant,67560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Decompress optic nerve,67570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Unlisted procedure orbit,67599,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Drainage of eyelid abscess,67700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Incision of eyelid,67710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Incision of eyelid fold,67715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove eyelid lesion,67800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Remove eyelid lesions,67801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Remove eyelid lesions,67805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Remove eyelid lesion(s),67808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Biopsy eyelid & lid margin,67810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Revise eyelashes,67820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Revise eyelashes,67825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Revise eyelashes,67830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Revise eyelashes,67835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove eyelid lesion,67840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Dstrj lesion lid margin <1cm,67850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Closure of eyelid by suture,67875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Revision of eyelid,67880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revision of eyelid,67882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair brow defect,67900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Repair eyelid defect,67903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Repair eyelid defect,67908,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise eyelid defect,67909,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise eyelid defect,67911,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Correction eyelid w/implant,67912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67914,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67916,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67917,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67923,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid defect,67924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid wound,67930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Repair eyelid wound,67935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove eyelid foreign body,67938,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Revision of eyelid,67950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revision of eyelid,67961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revision of eyelid,67966,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Reconstruction of eyelid,67971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Reconstruction of eyelid,67973,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Reconstruction of eyelid,67974,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Reconstruction of eyelid,67975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Unlisted procedure eyelids,67999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Incise/drain eyelid lining,68020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Treatment of eyelid lesions,68040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Biopsy of eyelid lining,68100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove eyelid lining lesion,68110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove eyelid lining lesion,68115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove eyelid lining lesion,68130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove eyelid lining lesion,68135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Treat eyelid by injection,68200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,119.31,1430.99,case rate,
Revise/graft eyelid lining,68320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise/graft eyelid lining,68325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise/graft eyelid lining,68326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise/graft eyelid lining,68328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise eyelid lining,68330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.02,,,,1055.97,8184.28,case rate,
Revise/graft eyelid lining,68335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Separate eyelid adhesions,68340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise eyelid lining,68360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Revise eyelid lining,68362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Harvest eye tissue alograft,68371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Unlisted px conjunctiva,68399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Incise/drain tear gland,68400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1025.75,,,,426.72,3307.31,fee schedule,
Incise/drain tear sac,68420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Incise tear duct opening,68440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Removal of tear gland,68500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Partial removal tear gland,68505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Biopsy of tear gland,68510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Removal of tear sac,68520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Biopsy of tear sac,68525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Clearance of tear duct,68530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Remove tear gland lesion,68540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Remove tear gland lesion,68550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Repair tear ducts,68700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Revise tear duct opening,68705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Create tear sac drain,68720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Create tear duct drain,68745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Create tear duct drain,68750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3917.24,,,,1709.3,13247.95,case rate,
Close tear duct opening,68760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Close tear duct opening,68761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Close tear system fistula,68770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Dilate tear duct opening,68801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Probe nasolacrimal duct,68810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Probe nasolacrimal duct,68811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Probe nasolacrimal duct,68815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Probe nl duct w/balloon,68816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Explore/irrigate tear ducts,68840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Insj rx elut implt lac canal,68841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Unlisted px lacrimal system,68899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.14,,,,129.44,1003.25,fee schedule,
Drain external ear lesion,69000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Drain external ear lesion,69005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Drain outer ear canal lesion,69020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,317.35,2459.6,fee schedule,
Biopsy of external ear,69100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Biopsy of external ear canal,69105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Remove external ear partial,69110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Removal of external ear,69120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove ear canal lesion(s),69140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove ear canal lesion(s),69145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2878.87,,,,1263.21,9790.52,case rate,
Extensive ear canal surgery,69150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Extensive ear/neck surgery,69155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,223.38,8759.27,case rate,
Clear outer ear canal,69200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Clear outer ear canal,69205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1642.61,,,,733.28,5683.29,case rate,
Remove impacted ear wax uni,69209,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Remove impacted ear wax uni,69210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Clean out mastoid cavity,69220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Clean out mastoid cavity,69222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Revise external ear,69300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Rebuild outer ear canal,69310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rebuild outer ear canal,69320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Unlisted px external ear,69399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Incision of eardrum,69420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Incision of eardrum,69421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Remove ventilating tube,69424,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Create eardrum opening,69433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Create eardrum opening,69436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Exploration of middle ear,69440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Eardrum revision,69450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Mastoidectomy,69501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Mastoidectomy,69502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove mastoid structures,69505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Extensive mastoid surgery,69511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Extensive mastoid surgery,69530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove part of temporal bone,69535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Remove ear lesion,69540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Remove ear lesion,69550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove ear lesion,69552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove ear lesion,69554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1391.22,10782.66,case rate,
Mastoid surgery revision,69601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Mastoid surgery revision,69602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Mastoid surgery revision,69603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Mastoid surgery revision,69604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair of eardrum,69610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Repair of eardrum,69620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair eardrum structures,69631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rebuild eardrum structures,69632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rebuild eardrum structures,69633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair eardrum structures,69635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rebuild eardrum structures,69636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rebuild eardrum structures,69637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear & mastoid,69641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear & mastoid,69642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear & mastoid,69643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear & mastoid,69644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear & mastoid,69645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear & mastoid,69646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Release middle ear bone,69650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Revise middle ear bone,69660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear bone,69661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Revise middle ear bone,69662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair middle ear structures,69666,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Repair middle ear structures,69667,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Remove mastoid air cells,69670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove middle ear nerve,69676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Close mastoid fistula,69700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Nps surg dilat eust tube uni,69705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Nps surg dilat eust tube bi,69706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove/repair hearing aid,69711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Impl oi implt skull perq esp,69714,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Impl oi implt sk tc esp<100,69716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Rplcmt oi implt skl prq esp,69717,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Rplcm oi implt sk tc esp<100,69719,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Release facial nerve,69720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Release facial nerve,69725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Rmv ntr oi implt skl prq esp,69726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Rmv ntr oi imp sk tc esp<100,69727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Rmv ntr oi imp sk tc>=100,69728,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,1455.59,11281.54,case rate,
Impl oi implt sk tc esp>=100,69729,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Rplc oi implt sk tc esp>=100,69730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Repair facial nerve,69740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Repair facial nerve,69745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Unlisted px middle ear,69799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Incise inner ear,69801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Explore inner ear,69805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Explore inner ear,69806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove inner ear,69905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove inner ear & mastoid,69910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Incise inner ear nerve,69915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,1391.22,10782.66,case rate,
Implant cochlear device,69930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33975.62,,,,16301.81,126347.34,case rate,
Unlisted px inner ear,69949,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Incise inner ear nerve,69950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1298.19,10782.66,case rate,
Release facial nerve,69955,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Release inner ear canal,69960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Remove inner ear lesion,69970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,2611.1,20237.35,case rate,
Unlisted px temporal bone,69979,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,101.63,787.68,fee schedule,
Contrast x-ray of brain,70010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Contrast x-ray of brain,70015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
X-ray eye for foreign body,70030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of jaw <4views,70100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of jaw 4/> views,70110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of mastoids,70120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of mastoids,70130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of middle ear,70134,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
X-ray exam of facial bones,70140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of facial bones,70150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of nasal bones,70160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of tear duct,70170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray exam of eye sockets,70190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of eye sockets,70200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of sinuses,70210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of sinuses,70220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam pituitary saddle,70240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of skull,70250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of skull,70260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of teeth,70300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of teeth,70310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Full mouth x-ray of teeth,70320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray exam of jaw joint,70328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of jaw joints,70330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of jaw joint,70332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Magnetic image jaw joint,70336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray head for orthodontia,70350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Panoramic x-ray of jaws,70355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of neck,70360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Throat x-ray & fluoroscopy,70370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Speech evaluation complex,70371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray exam of salivary gland,70380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of salivary duct,70390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Ct head/brain w/o dye,70450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct head/brain w/dye,70460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct head/brain w/o & w/dye,70470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct orbit/ear/fossa w/o dye,70480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct orbit/ear/fossa w/dye,70481,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct orbit/ear/fossa w/o&w/dye,70482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct maxillofacial w/o dye,70486,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct maxillofacial w/dye,70487,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct maxillofacial w/o & w/dye,70488,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct soft tissue neck w/o dye,70490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct soft tissue neck w/dye,70491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct sft tsue nck w/o & w/dye,70492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct angiography head,70496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct angiography neck,70498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Mri orbit/face/neck w/o dye,70540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri orbit/face/neck w/dye,70542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri orbt/fac/nck w/o &w/dye,70543,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mr angiography head w/o dye,70544,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mr angiography head w/dye,70545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mr angiograph head w/o&w/dye,70546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mr angiography neck w/o dye,70547,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mr angiography neck w/dye,70548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mr angiograph neck w/o&w/dye,70549,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri brain stem w/o dye,70551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri brain stem w/dye,70552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri brain stem w/o & w/dye,70553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Fmri brain by tech,70554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Fmri brain by phys/psych,70555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Mri brain w/o dye,70557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Mri brain w/dye,70558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Mri brain w/o & w/dye,70559,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
X-ray exam chest 1 view,71045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
X-ray exam chest 2 views,71046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
X-ray exam chest 3 views,71047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam chest 4+ views,71048,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam ribs uni 2 views,71100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam unilat ribs/chest,71101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam ribs bil 3 views,71110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam ribs/chest4/> vws,71111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam breastbone 2/>vws,71120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray strenoclavic jt 3/>vws,71130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Ct thorax dx c-,71250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct thorax dx c+,71260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct thorax dx c-/c+,71270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct thorax lung cancer scr c-,71271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Ct angiography chest,71275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Mri chest w/o dye,71550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri chest w/dye,71551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Mri chest w/o & w/dye,71552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of spine 1 view,72020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam neck spine 2-3 vw,72040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam neck spine 4/5vws,72050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam neck spine 6/>vws,72052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam thorac spine 2vws,72070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam thorac spine 3vws,72072,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam thorac spine4/>vw,72074,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam thoracolmb 2/> vw,72080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam entire spi 1 vw,72081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam entire spi 2/3 vw,72082,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam entire spi 4/5 vw,72083,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
X-ray exam entire spi 6/> vw,72084,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
X-ray exam l-s spine 2/3 vws,72100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam l-2 spine 4/>vws,72110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam l-s spine bending,72114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray bend only l-s spine,72120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct neck spine w/o dye,72125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct neck spine w/dye,72126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Ct neck spine w/o & w/dye,72127,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct chest spine w/o dye,72128,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct chest spine w/dye,72129,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct chest spine w/o & w/dye,72130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct lumbar spine w/o dye,72131,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct lumbar spine w/dye,72132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Ct lumbar spine w/o & w/dye,72133,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Mri neck spine w/o dye,72141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri neck spine w/dye,72142,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri chest spine w/o dye,72146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri chest spine w/dye,72147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri lumbar spine w/o dye,72148,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri lumbar spine w/dye,72149,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri neck spine w/o & w/dye,72156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri chest spine w/o & w/dye,72157,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri lumbar spine w/o & w/dye,72158,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of pelvis,72170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of pelvis,72190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct angiograph pelv w/o&w/dye,72191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct pelvis w/o dye,72192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct pelvis w/dye,72193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct pelvis w/o & w/dye,72194,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Mri pelvis w/o dye,72195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri pelvis w/dye,72196,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri pelvis w/o & w/dye,72197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam si joints,72200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam si joints 3/> vws,72202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam sacrum tailbone,72220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Myelography neck spine,72240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Myelography thoracic spine,72255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Myelography l-s spine,72265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Myelogphy 2/> spine regions,72270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Discography cerv/thor spine,72285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
X-ray of lower spine disk,72295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1956.17,,,,878.99,6812.6,case rate,
X-ray exam of collar bone,73000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of shoulder blade,73010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of shoulder,73020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of shoulder,73030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Contrast x-ray of shoulder,73040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of shoulders,73050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of humerus,73060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of elbow,73070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of elbow,73080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Contrast x-ray of elbow,73085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of forearm,73090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of arm infant,73092,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of wrist,73100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of wrist,73110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Contrast x-ray of wrist,73115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of hand,73120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of hand,73130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of finger(s),73140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Ct upper extremity w/o dye,73200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct upper extremity w/dye,73201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Ct uppr extremity w/o&w/dye,73202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct angio upr extrm w/o&w/dye,73206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Mri upper extremity w/o dye,73218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri upper extremity w/dye,73219,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri uppr extremity w/o&w/dye,73220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri joint upr extrem w/o dye,73221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri joint upr extrem w/dye,73222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Mri joint upr extr w/o&w/dye,73223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam hip uni 1 view,73501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam hip uni 2-3 views,73502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam hip uni 4/> views,73503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam hips bi 2 views,73521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam hips bi 3-4 views,73522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam hips bi 5/> views,73523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Contrast x-ray of hip,73525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of femur 1,73551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of femur 2/>,73552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of knee 1 or 2,73560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of knee 3,73562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam knee 4 or more,73564,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam of knees,73565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Contrast x-ray of knee joint,73580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of lower leg,73590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of leg infant,73592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of ankle,73600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of ankle,73610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Contrast x-ray of ankle,73615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of foot,73620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of foot,73630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of heel,73650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of toe(s),73660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Ct lower extremity w/o dye,73700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct lower extremity w/dye,73701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct lwr extremity w/o&w/dye,73702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct angio lwr extr w/o&w/dye,73706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Mri lower extremity w/o dye,73718,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri lower extremity w/dye,73719,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri lwr extremity w/o&w/dye,73720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri jnt of lwr extre w/o dye,73721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri joint of lwr extr w/dye,73722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Mri joint lwr extr w/o&w/dye,73723,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam abdomen 1 view,74018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam abdomen 2 views,74019,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam abdomen 3+ views,74021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray exam complete abdomen,74022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct abdomen w/o dye,74150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct abdomen w/dye,74160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct abdomen w/o & w/dye,74170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct angio abd&pelv w/o&w/dye,74174,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,fee schedule,
Ct angio abdom w/o & w/dye,74175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct abd & pelvis w/o contrast,74176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Ct abd & pelv w/contrast,74177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Ct abd & pelv 1/> regns,74178,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri abdomen w/o dye,74181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri abdomen w/dye,74182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri abdomen w/o & w/dye,74183,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray exam of peritoneum,74190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
X-ray xm phrnx&/crv esoph c+,74210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm esophagus 1cntrst,74220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm esophagus 2cntrst,74221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm swlng funcj c+,74230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm upr gi trc 1cntrst,74240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm upr gi trc 2cntrst,74246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm sm int 1cntrst std,74250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm sm int 2cntrst std,74251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ct colonography dx,74261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct colonography dx w/dye,74262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm colon 1cntrst std,74270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
X-ray xm colon 2cntrst std,74280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Ther nma rdctj intus/obstrcj,74283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Contrast x-ray gallbladder,74290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Urography iv +-kub tomog,74400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Urography nfs drip&/bolus,74410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Urography nfs drip&/bls w/nf,74415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Urography rtrgr +-kub,74420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,fee schedule,
Urography antegrade rs&i,74425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Contrast x-ray bladder,74430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
X-ray male genital tract,74440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray exam of penis,74445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-ray urethra/bladder,74450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray urethra/bladder,74455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray exam of kidney lesion,74470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
Dilation urtr/urt rs&i,74485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2063.6,,,,907.04,7030,case rate,
Mri fetal sngl/1st gestation,74712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
X-ray female genital tract,74740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray exam of perineum,74775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Cardiac mri for morph,75557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Cardiac mri w/stress img,75559,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
Cardiac mri for morph w/dye,75561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Card mri w/stress img & dye,75563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,case rate,
Ct hrt w/o dye w/ca test,75571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Ct hrt w/3d image,75572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Ct hrt c+ strux cgen hrt ds,75573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Ct angio hrt w/3d image,75574,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
N-invas est c ffr sw aly cta,75580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,1008.02,1059.29,fee schedule,
Contrast exam thoracic aorta,75600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Contrast exam thoracic aorta,75605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Contrast exam abdominl aorta,75625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
X-ray aorta leg arteries,75630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Ct angio abdominal arteries,75635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Artery x-rays spine,75705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Artery x-rays arm/leg,75710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Artery x-rays arms/legs,75716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Artery x-rays abdomen,75726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Artery x-rays adrenal gland,75731,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Artery x-rays adrenals,75733,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Artery x-rays pelvis,75736,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Artery x-rays lung,75741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Artery x-rays lungs,75743,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Artery x-rays lung,75746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Artery x-rays chest,75756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Lymph vessel x-ray arm/leg,75801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,case rate,
Lymph vessel x-ray arms/legs,75803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Lymph vessel x-ray trunk,75805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Lymph vessel x-ray trunk,75807,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Nonvascular shunt x-ray,75809,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Vein x-ray spleen/liver,75810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Vein x-ray arm/leg,75820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,694.71,5638.95,case rate,
Vein x-ray arms/legs,75822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Vein x-ray trunk,75825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Vein x-ray chest,75827,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,694.71,5638.95,case rate,
Vein x-ray kidney,75831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Vein x-ray kidneys,75833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Vein x-ray adrenal gland,75840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Vein x-ray adrenal glands,75842,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Vein x-ray neck,75860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Vein x-ray skull,75870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Vein x-ray skull epidural,75872,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,case rate,
Vein x-ray eye socket,75880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.47,,,,282.89,2192.52,case rate,
Vein x-ray liver w/hemodynam,75885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Vein x-ray liver w/o hemodyn,75887,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Vein x-ray liver w/hemodynam,75889,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Vein x-ray liver,75891,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Venous sampling by catheter,75893,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5567.63,,,,2513.34,19479.69,case rate,
Follow-up angiography,75898,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1225.39,11290.3,case rate,
Xray endovasc thor ao repr,75956,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,231.12,8759.27,case rate,
Xray endovasc thor ao repr,75957,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,188.37,8759.27,case rate,
Xray place prox ext thor ao,75958,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,131.11,8759.27,case rate,
Xray place dist ext thor ao,75959,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,115.04,8759.27,case rate,
Fluoroscopy <1 hr phys/qhp,76000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
X-ray nose to rectum,76010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-ray exam of fistula,76080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
X-ray exam surgical specimen,76098,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
X-ray exam of body section,76100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Cine/video x-rays,76120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Med physic dos eval rad exps,76145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Cat scan follow-up study,76380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Mr spectroscopy,76390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Mr elastography,76391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Unlisted fluoroscopic px,76496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Unlisted ct procedure,76497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Unlisted mr procedure,76498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Unlisted dx radiographic px,76499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Echo exam of head,76506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Oph us dx b-scan&quan a-scan,76510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Oph us dx quan a-scan only,76511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Oph us dx b-scan,76512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Oph us dx ant sgm us uni/bi,76513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Echo exam of eye thickness,76514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Echo exam of eye,76516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Echo exam of eye,76519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Echo exam of eye,76529,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Us exam of head and neck,76536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us exam chest,76604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ultrasound breast complete,76641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ultrasound breast limited,76642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Us exam abdom complete,76700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Echo exam of abdomen,76705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us abdl aorta screen aaa,76706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Us exam abdo back wall comp,76770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us exam abdo back wall lim,76775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us exam k transpl w/doppler,76776,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us exam spinal canal,76800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ob us < 14 wks single fetus,76801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Ob us >= 14 wks sngl fetus,76805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Ob us detailed sngl fetus,76811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Ob us nuchal meas 1 gest,76813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ob us limited fetus(s),76815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ob us follow-up per fetus,76816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Transvaginal us obstetric,76817,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Fetal biophys profile w/nst,76818,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Fetal biophys profil w/o nst,76819,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Umbilical artery echo,76820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Middle cerebral artery echo,76821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Echo exam of fetal heart,76825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Echo exam of fetal heart,76826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Echo exam of fetal heart,76827,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Echo exam of fetal heart,76828,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Transvaginal us non-ob,76830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Echo exam uterus,76831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Us exam pelvic complete,76856,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us exam pelvic limited,76857,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us exam scrotum,76870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us transrectal,76872,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Echograp trans r pros study,76873,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Us compl joint r-t w/img,76881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Us lmtd jt/fcl evl nvasc xtr,76882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us nrv&acc strux 1xtr compre,76883,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Us exam infant hips dynamic,76885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Us exam infant hips static,76886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Echo guide for artery repair,76936,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Gi endoscopic ultrasound,76975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Us bone density measure,76977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Us trgt dyn mbubb 1st les,76978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Use parenchyma,76981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Use 1st target lesion,76982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Dx intraop thoracic aorta us,76984,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,21.76,8759.27,case rate,
Dx intraop epicar car us chd,76987,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,68.4,8759.27,case rate,
Dx ntrop epcr us chd img acq,76988,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,43.26,8759.27,case rate,
Dx intraop epcar us chd i&r,76989,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,25.13,8759.27,case rate,
Echo examination procedure,76999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Mri breast c- unilateral,77046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mri breast c- bilateral,77047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray of mammary duct,77053,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
X-ray of mammary ducts,77054,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Breast tomosynthesis bi,77063,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.57,,,,18.91,100.99,fee schedule,
Dx mammo incl cad uni,77065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,89.15,,,,68.92,240.34,fee schedule,
Dx mammo incl cad bi,77066,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.16,,,,87.84,302.98,fee schedule,
Scr mammo bi incl cad,77067,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,94.27,,,,72.8,246.09,fee schedule,
X-ray stress view,77071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
X-rays for bone age,77072,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-rays bone length studies,77073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-rays bone survey limited,77074,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-rays bone survey complete,77075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
X-rays bone survey infant,77076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Joint survey single view,77077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Ct bone density axial,77078,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Dxa bone density axial,77080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Dxa bone density/peripheral,77081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Magnetic image bone marrow,77084,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Dxa bone density study,77085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Fracture assessment via dxa,77086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Tbs techl prep&transmis data,77090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Tbs techl calculation only,77091,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,fee schedule,
Set radiation therapy field,77280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Set radiation therapy field,77285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Set radiation therapy field,77290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
3-d radiotherapy plan,77295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1403.85,,,,655.59,5081.14,fee schedule,
Unlisted px ther rad tx plng,77299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Radiation therapy dose plan,77300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Radiotherapy dose plan imrt,77301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1403.85,,,,655.59,5081.14,fee schedule,
Telethx isodose plan simple,77306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Telethx isodose plan cplx,77307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Brachytx isodose plan simple,77316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Brachytx isodose intermed,77317,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Brachytx isodose complex,77318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Special teletx port plan,77321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Special radiation dosimetry,77331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Radiation treatment aid(s),77332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Radiation treatment aid(s),77333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Radiation treatment aid(s),77334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Radiation physics consult,77336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Design mlc device for imrt,77338,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.36,,,,175.41,1359.55,fee schedule,
Radiation physics consult,77370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Srs multisource,77371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7889.7,,,,3760.69,29147.26,case rate,
Srs linear based,77372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7889.7,,,,3760.69,29147.26,case rate,
Sbrt delivery,77373,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1807.83,,,,864.28,6698.64,fee schedule,
Ntsty modul rad tx dlvr smpl,77385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Ntsty modul rad tx dlvr cplx,77386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Unlisted px med radj physics,77399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.47,,,,65.22,505.51,fee schedule,
Radiation treatment delivery,77401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.49,,,,59.85,463.86,fee schedule,
Radiation treatment delivery,77402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.49,,,,59.85,463.86,fee schedule,
Radiation treatment delivery,77407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.29,,,,128.57,996.5,fee schedule,
Radiation treatment delivery,77412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.29,,,,128.57,996.5,fee schedule,
Neutron beam tx complex,77423,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Io rad tx delivery by x-ray,77424,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7889.7,,,,3760.69,29147.26,case rate,
Io rad tx deliver by elctrns,77425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7889.7,,,,3760.69,29147.26,case rate,
Special radiation treatment,77470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Proton trmt simple w/o comp,77520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Proton trmt simple w/comp,77522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1437.25,,,,647.05,5015,fee schedule,
Proton trmt intermediate,77523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1437.25,,,,647.05,5015,fee schedule,
Proton treatment complex,77525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1437.25,,,,647.05,5015,fee schedule,
Hyperthermia treatment,77600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.29,,,,128.57,996.5,fee schedule,
Hyperthermia treatment,77605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.4,,,,352.92,2735.32,fee schedule,
Hyperthermia treatment,77610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Hyperthermia treatment,77615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Hyperthermia treatment,77620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Infuse radioactive materials,77750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.29,,,,128.57,996.5,fee schedule,
Apply intrcav radiat simple,77761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Apply intrcav radiat interm,77762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,596.4,,,,279.94,2169.66,fee schedule,
Apply intrcav radiat compl,77763,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.4,,,,352.92,2735.32,fee schedule,
Hdr rdncl skn surf brachytx,77767,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.29,,,,128.57,996.5,fee schedule,
Hdr rdncl skn surf brachytx,77768,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.29,,,,128.57,996.5,fee schedule,
Hdr rdncl ntrstl/icav brchtx,77770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.4,,,,352.92,2735.32,fee schedule,
Hdr rdncl ntrstl/icav brchtx,77771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.4,,,,352.92,2735.32,fee schedule,
Hdr rdncl ntrstl/icav brchtx,77772,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.4,,,,352.92,2735.32,fee schedule,
Apply interstit radiat compl,77778,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.4,,,,352.92,2735.32,fee schedule,
Apply surf ldr radionuclide,77789,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.49,,,,59.85,463.86,fee schedule,
Unlisted px clin brachytx,77799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.49,,,,59.85,463.86,fee schedule,
Thyroid uptake measurement,78012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Thyroid imaging w/blood flow,78013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Thyroid imaging w/blood flow,78014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Thyroid met imaging,78015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Thyroid met imaging/studies,78016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Thyroid met imaging body,78018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Parathyroid planar imaging,78070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Parathyrd planar w/wo subtrj,78071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Parathyrd planar w/spect&ct,78072,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Adrenal cortex & medulla img,78075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Unlisted endocrine px dx nuc,78099,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Bone marrow imaging ltd,78102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Bone marrow imaging mult,78103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Bone marrow imaging body,78104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Plasma volume single,78110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Plasma volume multiple,78111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Red cell mass single,78120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Red cell mass multiple,78121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Blood volume,78122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Red cell survival study,78130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Red cell sequestration,78140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Spleen imaging,78185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Platelet survival,78191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Lymph system imaging,78195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Unlstd hematop ret/endo lymp,78199,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Liver imaging,78201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Liver imaging with flow,78202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Liver and spleen imaging,78215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Liver & spleen image/flow,78216,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Hepatobiliary system imaging,78226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Hepatobil syst image w/drug,78227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Salivary gland imaging,78230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Serial salivary imaging,78231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Salivary gland function exam,78232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Esophageal motility study,78258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Gastric mucosa imaging,78261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Gastroesophageal reflux exam,78262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Gastric emptying imag study,78264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Gastric emptying imag study,78265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Gastric emptying imag study,78266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Breath tst attain/anal c-14,78267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.06,,,,11.06,18.25,fee schedule,
Breath test analysis c-14,78268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,94.41,,,,94.41,155.78,fee schedule,
Acute gi blood loss imaging,78278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Gi protein loss exam,78282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Meckels divert exam,78290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Leveen/shunt patency exam,78291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Unlisted gi px dx nuc med,78299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Bone imaging limited area,78300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Bone imaging multiple areas,78305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Bone imaging whole body,78306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Bone imaging 3 phase,78315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Unlisted muscskel px dx nuc,78399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Non-imaging heart function,78414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Cardiac shunt imaging,78428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Myocrd img pet 1 std w/ct,78429,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Myocrd img pet rst/strs w/ct,78430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Myocrd img pet rst&strs ct,78431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2393.07,,,,1344.99,10424.4,fee schedule,
Myocrd img pet 2rtracer,78432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1967.73,,,,904.89,7013.4,fee schedule,
Myocrd img pet 2rtracer ct,78433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2074.07,,,,953.79,7392.4,fee schedule,
Vascular flow imaging,78445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Ht muscle image spect sing,78451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Ht muscle image spect mult,78452,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Ht muscle image planar sing,78453,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Ht musc image planar mult,78454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Acute venous thrombus image,78456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Venous thrombosis imaging,78457,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Ven thrombosis images bilat,78458,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Myocrd img pet single study,78459,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Heart infarct image,78466,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Heart infarct image (ef),78468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Heart infarct image (3d),78469,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Gated heart planar single,78472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Gated heart multiple,78473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Heart first pass single,78481,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Heart first pass multiple,78483,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Myocrd img pet 1std rst/strs,78491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Myocrd img pet mlt rst&strs,78492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Heart image spect,78494,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Unlisted cv px dx nuc med,78499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Lung ventilation imaging,78579,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Lung perfusion imaging,78580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Lung ventilat&perfus imaging,78582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Lung perfusion differential,78597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Lung perf&ventilat diferentl,78598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Unlisted resp px dx nuc med,78599,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Brain image < 4 views,78600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Brain image w/flow < 4 views,78601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Brain image 4+ views,78605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Brain image w/flow 4 + views,78606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Brain imaging (pet),78608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Brain flow imaging only,78610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Cerebrospinal fluid scan,78630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Csf ventriculography,78635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Csf shunt evaluation,78645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Csf leakage imaging,78650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Nuclear exam of tear flow,78660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Unlisted nrvs sys px dx nuc,78699,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Kidney imaging morphol,78700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Kidney imaging with flow,78701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
K flow/funct image w/o drug,78707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
K flow/funct image w/drug,78708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
K flow/funct image multiple,78709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,547.62,,,,246.7,1912.06,fee schedule,
Kidney function study,78725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Ureteral reflux study,78740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Testicular imaging w/flow,78761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Unlisted gu px dx nuc med,78799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Rp loclzj tum 1 area 1 d img,78800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Rp loclzj tum 2+area 1+d img,78801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Rp loclzj tum whbdy 1 d img,78802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Rp loclzj tum spect 1 area,78803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,510.4,5030.35,fee schedule,
Rp loclzj tum whbdy 2+d img,78804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Iv inj ra drug dx study,78808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,case rate,
Pet image ltd area,78811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Pet image skull-thigh,78812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Pet image full body,78813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Pet image w/ct lmtd,78814,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Pet image w/ct skull-thigh,78815,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Pet image w/ct full body,78816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Rp loclzj tum spect w/ct 1,78830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Rp loclzj tum spect 2 areas,78831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1438.64,,,,649.04,5030.35,fee schedule,
Rp loclzj tum spect w/ct 2,78832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1585.03,,,,728.29,5644.64,fee schedule,
Unlisted misc px dx nuc med,78999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Nuclear rx oral admin,79005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Nuclear rx iv admin,79101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Nuclear rx intracav admin,79200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Nuclr rx interstit colloid,79300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Hematopoietic nuclear tx,79403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Nuclear rx intra-articular,79440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Nuclear rx intra-arterial,79445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Rp therapy unlisted px,79999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.06,,,,122.12,946.48,fee schedule,
Metabolic panel ionized ca,80047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.73,,,,13.73,22.65,fee schedule,
Metabolic panel total ca,80048,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.46,,,,8.46,13.96,fee schedule,
Electrolyte panel,80051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.01,,,,7.01,11.57,fee schedule,
Comprehen metabolic panel,80053,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.56,,,,10.56,17.42,fee schedule,
Obstetric panel,80055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.81,,,,47.81,78.89,fee schedule,
Lipid panel,80061,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.39,,,,13.39,22.09,fee schedule,
Renal function panel,80069,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.68,,,,8.68,14.32,fee schedule,
Acute hepatitis panel,80074,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.63,,,,47.63,78.59,fee schedule,
Hepatic function panel,80076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.17,,,,8.17,13.48,fee schedule,
Obstetric panel,80081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.86,,,,74.86,123.52,fee schedule,
Drug assay acetaminophen,80143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Drug assay adalimumab,80145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.57,,,,38.57,63.64,fee schedule,
Assay of amikacin,80150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.08,,,,15.08,24.88,fee schedule,
Drug assay amiodarone,80151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Drug assay caffeine,80155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.57,,,,38.57,63.64,fee schedule,
Assay carbamazepine total,80156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.57,,,,14.57,24.04,fee schedule,
Assay carbamazepine free,80157,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Drug assay cyclosporine,80158,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.05,,,,18.05,29.78,fee schedule,
Drug assay clozapine,80159,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.15,,,,20.15,33.25,fee schedule,
Asy carbamazepin 1011-epxid,80161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Assay of digoxin total,80162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.28,,,,13.28,21.91,fee schedule,
Assay of digoxin free,80163,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.28,,,,13.28,21.91,fee schedule,
Assay dipropylacetic acd tot,80164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.54,,,,13.54,22.34,fee schedule,
Dipropylacetic acid free,80165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.54,,,,13.54,22.34,fee schedule,
Drug assay felbamate,80167,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Assay of ethosuximide,80168,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.34,,,,16.34,26.96,fee schedule,
Drug assay everolimus,80169,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.73,,,,13.73,22.65,fee schedule,
Assay of gentamicin,80170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.38,,,,16.38,27.03,fee schedule,
Drug screen quant gabapentin,80171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.67,,,,21.67,35.76,fee schedule,
Assay of haloperidol,80173,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.78,,,,15.78,26.04,fee schedule,
Drug screen quan lamotrigine,80175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Assay of lidocaine,80176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.69,,,,14.69,24.24,fee schedule,
Drug scrn quan levetiracetam,80177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Assay of lithium,80178,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.61,,,,6.61,10.91,fee schedule,
Drug assay salicylate,80179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Drug scrn quan mycophenolate,80180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.05,,,,18.05,29.78,fee schedule,
Drug assay flecainide,80181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Drug scrn quant oxcarbazepin,80183,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Assay of phenobarbital,80184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.3,,,,15.3,25.25,fee schedule,
Assay of phenytoin total,80185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Assay of phenytoin free,80186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.76,,,,13.76,22.7,fee schedule,
Drug assay posaconazole,80187,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.11,,,,27.11,44.73,fee schedule,
Assay of primidone,80188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.59,,,,16.59,27.37,fee schedule,
Drug assay itraconazole,80189,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.11,,,,27.11,44.73,fee schedule,
Assay of procainamide,80190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,60,,,,60,99,fee schedule,
Assay of procainamide,80192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.75,,,,16.75,27.64,fee schedule,
Drug assay leflunomide,80193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.57,,,,38.57,63.64,fee schedule,
Assay of quinidine,80194,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.6,,,,14.6,24.09,fee schedule,
Assay of sirolimus,80195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.73,,,,13.73,22.65,fee schedule,
Assay of tacrolimus,80197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.73,,,,13.73,22.65,fee schedule,
Assay of theophylline,80198,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.14,,,,14.14,23.33,fee schedule,
Drug screen quant tiagabine,80199,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.11,,,,27.11,44.73,fee schedule,
Assay of tobramycin,80200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.13,,,,16.13,26.61,fee schedule,
Assay of topiramate,80201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.92,,,,11.92,19.67,fee schedule,
Assay of vancomycin,80202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.54,,,,13.54,22.34,fee schedule,
Drug screen quant zonisamide,80203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Drug assay methotrexate,80204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.57,,,,38.57,63.64,fee schedule,
Drug assay rufinamide,80210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.11,,,,27.11,44.73,fee schedule,
Drug asy hydroxychloroquine,80220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Drug assay infliximab,80230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.57,,,,38.57,63.64,fee schedule,
Drug assay lacosamide,80235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.11,,,,27.11,44.73,fee schedule,
Drug assay vedolizumab,80280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.57,,,,38.57,63.64,fee schedule,
Drug assay voriconazole,80285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.11,,,,27.11,44.73,fee schedule,
Quantitative assay drug,80299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.64,,,,18.64,30.76,fee schedule,
Drug test prsmv dir opt obs,80305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.6,,,,12.6,20.79,fee schedule,
Drug test prsmv instrmnt,80306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.14,,,,17.14,28.28,fee schedule,
Drug test prsmv chem anlyzr,80307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62.14,,,,62.14,102.53,fee schedule,
Acth stimulation panel,80400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.62,,,,32.62,53.82,fee schedule,
Acth stimulation panel,80402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.96,,,,86.96,143.48,fee schedule,
Acth stimulation panel,80406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,78.26,,,,78.26,129.13,fee schedule,
Aldosterone suppression eval,80408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,125.5,,,,125.5,207.08,fee schedule,
Calcitonin stimul panel,80410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,80.37,,,,80.37,132.61,fee schedule,
Crh stimulation panel,80412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,801.62,,,,801.62,1322.67,fee schedule,
Testosterone response panel,80414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.64,,,,51.64,85.21,fee schedule,
Tot estradiol response panel,80415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.89,,,,55.89,92.22,fee schedule,
Renin stimulation panel,80416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,209.32,,,,209.32,345.38,fee schedule,
Renin stimulation panel,80417,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.99,,,,43.99,72.58,fee schedule,
Pituitary evaluation panel,80418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,579.48,,,,579.48,956.14,fee schedule,
Dexamethasone panel,80420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.88,,,,161.88,267.1,fee schedule,
Glucagon tolerance panel,80422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.07,,,,46.07,76.02,fee schedule,
Glucagon tolerance panel,80424,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.5,,,,50.5,83.33,fee schedule,
Gonadotropin hormone panel,80426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,148.41,,,,148.41,244.88,fee schedule,
Growth hormone panel,80428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,66.7,,,,66.7,110.06,fee schedule,
Growth hormone panel,80430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.33,,,,129.33,213.39,fee schedule,
Insulin suppression panel,80432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,165.61,,,,165.61,273.26,fee schedule,
Insulin tolerance panel,80434,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,285.03,,,,285.03,470.3,fee schedule,
Insulin tolerance panel,80435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,103,,,,103,169.95,fee schedule,
Metyrapone panel,80436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.16,,,,91.16,150.41,fee schedule,
Trh stimulation panel,80438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.41,,,,50.41,83.18,fee schedule,
Trh stimulation panel,80439,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,67.21,,,,67.21,110.9,fee schedule,
Path clin consltj sf 5-20,80503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Path clin consltj mod 21-40,80504,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Path clin consltj high 41-60,80505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Urinalysis nonauto w/scope,81000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.02,,,,4.02,6.63,fee schedule,
Urinalysis auto w/scope,81001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.17,,,,3.17,5.23,fee schedule,
Urinalysis nonauto w/o scope,81002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.48,,,,3.48,5.74,fee schedule,
Urinalysis auto w/o scope,81003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.25,,,,2.25,3.71,fee schedule,
Urinalysis,81005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.17,,,,2.17,3.58,fee schedule,
Urine screen for bacteria,81007,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.98,,,,29.98,49.47,fee schedule,
Microscopic exam of urine,81015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.05,,,,3.05,5.03,fee schedule,
Urinalysis glass test,81020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.7,,,,4.7,7.76,fee schedule,
Urine pregnancy test,81025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.61,,,,8.61,14.21,fee schedule,
Urinalysis volume measure,81050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.64,,,,3.64,6.01,fee schedule,
Hpa-1 genotyping,81105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hpa-2 genotyping,81106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hpa-3 genotyping,81107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hpa-4 genotyping,81108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hpa-5 genotyping,81109,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hpa-6 genotyping,81110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hpa-9 genotyping,81111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hpa-15 genotyping,81112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Idh1 common variants,81120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,193.25,,,,193.25,318.86,fee schedule,
Idh2 common variants,81121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.79,,,,295.79,488.05,fee schedule,
Dmd dup/delet analysis,81161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,279,,,,279,460.35,fee schedule,
Brca1&2 gen full seq dup/del,81162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1824.88,,,,1025,3011.05,fee schedule,
Brca1&2 gene full seq alys,81163,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,468,,,,468,772.2,fee schedule,
Brca1&2 gen ful dup/del alys,81164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.23,,,,584.23,963.98,fee schedule,
Brca1 gene full seq alys,81165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,466.75,fee schedule,
Brca1 gene full dup/del alys,81166,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,301.35,,,,301.35,497.23,fee schedule,
Brca2 gene full dup/del alys,81167,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,466.75,fee schedule,
Ccnd1/igh translocation alys,81168,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.31,,,,207.31,342.06,fee schedule,
Abl1 gene,81170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300,,,,300,495,fee schedule,
Aff2 gen aly detc abnl allel,81171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Aff2 gen alys charac alleles,81172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
Ar gene full gene sequence,81173,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,301.35,,,,301.35,497.23,fee schedule,
Ar gene known famil variant,81174,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Asxl1 full gene sequence,81175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,676.5,,,,676.5,1116.23,fee schedule,
Asxl1 gene target seq alys,81176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,241.9,,,,241.9,399.14,fee schedule,
Atn1 gene detc abnor alleles,81177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Atxn1 gene detc abnor allele,81178,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Atxn2 gene detc abnor allele,81179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Atxn3 gene detc abnor allele,81180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Atxn7 gene detc abnor allele,81181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Atxn8os gen detc abnor allel,81182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Atxn10 gene detc abnor allel,81183,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Cacna1a gen detc abnor allel,81184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Cacna1a gene full gene seq,81185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,846.27,,,,846.27,1396.35,fee schedule,
Cacna1a gen known famil vrnt,81186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Cnbp gene detc abnor allele,81187,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Cstb gene detc abnor allele,81188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Cstb gene full gene sequence,81189,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
Cstb gene known famil vrnt,81190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Ntrk1 translocation analysis,81191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.31,,,,207.31,342.06,fee schedule,
Ntrk2 translocation analysis,81192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.31,,,,207.31,342.06,fee schedule,
Ntrk3 translocation analysis,81193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.31,,,,207.31,342.06,fee schedule,
Ntrk translocation analysis,81194,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,518.28,,,,518.28,855.16,fee schedule,
Aspa gene,81200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.25,,,,47.25,47.25,fee schedule,
Apc gene full sequence,81201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,780,,,,780,1287,fee schedule,
Apc gene known fam variants,81202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,280,,,,280,462,fee schedule,
Apc gene dup/delet variants,81203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200,,,,200,330,fee schedule,
Ar gene charac alleles,81204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Bckdhb gene,81205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,94.99,,,,94.99,94.99,fee schedule,
Bcr/abl1 gene major bp,81206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,163.96,,,,163.96,270.53,fee schedule,
Bcr/abl1 gene minor bp,81207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,144.84,,,,144.84,238.99,fee schedule,
Bcr/abl1 gene other bp,81208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,214.62,,,,214.62,354.12,fee schedule,
Blm gene,81209,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.31,,,,39.31,39.31,fee schedule,
Braf gene,81210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,175.4,,,,175.4,289.41,fee schedule,
Brca1&2 185&5385&6174 vrnt,81212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,440,,,,440,726,fee schedule,
Brca1 gene known famil vrnt,81215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,375.25,,,,375.25,619.16,fee schedule,
Brca2 gene full seq alys,81216,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.12,,,,185.12,305.45,fee schedule,
Brca2 gene known famil vrnt,81217,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,375.25,,,,375.25,619.16,fee schedule,
Cebpa gene full sequence,81218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,241.9,,,,241.9,399.14,fee schedule,
Calr gene com variants,81219,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.63,,,,121.63,200.69,fee schedule,
Cftr gene com variants,81220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,556.6,,,,556.6,918.39,fee schedule,
Cftr gene known fam variants,81221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,97.22,,,,97.22,160.41,fee schedule,
Cftr gene dup/delet variants,81222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,435.07,,,,435.07,717.87,fee schedule,
Cftr gene full sequence,81223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,499,,,,499,823.35,fee schedule,
Cftr gene intron poly t,81224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,168.75,,,,168.75,278.44,fee schedule,
Cyp2c19 gene com variants,81225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,291.36,,,,291.36,291.36,fee schedule,
Cyp2d6 gene com variants,81226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,450.91,,,,450.91,744,fee schedule,
Cyp2c9 gene com variants,81227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,174.81,fee schedule,
Cytog alys chrml abnr cgh,81228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,900,,,,900,1485,fee schedule,
Cytog alys chrml abnr snpcgh,81229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1160,,,,1160,1914,fee schedule,
Cyp3a4 gene common variants,81230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
Cyp3a5 gene common variants,81231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
Dpyd gene common variants,81232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
Btk gene common variants,81233,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,175.4,,,,175.4,289.41,fee schedule,
Dmpk gene detc abnor allele,81234,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Egfr gene com variants,81235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,324.58,,,,324.58,535.56,fee schedule,
Ezh2 gene full gene sequence,81236,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,466.75,fee schedule,
Ezh2 gene common variants,81237,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,175.4,,,,175.4,289.41,fee schedule,
F9 full gene sequence,81238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,600,,,,600,990,fee schedule,
Dmpk gene charac alleles,81239,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
F2 gene,81240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65.69,,,,65.69,108.39,fee schedule,
F5 gene,81241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,73.37,,,,73.37,121.06,fee schedule,
Fancc gene,81242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.62,,,,36.62,36.62,fee schedule,
Fmr1 gen aly detc abnl allel,81243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,57.04,,,,57.04,94.12,fee schedule,
Fmr1 gen alys charac alleles,81244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,44.89,,,,44.89,74.07,fee schedule,
Flt3 gene,81245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,165.51,,,,165.51,273.09,fee schedule,
Flt3 gene analysis,81246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,83,,,,83,136.95,fee schedule,
G6pd gene alys cmn variant,81247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
G6pd known familial variant,81248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,375.25,,,,375.25,619.16,fee schedule,
G6pd full gene sequence,81249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,600,,,,600,990,fee schedule,
G6pc gene,81250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.49,,,,58.49,58.49,fee schedule,
Gba gene,81251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.25,,,,47.25,47.25,fee schedule,
Gjb2 gene full sequence,81252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.12,,,,101.12,166.85,fee schedule,
Gjb2 gene known fam variants,81253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.52,,,,61.52,101.51,fee schedule,
Gjb6 gene com variants,81254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35,,,,35,35,fee schedule,
Hexa gene,81255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.45,,,,51.45,51.45,fee schedule,
Hfe gene,81256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65.36,,,,65.36,107.84,fee schedule,
Hba1/hba2 gene,81257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,102.26,,,,102.26,168.73,fee schedule,
Hba1/hba2 gene fam vrnt,81258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,375.25,,,,375.25,619.16,fee schedule,
Hba1/hba2 full gene sequence,81259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,600,,,,600,990,fee schedule,
Ikbkap gene,81260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.31,,,,39.31,39.31,fee schedule,
Igh gene rearrange amp meth,81261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,197.99,,,,197.99,326.68,fee schedule,
Igh gene rearrang dir probe,81262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.55,,,,68.55,113.11,fee schedule,
Igh vari regional mutation,81263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,294.52,,,,294.52,485.96,fee schedule,
Igk rearrangeabn clonal pop,81264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,172.73,,,,172.73,285,fee schedule,
Str markers specimen anal,81265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,233.07,,,,233.07,384.57,fee schedule,
Str markers spec anal addl,81266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,304.81,,,,304.81,304.81,fee schedule,
Chimerism anal no cell selec,81267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.46,,,,207.46,342.31,fee schedule,
Chimerism anal w/cell select,81268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,260.79,,,,260.79,430.3,fee schedule,
Hba1/hba2 gene dup/del vrnts,81269,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.4,,,,202.4,333.96,fee schedule,
Jak2 gene,81270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.66,,,,91.66,151.24,fee schedule,
Htt gene detc abnor alleles,81271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Kit gene targeted seq analys,81272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,329.51,,,,329.51,543.69,fee schedule,
Kit gene analys d816 variant,81273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,124.87,,,,124.87,206.04,fee schedule,
Htt gene charac alleles,81274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
Kras gene variants exon 2,81275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,193.25,,,,193.25,318.86,fee schedule,
Kras gene addl variants,81276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,193.25,,,,193.25,318.86,fee schedule,
Cytogenomic neo microra alys,81277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1160,,,,1160,1914,fee schedule,
Igh@/bcl2 translocation alys,81278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.31,,,,207.31,342.06,fee schedule,
Jak2 gene trgt sequence alys,81279,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Ifnl3 gene,81283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,73.37,,,,73.37,121.06,fee schedule,
Fxn gene detc abnor alleles,81284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Fxn gene charac alleles,81285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
Fxn gene full gene sequence,81286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
Mgmt gene prmtr mthyltn alys,81287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,124.64,,,,124.64,205.66,fee schedule,
Mlh1 gene,81288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,192.32,,,,192.32,317.33,fee schedule,
Fxn gene known famil variant,81289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Mcoln1 gene,81290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.31,,,,39.31,39.31,fee schedule,
Mthfr gene,81291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65.34,,,,65.34,65.34,fee schedule,
Mlh1 gene full seq,81292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,675.4,,,,675.4,1114.41,fee schedule,
Mlh1 gene known variants,81293,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,331,,,,331,546.15,fee schedule,
Mlh1 gene dup/delete variant,81294,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.4,,,,202.4,333.96,fee schedule,
Msh2 gene full seq,81295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,381.7,,,,381.7,629.81,fee schedule,
Msh2 gene known variants,81296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,337.73,,,,337.73,557.25,fee schedule,
Msh2 gene dup/delete variant,81297,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,213.3,,,,213.3,351.95,fee schedule,
Msh6 gene full seq,81298,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,641.85,,,,641.85,1059.05,fee schedule,
Msh6 gene known variants,81299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,308,,,,308,508.2,fee schedule,
Msh6 gene dup/delete variant,81300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238,,,,238,392.7,fee schedule,
Microsatellite instability,81301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,348.56,,,,348.56,575.12,fee schedule,
Mecp2 gene full seq,81302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,527.87,,,,527.87,527.87,fee schedule,
Mecp2 gene known variant,81303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,120,,,,120,120,fee schedule,
Mecp2 gene dup/delet variant,81304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,150,,,,150,150,fee schedule,
Myd88 gene p.leu265pro vrnt,81305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,175.4,,,,175.4,289.41,fee schedule,
Nudt15 gene common variants,81306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,291.36,,,,291.36,480.74,fee schedule,
Palb2 gene full gene seq,81307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,676.5,,,,676.5,1116.23,fee schedule,
Palb2 gene known famil vrnt,81308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,301.35,,,,301.35,497.23,fee schedule,
Pik3ca gene trgt seq alys,81309,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
Npm1 gene,81310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,246.52,,,,246.52,406.76,fee schedule,
Nras gene variants exon 2&3,81311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,295.79,,,,295.79,488.05,fee schedule,
Pabpn1 gene detc abnor allel,81312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Pca3/klk3 antigen,81313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,255.05,,,,255.05,420.83,fee schedule,
Pdgfra gene,81314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,329.51,,,,329.51,543.69,fee schedule,
Pml/raralpha com breakpoints,81315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.31,,,,207.31,342.06,fee schedule,
Pml/raralpha 1 breakpoint,81316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.31,,,,207.31,342.06,fee schedule,
Pms2 gene full seq analysis,81317,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,676.5,,,,676.5,1116.23,fee schedule,
Pms2 known familial variants,81318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,331,,,,331,546.15,fee schedule,
Pms2 gene dup/delet variants,81319,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,203.5,,,,203.5,335.78,fee schedule,
Plcg2 gene common variants,81320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,291.36,,,,291.36,480.74,fee schedule,
Pten gene full sequence,81321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,600,,,,600,990,fee schedule,
Pten gene known fam variant,81322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.6,,,,46.6,76.89,fee schedule,
Pten gene dup/delet variant,81323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300,,,,300,495,fee schedule,
Pmp22 gene dup/delet,81324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,758.36,,,,758.36,1251.29,fee schedule,
Pmp22 gene full sequence,81325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,769.58,,,,769.58,1269.81,fee schedule,
Pmp22 gene known fam variant,81326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.6,,,,46.6,76.89,fee schedule,
Sept9 gen prmtr mthyltn alys,81327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,192,,,,192,316.8,fee schedule,
Slco1b1 gene com variants,81328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
Smn1 gene dos/deletion alys,81329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Smpd1 gene common variants,81330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47,,,,47,77.55,fee schedule,
Snrpn/ube3a gene,81331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.07,,,,51.07,84.27,fee schedule,
Serpina1 gene,81332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.65,,,,43.65,72.02,fee schedule,
Tgfbi gene common variants,81333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Runx1 gene targeted seq alys,81334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,329.51,,,,329.51,543.69,fee schedule,
Tpmt gene com variants,81335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
Smn1 gene full gene sequence,81336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,301.35,,,,301.35,497.23,fee schedule,
Smn1 gen nown famil seq vrnt,81337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Mpl gene common variants,81338,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,150.33,,,,150.33,248.04,fee schedule,
Mpl gene seq alys exon 10,81339,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Trb@ gene rearrange amplify,81340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,208.92,,,,208.92,344.72,fee schedule,
Trb@ gene rearrange dirprobe,81341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.59,,,,49.59,81.82,fee schedule,
Trg gene rearrangement anal,81342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.5,,,,201.5,332.48,fee schedule,
Ppp2r2b gen detc abnor allel,81343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Tbp gene detc abnor alleles,81344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Tert gene targeted seq alys,81345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Tyms gene com variants,81346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
Sf3b1 gene common variants,81347,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,193.25,,,,193.25,318.86,fee schedule,
Srsf2 gene common variants,81348,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,175.4,,,,175.4,289.41,fee schedule,
Cytog alys chrml abnr lw-ps,81349,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1197.94,,,,1160,1197.94,fee schedule,
Ugt1a1 gene common variants,81350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,234,,,,234,234,fee schedule,
Tp53 gene full gene sequence,81351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,641.85,,,,641.85,1059.05,fee schedule,
Tp53 gene trgt sequence alys,81352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,329.51,,,,329.51,543.69,fee schedule,
Tp53 gene known famil vrnt,81353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,308,,,,308,508.2,fee schedule,
Vkorc1 gene,81355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,88.2,,,,88.2,88.2,fee schedule,
U2af1 gene common variants,81357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,193.25,,,,193.25,318.86,fee schedule,
Zrsr2 gene common variants,81360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,193.25,,,,193.25,318.86,fee schedule,
Hbb gene com variants,81361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.81,,,,174.81,288.44,fee schedule,
Hbb gene known fam variant,81362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,375.25,,,,375.25,619.16,fee schedule,
Hbb gene dup/del variants,81363,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.4,,,,202.4,333.96,fee schedule,
Hbb full gene sequence,81364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,324.58,,,,324.58,535.56,fee schedule,
Hla i & ii typing lr,81370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,402.12,,,,402.12,663.5,fee schedule,
Hla i & ii type verify lr,81371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,404.52,,,,404.52,667.46,fee schedule,
Hla i typing complete lr,81372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.59,,,,403.59,665.92,fee schedule,
Hla i typing 1 locus lr,81373,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,127.43,,,,127.43,210.26,fee schedule,
Hla i typing 1 antigen lr,81374,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.33,,,,74.33,122.64,fee schedule,
Hla ii typing ag equiv lr,81375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,220.74,,,,220.74,364.22,fee schedule,
Hla ii typing 1 locus lr,81376,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.22,,,,122.22,201.66,fee schedule,
Hla ii type 1 ag equiv lr,81377,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,94.74,,,,94.74,156.32,fee schedule,
Hla i & ii typing hr,81378,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,345.57,,,,345.57,570.19,fee schedule,
Hla i typing complete hr,81379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,335.38,,,,335.38,553.38,fee schedule,
Hla i typing 1 locus hr,81380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,177.25,,,,177.25,292.46,fee schedule,
Hla i typing 1 allele hr,81381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,169.9,,,,169.9,280.34,fee schedule,
Hla ii typing 1 loc hr,81382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,123.68,,,,123.68,204.07,fee schedule,
Hla ii typing 1 allele hr,81383,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,109.13,,,,109.13,180.06,fee schedule,
Mopath procedure level 1,81400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63.96,,,,63.96,105.53,fee schedule,
Mopath procedure level 2,81401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137,,,,137,226.05,fee schedule,
Mopath procedure level 3,81402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,150.33,,,,150.33,248.04,fee schedule,
Mopath procedure level 4,81403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,185.2,,,,185.2,305.58,fee schedule,
Mopath procedure level 5,81404,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274.83,,,,274.83,453.47,fee schedule,
Mopath procedure level 6,81405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,301.35,,,,301.35,497.23,fee schedule,
Mopath procedure level 7,81406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.88,,,,282.88,466.75,fee schedule,
Mopath procedure level 8,81407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,846.27,,,,846.27,1396.35,fee schedule,
Mopath procedure level 9,81408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2000,,,,2000,3300,fee schedule,
Aortic dysfunction/dilation,81410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,504,,,,504,831.6,fee schedule,
Aortic dysfunction/dilation,81411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1350.19,,,,1350.19,2227.81,fee schedule,
Ashkenazi jewish assoc dis,81412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2448.56,,,,2448.56,4040.12,fee schedule,
Car ion chnnlpath inc 10 gns,81413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,649.89,fee schedule,
Car ion chnnlpath inc 2 gns,81414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,649.89,fee schedule,
Exome sequence analysis,81415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4780,,,,4780,7887,fee schedule,
Exome sequence analysis,81416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12000,,,,2760,19800,fee schedule,
Exome re-evaluation,81417,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,320,,,,320,528,fee schedule,
Rx metab gen seq alys pnl 6,81418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,917.08,,,,856.12,1513.18,fee schedule,
Epilepsy gen seq alys panel,81419,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2448.56,,,,2448.56,4040.12,fee schedule,
Fetal chrmoml aneuploidy,81420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,759.05,,,,759.05,1252.43,fee schedule,
Fetal chrmoml microdeltj,81422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,759.05,,,,759.05,759.05,fee schedule,
Genome sequence analysis,81425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5031.2,,,,5031.2,8301.48,fee schedule,
Genome sequence analysis,81426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2709.95,,,,2709.95,4471.42,fee schedule,
Genome re-evaluation,81427,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2337.65,,,,2337.65,3857.12,fee schedule,
Hearing loss sequence analys,81430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1625,,,,1625,2681.25,fee schedule,
Hearing loss dup/del analys,81431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,679.57,,,,679.57,1121.29,fee schedule,
Hrdtry brst ca-rlatd dsordrs,81432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,679.05,,,,679.05,1120.43,fee schedule,
Hrdtry brst ca-rlatd dsordrs,81433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,438.93,,,,438.93,724.23,fee schedule,
Hereditary retinal disorders,81434,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,597.91,,,,597.91,597.91,fee schedule,
Hereditary colon ca dsordrs,81435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,965.09,fee schedule,
Hereditary colon ca dsordrs,81436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,965.09,fee schedule,
Heredtry nurondcrn tum dsrdr,81437,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,438.93,,,,438.93,487.7,fee schedule,
Heredtry nurondcrn tum dsrdr,81438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,438.93,,,,438.93,487.7,fee schedule,
Hrdtry cardmypy gene panel,81439,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,649.89,fee schedule,
Mitochondrial gene,81440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3324,,,,3324,3324,fee schedule,
Ibmfs seq alys pnl 30 genes,81441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2448.56,,,,2448.56,4040.12,fee schedule,
Noonan spectrum disorders,81442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2143.6,,,,2143.6,2143.6,fee schedule,
Genetic tstg severe inh cond,81443,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2448.56,,,,2448.56,2448.56,fee schedule,
So neo gsap 5-50dna/dna&rna,81445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,597.91,,,,597.91,986.55,fee schedule,
Hrdtry perph neurphy panel,81448,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,584.9,,,,584.9,965.09,fee schedule,
So neo gsap 5-50 rna alys,81449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,597.91,,,,597.91,986.55,fee schedule,
Hl neo gsap 5-50dna/dna&rna,81450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,759.53,,,,759.53,1253.22,fee schedule,
Hl neo gsap 5-50 rna alys,81451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,759.53,,,,759.53,1253.22,fee schedule,
So/hl 51/>gsap dna/dna&rna,81455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2919.6,,,,2919.6,4817.34,fee schedule,
So/hl 51/>gsap rna alys,81456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2919.6,,,,2919.6,4817.34,fee schedule,
Whole mitochondrial genome,81460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1287,,,,1287,2123.55,fee schedule,
Whole mitochondrial genome,81465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,936,,,,936,1544.4,fee schedule,
X-linked intellectual dblt,81470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,914,,,,914,1508.1,fee schedule,
X-linked intellectual dblt,81471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,914,,,,914,1508.1,fee schedule,
Autoimmune ra alys 12 bmrk,81490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,840.65,,,,840.65,840.65,fee schedule,
Cor artery disease mrna,81493,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1050,,,,1050,1050,fee schedule,
Onco (ovar) two proteins,81500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,260.5,,,,260.5,429.83,fee schedule,
Onco (ovar) five proteins,81503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,897,,,,897,1480.05,fee schedule,
Oncology tissue of origin,81504,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,520,,,,520,520,fee schedule,
Endo assay seven anal,81506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.92,,,,68.92,74.67,fee schedule,
Fetal aneuploidy trisom risk,81507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,795,,,,795,1311.75,fee schedule,
Ftl cgen abnor two proteins,81508,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.3,,,,54.3,54.3,fee schedule,
Ftl cgen abnor 3 proteins,81509,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1487.37,,,,1487.37,1487.37,fee schedule,
Ftl cgen abnor three anal,81510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.54,,,,55.54,55.54,fee schedule,
Ftl cgen abnor four anal,81511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,153.5,,,,153.5,253.28,fee schedule,
Ftl cgen abnor five anal,81512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69.52,,,,69.52,69.52,fee schedule,
Nfct ds bv rna vag flu alg,81513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,235.34,fee schedule,
Nfct ds bv&vaginitis dna alg,81514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,262.99,,,,262.99,433.93,fee schedule,
Liver ds alys 3 bmrk srm alg,81517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,176.19,,,,176.19,526.19,fee schedule,
Onc brst mrna 11 genes,81518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Oncology breast mrna,81519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Onc breast mrna 58 genes,81520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2510.21,,,,2510.21,4141.85,fee schedule,
Onc breast mrna 70 genes,81521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Onc breast mrna 12 genes,81522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Onc brst mrna 70 cnt 31 gene,81523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,3873,fee schedule,
Oncology colon mrna,81525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3116,,,,3116,3116,fee schedule,
Oncology colorectal scr,81528,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,508.87,,,,508.87,839.64,fee schedule,
Onc cutan mlnma mrna 31 gene,81529,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7193,,,,7193,11868.45,fee schedule,
Oncology gynecologic,81535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,579.46,,,,579.46,579.46,fee schedule,
Oncology gynecologic,81536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,177.56,,,,177.56,177.56,fee schedule,
Oncology lung,81538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2871,,,,2871,2871,fee schedule,
Oncology prostate prob score,81539,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760,,,,760,760,fee schedule,
Oncology tum unknown origin,81540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3750,,,,3750,3750,fee schedule,
Onc prostate mrna 46 genes,81541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Onc prostate mrna 22 cnt gen,81542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3873,,,,3873,6390.45,fee schedule,
Onc thyr mrna 10196 gen alg,81546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3600,,,,3600,5940,fee schedule,
Onc prostate 3 genes,81551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2030,,,,2030,3349.5,fee schedule,
Onc uveal mlnma mrna 15 gene,81552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7776,,,,7776,12830.4,fee schedule,
Pulm ds ipf mrna 190 gen alg,81554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5500,,,,5500,9075,fee schedule,
Trnsplj pd lvr&bwl cd154+cll,81560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,640.73,,,,640.73,640.73,fee schedule,
Cardiology hrt trnspl mrna,81595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3240,,,,3240,3240,fee schedule,
Nfct ds chrnc hcv 6 assays,81596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.19,,,,72.19,119.11,fee schedule,
Test for acetone/ketones,82009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.52,,,,4.52,7.46,fee schedule,
Acetone assay,82010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.17,,,,8.17,13.48,fee schedule,
Acetylcholinesterase assay,82013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.29,,,,12.29,20.28,fee schedule,
Acylcarnitines qual,82016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.49,,,,16.49,27.21,fee schedule,
Acylcarnitines quant,82017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.87,,,,16.87,27.84,fee schedule,
Assay of acth,82024,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.62,,,,38.62,63.72,fee schedule,
Assay of adp & amp,82030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.8,,,,25.8,42.57,fee schedule,
Assay of serum albumin,82040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.95,,,,4.95,8.17,fee schedule,
Other source albumin quan ea,82042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.78,,,,7.78,12.84,fee schedule,
Ur albumin quantitative,82043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.78,,,,5.78,9.54,fee schedule,
Ur albumin semiquantitative,82044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.23,,,,6.23,10.28,fee schedule,
Albumin ischemia modified,82045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.94,,,,33.94,56,fee schedule,
Assay of breath ethanol,82075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30,,,,30,49.5,fee schedule,
Assay spec xcp ur&breath ia,82077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,28.5,fee schedule,
Assay of aldolase,82085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.71,,,,9.71,16.02,fee schedule,
Assay of aldosterone,82088,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.75,,,,40.75,67.24,fee schedule,
Alpha-1-antitrypsin total,82103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.44,,,,13.44,22.18,fee schedule,
Alpha-1-antitrypsin pheno,82104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.46,,,,14.46,23.86,fee schedule,
Alpha-fetoprotein serum,82105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.77,,,,16.77,27.67,fee schedule,
Alpha-fetoprotein amniotic,82106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17,,,,17,28.05,fee schedule,
Alpha-fetoprotein l3,82107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.41,,,,64.41,106.28,fee schedule,
Assay of aluminum,82108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.48,,,,25.48,42.04,fee schedule,
Amines vaginal fluid qual,82120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.99,,,,5.99,9.88,fee schedule,
Amino acid single qual,82127,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.18,,,,14.18,23.4,fee schedule,
Amino acids mult qual,82128,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.87,,,,13.87,22.89,fee schedule,
Amino acids single quant,82131,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.98,,,,22.98,37.92,fee schedule,
Assay aminolevulinic acid,82135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.45,,,,16.45,27.14,fee schedule,
Amino acids quant 2-5,82136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.61,,,,19.61,32.36,fee schedule,
Amino acids quan 6 or more,82139,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.87,,,,16.87,27.84,fee schedule,
Assay of ammonia,82140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.57,,,,14.57,24.04,fee schedule,
Amniotic fluid scan,82143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.35,,,,9.35,15.43,fee schedule,
Assay of amylase,82150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.48,,,,6.48,10.69,fee schedule,
Androstanediol glucuronide,82154,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.83,,,,28.83,47.57,fee schedule,
Assay of androstenedione,82157,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.28,,,,29.28,48.31,fee schedule,
Assay of androsterone,82160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.55,,,,25.55,42.16,fee schedule,
Assay of angiotensin ii,82163,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.52,,,,20.52,33.86,fee schedule,
Angiotensin i enzyme test,82164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.6,,,,14.6,24.09,fee schedule,
Assay anti-mullerian horm,82166,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.62,,,,38.62,38.62,fee schedule,
Assay of apolipoprotein,82172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.09,,,,21.09,34.8,fee schedule,
Assay of arsenic,82175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.97,,,,18.97,31.3,fee schedule,
Assay of ascorbic acid,82180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.89,,,,9.89,16.32,fee schedule,
Atomic absorption,82190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.9,,,,15.9,26.24,fee schedule,
Assay of beta-2 protein,82232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.18,,,,16.18,26.7,fee schedule,
Bile acids total,82239,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.12,,,,17.12,28.25,fee schedule,
Bile acids cholylglycine,82240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.58,,,,26.58,43.86,fee schedule,
Bilirubin total,82247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.02,,,,5.02,8.28,fee schedule,
Bilirubin direct,82248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.02,,,,5.02,8.28,fee schedule,
Fecal bilirubin test,82252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.56,,,,4.56,7.52,fee schedule,
Assay of biotinidase,82261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.87,,,,16.87,27.84,fee schedule,
Occult blood feces,82270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.38,,,,4.38,7.23,fee schedule,
Occult blood other sources,82271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.32,,,,5.32,8.78,fee schedule,
Occult bld feces 1-3 tests,82272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.23,,,,4.23,6.98,fee schedule,
Assay test for blood fecal,82274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.92,,,,15.92,26.27,fee schedule,
Assay of bradykinin,82286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.16,,,,5.16,8.51,fee schedule,
Assay of cadmium,82300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.64,,,,23.64,39.01,fee schedule,
Vitamin d 25 hydroxy,82306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.6,,,,29.6,48.84,fee schedule,
Assay of calcitonin,82308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.79,,,,26.79,44.2,fee schedule,
Assay of calcium,82310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.16,,,,5.16,8.51,fee schedule,
Assay of calcium,82330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.68,,,,13.68,22.57,fee schedule,
Calcium infusion test,82331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.34,,,,13.34,22.01,fee schedule,
Assay of calcium in urine,82340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.03,,,,6.03,9.95,fee schedule,
Calculus analysis qual,82355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.58,,,,11.58,19.11,fee schedule,
Calculus assay quant,82360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.87,,,,12.87,21.24,fee schedule,
Calculus spectroscopy,82365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.9,,,,12.9,21.29,fee schedule,
X-ray assay calculus,82370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.52,,,,12.52,20.66,fee schedule,
Assay c-d transfer measure,82373,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.06,,,,18.06,29.8,fee schedule,
Assay blood carbon dioxide,82374,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.88,,,,4.88,8.05,fee schedule,
Assay carboxyhb quant,82375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.32,,,,12.32,20.33,fee schedule,
Assay carboxyhb qual,82376,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.07,,,,14.07,23.22,fee schedule,
Carcinoembryonic antigen,82378,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.96,,,,18.96,31.28,fee schedule,
Assay of carnitine,82379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.87,,,,16.87,27.84,fee schedule,
Assay of carotene,82380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.22,,,,9.22,15.21,fee schedule,
Assay urine catecholamines,82382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.3,,,,27.3,45.05,fee schedule,
Assay blood catecholamines,82383,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.08,,,,29.08,47.98,fee schedule,
Assay three catecholamines,82384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.25,,,,25.25,41.66,fee schedule,
Assay of cathepsin-d,82387,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.06,,,,18.06,29.8,fee schedule,
Assay of ceruloplasmin,82390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.74,,,,10.74,17.72,fee schedule,
Chemiluminescent assay,82397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.12,,,,14.12,23.3,fee schedule,
Assay of chloramphenicol,82415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.67,,,,12.67,20.91,fee schedule,
Assay of blood chloride,82435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.6,,,,4.6,7.59,fee schedule,
Assay of urine chloride,82436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.75,,,,5.75,9.49,fee schedule,
Assay other fluid chlorides,82438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5,,,,5,8.25,fee schedule,
Test for chlorohydrocarbons,82441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.01,,,,6.01,9.92,fee schedule,
Assay bld/serum cholesterol,82465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.35,,,,4.35,7.18,fee schedule,
Assay serum cholinesterase,82480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.87,,,,7.87,12.99,fee schedule,
Assay rbc cholinesterase,82482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.81,,,,9.81,16.19,fee schedule,
Assay chondroitin sulfate,82485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.65,,,,20.65,34.07,fee schedule,
Assay of chromium,82495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.28,,,,20.28,33.46,fee schedule,
Assay of citrate,82507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.8,,,,27.8,45.87,fee schedule,
Collagen crosslinks,82523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.68,,,,18.68,30.82,fee schedule,
Assay of copper,82525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.41,,,,12.41,20.48,fee schedule,
Assay of corticosterone,82528,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.52,,,,22.52,37.16,fee schedule,
Cortisol free,82530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.71,,,,16.71,27.57,fee schedule,
Total cortisol,82533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.3,,,,16.3,26.9,fee schedule,
Assay of creatine,82540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.64,,,,4.64,7.66,fee schedule,
Col chromotography qual/quan,82542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.09,,,,24.09,39.75,fee schedule,
Assay of ck (cpk),82550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.51,,,,6.51,10.74,fee schedule,
Assay of cpk in blood,82552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.39,,,,13.39,22.09,fee schedule,
Creatine mb fraction,82553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.55,,,,11.55,19.06,fee schedule,
Creatine isoforms,82554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.87,,,,11.87,19.59,fee schedule,
Assay of creatinine,82565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.12,,,,5.12,8.45,fee schedule,
Assay of urine creatinine,82570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.18,,,,5.18,8.55,fee schedule,
Creatinine clearance test,82575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.46,,,,9.46,15.61,fee schedule,
Assay of cryofibrinogen,82585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.14,,,,14.14,23.33,fee schedule,
Assay of cryoglobulin,82595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Assay of cyanide,82600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.4,,,,19.4,32.01,fee schedule,
Vitamin b-12,82607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.08,,,,15.08,24.88,fee schedule,
B-12 binding capacity,82608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.32,,,,14.32,23.63,fee schedule,
Cystatin c,82610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.52,,,,18.52,30.56,fee schedule,
Test for urine cystines,82615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.55,,,,9.55,15.76,fee schedule,
Dehydroepiandrosterone,82626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.27,,,,25.27,41.7,fee schedule,
Dehydroepiandrosterone,82627,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.23,,,,22.23,36.68,fee schedule,
Desoxycorticosterone,82633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.98,,,,30.98,51.12,fee schedule,
Deoxycortisol,82634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.28,,,,29.28,48.31,fee schedule,
Assay of dibucaine number,82638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.25,,,,12.25,20.21,fee schedule,
Dihydrotestosterone,82642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.28,,,,29.28,48.31,fee schedule,
Vit d 1 25-dihydroxy,82652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.5,,,,38.5,63.53,fee schedule,
El-1 fecal quantitative,82653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.97,,,,22.97,22.97,fee schedule,
El-1 fecal qual/semiq,82656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,19.02,fee schedule,
Enzyme cell activity,82657,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.17,,,,22.17,36.58,fee schedule,
Enzyme cell activity ra,82658,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,44.03,,,,44.03,72.65,fee schedule,
Electrophoretic test,82664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.5,,,,61.5,101.48,fee schedule,
Assay of erythropoietin,82668,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.79,,,,18.79,31,fee schedule,
Assay of total estradiol,82670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.94,,,,27.94,46.1,fee schedule,
Assay of estrogens,82671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.3,,,,32.3,53.3,fee schedule,
Assay of estrogen,82672,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.7,,,,21.7,35.81,fee schedule,
Assay of estriol,82677,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.18,,,,24.18,39.9,fee schedule,
Assay of estrone,82679,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.95,,,,24.95,41.17,fee schedule,
Assay dir meas fr estradiol,82681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.94,,,,27.94,46.1,fee schedule,
Assay of ethylene glycol,82693,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.9,,,,14.9,24.59,fee schedule,
Assay of etiocholanolone,82696,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.24,,,,26.24,43.3,fee schedule,
Fats/lipids feces qual,82705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.1,,,,5.1,8.42,fee schedule,
Fats/lipids feces quant,82710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.8,,,,16.8,27.72,fee schedule,
Assay of fecal fat,82715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.97,,,,22.97,37.9,fee schedule,
Assay of blood fatty acids,82725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.77,,,,18.77,30.97,fee schedule,
Long chain fatty acids,82726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.75,,,,19.75,32.59,fee schedule,
Assay of ferritin,82728,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.63,,,,13.63,22.49,fee schedule,
Assay of fetal fibronectin,82731,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.41,,,,64.41,106.28,fee schedule,
Assay of fluoride,82735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.54,,,,18.54,30.59,fee schedule,
Assay of folic acid serum,82746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.7,,,,14.7,24.26,fee schedule,
Assay of folic acid rbc,82747,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.65,,,,17.65,29.12,fee schedule,
Assay of semen fructose,82757,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.34,,,,17.34,28.61,fee schedule,
Assay of rbc galactokinase,82759,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.48,,,,21.48,35.44,fee schedule,
Assay of galactose,82760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.2,,,,11.2,18.48,fee schedule,
Assay galactose transferase,82775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.07,,,,21.07,34.77,fee schedule,
Galactose transferase test,82776,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.74,,,,11.74,19.37,fee schedule,
Galectin-3,82777,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,44.25,,,,44.25,73.01,fee schedule,
Assay iga/igd/igg/igm each,82784,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.3,,,,9.3,15.35,fee schedule,
Assay of ige,82785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.46,,,,16.46,27.16,fee schedule,
Igg 1 2 3 or 4 each,82787,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.02,,,,8.02,13.23,fee schedule,
Blood ph,82800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11,,,,11,18.15,fee schedule,
Blood gases any combination,82803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.07,,,,26.07,43.02,fee schedule,
Blood gases w/o2 saturation,82805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,78.77,,,,78.77,129.97,fee schedule,
Blood gases o2 sat only,82810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.77,,,,9.77,16.12,fee schedule,
Hemoglobin-oxygen affinity,82820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.34,,,,13.34,22.01,fee schedule,
Gastric analy w/ph ea spec,82930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.71,,,,6.71,11.07,fee schedule,
Gastrin test,82938,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.69,,,,17.69,29.19,fee schedule,
Assay of gastrin,82941,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.63,,,,17.63,29.09,fee schedule,
Assay of glucagon,82943,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.29,,,,14.29,23.58,fee schedule,
Glucose other fluid,82945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.93,,,,3.93,6.48,fee schedule,
Glucagon tolerance test,82946,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.77,,,,17.77,29.32,fee schedule,
Assay glucose blood quant,82947,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.93,,,,3.93,6.48,fee schedule,
Reagent strip/blood glucose,82948,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.04,,,,5.04,8.32,fee schedule,
Glucose test,82950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.75,,,,4.75,7.84,fee schedule,
Glucose tolerance test (gtt),82951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.87,,,,12.87,21.24,fee schedule,
Gtt-added samples,82952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.92,,,,3.92,6.47,fee schedule,
Assay of g6pd enzyme,82955,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.7,,,,9.7,16.01,fee schedule,
Test for g6pd enzyme,82960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.05,,,,6.05,9.98,fee schedule,
Glucose blood test,82962,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.28,,,,3.28,5.41,fee schedule,
Assay of glucosidase,82963,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.48,,,,21.48,35.44,fee schedule,
Assay of gdh enzyme,82965,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.15,,,,13.15,21.7,fee schedule,
Assay of ggt,82977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.2,,,,7.2,11.88,fee schedule,
Assay of glutathione,82978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.45,,,,15.45,25.49,fee schedule,
Assay rbc glutathione,82979,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.44,,,,9.44,15.58,fee schedule,
Assay of glycated protein,82985,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.76,,,,16.76,27.65,fee schedule,
Assay of gonadotropin (fsh),83001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.58,,,,18.58,30.66,fee schedule,
Assay of gonadotropin (lh),83002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.52,,,,18.52,30.56,fee schedule,
Assay growth hormone (hgh),83003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.67,,,,16.67,27.51,fee schedule,
Growth stimulation gene 2,83006,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,75.6,,,,75.6,124.74,fee schedule,
H pylori (c-13) blood,83009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,67.36,,,,67.36,111.14,fee schedule,
Assay of haptoglobin quant,83010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.58,,,,12.58,20.76,fee schedule,
Assay of haptoglobins,83012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.89,,,,26.89,44.37,fee schedule,
H pylori (c-13) breath,83013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,67.36,,,,67.36,111.14,fee schedule,
H pylori drug admin,83014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.86,,,,7.86,12.97,fee schedule,
Heavy metal qual any anal,83015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.94,,,,20.94,34.55,fee schedule,
Heavy metal quant each nes,83018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.96,,,,21.96,36.23,fee schedule,
Hemoglobin electrophoresis,83020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.87,,,,12.87,26.89,fee schedule,
Hemoglobin chromotography,83021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.06,,,,18.06,29.8,fee schedule,
Hemoglobin copper sulfate,83026,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.01,,,,4.01,6.62,fee schedule,
Hemoglobin f fetal chemical,83030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.74,,,,10.74,17.72,fee schedule,
Hemoglobin ftl f assay qual,83033,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8,,,,8,13.2,fee schedule,
Hemoglobin glycosylated a1c,83036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.71,,,,9.71,16.02,fee schedule,
Hb glycosylated a1c home dev,83037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.71,,,,9.71,16.02,fee schedule,
Hgb methemoglobin qual,83045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.49,,,,6.49,10.71,fee schedule,
Hgb methemoglobin quan,83050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.2,,,,8.2,13.53,fee schedule,
Hemoglobin plasma,83051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.31,,,,7.31,12.06,fee schedule,
Hgb sulfhemoglobin quan,83060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.8,,,,8.8,14.52,fee schedule,
Hemoglobin thermolabile,83065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9,,,,9,14.85,fee schedule,
Hemoglobin unstable screen,83068,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.47,,,,9.47,15.63,fee schedule,
Hemoglobin urine,83069,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.95,,,,3.95,6.52,fee schedule,
Assay of hemosiderin qual,83070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.75,,,,4.75,7.84,fee schedule,
Assay of b hexosaminidase ea,83080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.87,,,,16.87,27.84,fee schedule,
Assay of histamine,83088,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.53,,,,29.53,48.72,fee schedule,
Assay of homocysteine,83090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.92,,,,17.92,29.57,fee schedule,
Assay of homovanillic acid,83150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.41,,,,22.41,36.98,fee schedule,
Asy hydroxycorticosteroids17,83491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.9,,,,17.9,29.54,fee schedule,
Assay of 5-hiaa,83497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.9,,,,12.9,21.29,fee schedule,
Asy hydroxyprogesterone 17-d,83498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.17,,,,27.17,44.83,fee schedule,
Assay free hydroxyproline,83500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.65,,,,22.65,37.37,fee schedule,
Assay total hydroxyproline,83505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.3,,,,24.3,40.1,fee schedule,
Immunoassay nonantibody,83516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,19.02,fee schedule,
Immunoassay dipstick,83518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.64,,,,9.64,15.91,fee schedule,
Ria nonantibody,83519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.4,,,,18.4,30.36,fee schedule,
Immunoassay quant nos nonab,83520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,28.5,fee schedule,
Ig light chains free each,83521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,17.27,fee schedule,
Assay of insulin,83525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.43,,,,11.43,18.86,fee schedule,
Assay of insulin,83527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.95,,,,12.95,21.37,fee schedule,
Assay of intrinsic factor,83528,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.82,,,,19.82,32.7,fee schedule,
Asay of interleukin-6 (il-6),83529,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,17.27,fee schedule,
Assay of iron,83540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Iron binding test,83550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.74,,,,8.74,14.42,fee schedule,
Assay of idh enzyme,83570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.85,,,,8.85,14.6,fee schedule,
Assay of ketogenic steroids,83582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.47,,,,15.47,25.53,fee schedule,
Assay 17- ketosteroids,83586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.8,,,,12.8,21.12,fee schedule,
Fractionation ketosteroids,83593,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.5,,,,28.5,47.03,fee schedule,
Assay of lactic acid,83605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.57,,,,11.57,19.09,fee schedule,
Lactate (ld) (ldh) enzyme,83615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.04,,,,6.04,9.97,fee schedule,
Assay of ldh enzymes,83625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.79,,,,12.79,21.1,fee schedule,
Lactoferrin fecal (qual),83630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.7,,,,19.7,32.51,fee schedule,
Lactoferrin fecal (quant),83631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.63,,,,19.63,32.39,fee schedule,
Placental lactogen,83632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.22,,,,20.22,33.36,fee schedule,
Test urine for lactose,83633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.25,,,,11.25,18.56,fee schedule,
Assay of lead,83655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.11,,,,12.11,19.98,fee schedule,
L/s ratio fetal lung,83661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.99,,,,21.99,36.28,fee schedule,
Foam stability fetal lung,83662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.91,,,,18.91,31.2,fee schedule,
Fluoro polarize fetal lung,83663,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.91,,,,18.91,31.2,fee schedule,
Lamellar bdy fetal lung,83664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.32,,,,19.32,31.88,fee schedule,
Assay of lap enzyme,83670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.81,,,,9.81,16.19,fee schedule,
Assay of lipase,83690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.89,,,,6.89,11.37,fee schedule,
Assay of lipoprotein(a),83695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.32,,,,14.32,23.63,fee schedule,
Assay lipoprotein pla2,83698,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.31,,,,46.31,76.41,fee schedule,
Lipopro bld electrophoretic,83700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.26,,,,11.26,18.58,fee schedule,
Lipoprotein bld hr fraction,83701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.86,,,,33.86,55.87,fee schedule,
Lipoprotein bld quan part,83704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.19,,,,34.19,56.41,fee schedule,
Assay of lipoprotein,83718,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.19,,,,8.19,13.51,fee schedule,
Assay of blood lipoprotein,83719,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.75,,,,12.75,21.04,fee schedule,
Assay of blood lipoprotein,83721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.5,,,,10.5,17.33,fee schedule,
Lipoprtn dir meas sd ldl chl,83722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.19,,,,34.19,56.41,fee schedule,
Assay of lrh hormone,83727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.19,,,,17.19,28.36,fee schedule,
Assay of magnesium,83735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.7,,,,6.7,11.06,fee schedule,
Assay malate dehydrogenase,83775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.37,,,,7.37,12.16,fee schedule,
Assay of manganese,83785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.65,,,,26.65,43.97,fee schedule,
Mass spectrometry qual/quan,83789,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.11,,,,24.11,39.78,fee schedule,
Assay of mercury,83825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.26,,,,16.26,26.83,fee schedule,
Assay of metanephrines,83835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.94,,,,16.94,27.95,fee schedule,
Assay of methemalbumin,83857,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.74,,,,10.74,17.72,fee schedule,
Microfluid analy tears,83861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.48,,,,22.48,37.09,fee schedule,
Mucopolysaccharides,83864,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.5,,,,28.5,47.03,fee schedule,
Assay synovial fluid mucin,83872,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.86,,,,5.86,9.67,fee schedule,
Assay of csf protein,83873,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.2,,,,17.2,28.38,fee schedule,
Assay of myoglobin,83874,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.92,,,,12.92,21.32,fee schedule,
Assay myeloperoxidase,83876,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.86,,,,50.86,83.92,fee schedule,
Assay of natriuretic peptide,83880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.26,,,,39.26,64.78,fee schedule,
Assay nephelometry not spec,83883,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.6,,,,13.6,22.44,fee schedule,
Assay of nickel,83885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.51,,,,24.51,40.44,fee schedule,
Assay of nucleotidase,83915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.15,,,,11.15,18.4,fee schedule,
Oligoclonal bands,83916,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.39,,,,27.39,45.19,fee schedule,
Organic acids total quant,83918,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.6,,,,23.6,38.94,fee schedule,
Organic acids qual each,83919,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.45,,,,16.45,27.14,fee schedule,
Organic acid single quant,83921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.21,,,,21.21,35,fee schedule,
Assay of blood osmolality,83930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.61,,,,6.61,10.91,fee schedule,
Assay of urine osmolality,83935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.82,,,,6.82,11.25,fee schedule,
Assay of osteocalcin,83937,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.85,,,,29.85,49.25,fee schedule,
Assay of oxalate,83945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.45,,,,14.45,23.84,fee schedule,
Oncoprotein her-2/neu,83950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.41,,,,64.41,106.28,fee schedule,
Oncoprotein dcp,83951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.41,,,,64.41,106.28,fee schedule,
Assay of parathormone,83970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.28,,,,41.28,68.11,fee schedule,
Assay ph body fluid nos,83986,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.58,,,,3.58,5.91,fee schedule,
Exhaled breath condensate,83987,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.58,,,,3.58,3.98,fee schedule,
Assay for calprotectin fecal,83993,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.63,,,,19.63,32.39,fee schedule,
Assay of blood pku,84030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.5,,,,5.5,9.08,fee schedule,
Assay of phenylketones,84035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.98,,,,3.98,6.57,fee schedule,
Assay acid phosphatase,84060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.64,,,,7.64,12.61,fee schedule,
Assay prostate phosphatase,84066,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.66,,,,9.66,15.94,fee schedule,
Assay alkaline phosphatase,84075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.18,,,,5.18,8.55,fee schedule,
Assay alkaline phosphatase,84078,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.26,,,,8.26,13.63,fee schedule,
Assay alkaline phosphatases,84080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.78,,,,14.78,24.39,fee schedule,
Assay phosphatidylglycerol,84081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.52,,,,16.52,27.26,fee schedule,
Assay of rbc pg6d enzyme,84085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.44,,,,9.44,15.58,fee schedule,
Assay phosphohexose enzymes,84087,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.73,,,,10.73,17.7,fee schedule,
Assay of phosphorus,84100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.74,,,,4.74,7.82,fee schedule,
Assay of urine phosphorus,84105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.78,,,,5.78,9.54,fee schedule,
Test for porphobilinogen,84106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.82,,,,5.82,9.6,fee schedule,
Assay of porphobilinogen,84110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.44,,,,8.44,13.93,fee schedule,
Eval amniotic fluid protein,84112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.11,,,,98.11,161.88,fee schedule,
Test urine for porphyrins,84119,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.36,,,,13.36,22.04,fee schedule,
Assay of urine porphyrins,84120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.71,,,,14.71,24.27,fee schedule,
Assay of feces porphyrins,84126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.11,,,,39.11,64.53,fee schedule,
Assay of serum potassium,84132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.76,,,,4.76,7.85,fee schedule,
Assay of urine potassium,84133,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.73,,,,4.73,7.8,fee schedule,
Assay of prealbumin,84134,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.59,,,,14.59,24.07,fee schedule,
Assay of pregnanediol,84135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.27,,,,21.27,35.1,fee schedule,
Assay of pregnanetriol,84138,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.05,,,,21.05,34.73,fee schedule,
Assay of pregnenolone,84140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.67,,,,20.67,34.11,fee schedule,
Assay of 17-hydroxypregneno,84143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.81,,,,22.81,37.64,fee schedule,
Assay of progesterone,84144,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.86,,,,20.86,34.42,fee schedule,
Procalcitonin (pct),84145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.22,,,,27.22,44.91,fee schedule,
Assay of prolactin,84146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.38,,,,19.38,31.98,fee schedule,
Assay of prostaglandin,84150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.77,,,,41.77,68.92,fee schedule,
Assay of psa complexed,84152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.39,,,,18.39,30.34,fee schedule,
Assay of psa total,84153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.39,,,,18.39,30.34,fee schedule,
Assay of psa free,84154,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.39,,,,18.39,30.34,fee schedule,
Assay of protein serum,84155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.67,,,,3.67,6.06,fee schedule,
Assay of protein urine,84156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.67,,,,3.67,6.06,fee schedule,
Assay of protein other,84157,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4,,,,4,6.6,fee schedule,
Assay of protein any source,84160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.61,,,,5.61,9.26,fee schedule,
Pappa serum,84163,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.05,,,,15.05,24.83,fee schedule,
Protein e-phoresis serum,84165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.74,,,,10.74,26.89,fee schedule,
Protein e-phoresis/urine/csf,84166,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.83,,,,17.83,29.42,fee schedule,
Western blot test,84181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.03,,,,17.03,28.1,fee schedule,
Protein western blot test,84182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.21,,,,26.89,48.2,fee schedule,
Assay rbc protoporphyrin,84202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.35,,,,14.35,23.68,fee schedule,
Test rbc protoporphyrin,84203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.74,,,,9.74,16.07,fee schedule,
Assay of proinsulin,84206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.69,,,,26.69,44.04,fee schedule,
Assay of vitamin b-6,84207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.1,,,,28.1,46.37,fee schedule,
Assay of pyruvate,84210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.48,,,,14.48,23.89,fee schedule,
Assay of pyruvate kinase,84220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.44,,,,9.44,15.58,fee schedule,
Assay of quinine,84228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.63,,,,11.63,19.19,fee schedule,
Assay of estrogen,84233,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,87.88,,,,87.88,145,fee schedule,
Assay of progesterone,84234,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.88,,,,64.88,107.05,fee schedule,
Assay of endocrine hormone,84235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.23,,,,71.23,117.53,fee schedule,
Assay nonendocrine receptor,84238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.57,,,,36.57,60.34,fee schedule,
Assay of renin,84244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.99,,,,21.99,36.28,fee schedule,
Assay of vitamin b-2,84252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.24,,,,20.24,33.4,fee schedule,
Assay of selenium,84255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.53,,,,25.53,42.12,fee schedule,
Assay of serotonin,84260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.98,,,,30.98,51.12,fee schedule,
Assay of sex hormone globul,84270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.73,,,,21.73,35.85,fee schedule,
Assay of sialic acid,84275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.44,,,,13.44,22.18,fee schedule,
Assay of silica,84285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.21,,,,25.21,41.6,fee schedule,
Assay of serum sodium,84295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.81,,,,4.81,7.94,fee schedule,
Assay of urine sodium,84300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.06,,,,5.06,8.35,fee schedule,
Assay of sweat sodium,84302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.86,,,,4.86,8.02,fee schedule,
Assay of somatomedin,84305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.26,,,,21.26,35.08,fee schedule,
Assay of somatostatin,84307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.28,,,,18.28,30.16,fee schedule,
Spectrophotometry,84311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.1,,,,8.1,13.37,fee schedule,
Body fluid specific gravity,84315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.28,,,,3.28,5.41,fee schedule,
Chromatogram assay sugars,84375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39,,,,39,64.35,fee schedule,
Sugars single qual,84376,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.5,,,,5.5,9.08,fee schedule,
Sugars multiple qual,84377,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.5,,,,5.5,9.08,fee schedule,
Sugars single quant,84378,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,19.02,fee schedule,
Sugars multiple quant,84379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,19.02,fee schedule,
Assay of urine sulfate,84392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.49,,,,5.49,9.06,fee schedule,
Assay of free testosterone,84402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.47,,,,25.47,42.03,fee schedule,
Assay of total testosterone,84403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.81,,,,25.81,42.59,fee schedule,
Testosterone bioavailable,84410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.28,,,,51.28,84.61,fee schedule,
Assay of vitamin b-1,84425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.23,,,,21.23,35.03,fee schedule,
Assay of thiocyanate,84430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.63,,,,11.63,19.19,fee schedule,
Thromboxane urine,84431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.11,,,,35.11,57.93,fee schedule,
Assay of thyroglobulin,84432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.06,,,,16.06,26.5,fee schedule,
Asy thiopurin s-mthyltrnsfrs,84433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.17,,,,22.17,36.58,fee schedule,
Assay of total thyroxine,84436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.87,,,,6.87,11.34,fee schedule,
Assay of neonatal thyroxine,84437,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Assay of free thyroxine,84439,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.02,,,,9.02,14.88,fee schedule,
Assay of thyroid activity,84442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.78,,,,14.78,24.39,fee schedule,
Assay thyroid stim hormone,84443,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.8,,,,16.8,27.72,fee schedule,
Assay of tsi globulin,84445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.86,,,,50.86,83.92,fee schedule,
Assay of vitamin e,84446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.18,,,,14.18,23.4,fee schedule,
Assay of transcortin,84449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18,,,,18,29.7,fee schedule,
Transferase (ast) (sgot),84450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.18,,,,5.18,8.55,fee schedule,
Alanine amino (alt) (sgpt),84460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.3,,,,5.3,8.75,fee schedule,
Assay of transferrin,84466,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.76,,,,12.76,21.05,fee schedule,
Assay of triglycerides,84478,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.74,,,,5.74,9.47,fee schedule,
Assay of thyroid (t3 or t4),84479,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Assay triiodothyronine (t3),84480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.18,,,,14.18,23.4,fee schedule,
Free assay (ft-3),84481,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.94,,,,16.94,27.95,fee schedule,
T3 reverse,84482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.76,,,,15.76,26,fee schedule,
Assay of troponin quant,84484,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.47,,,,12.47,20.58,fee schedule,
Assay duodenal fluid trypsin,84485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.2,,,,7.2,11.88,fee schedule,
Test feces for trypsin,84488,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.3,,,,7.3,12.05,fee schedule,
Assay of feces for trypsin,84490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.93,,,,9.93,16.38,fee schedule,
Assay of tyrosine,84510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.63,,,,10.63,17.54,fee schedule,
Assay of troponin qual,84512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.09,,,,10.09,16.65,fee schedule,
Assay of urea nitrogen,84520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.95,,,,3.95,6.52,fee schedule,
Urea nitrogen semi-quant,84525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.13,,,,5.13,8.46,fee schedule,
Assay of urine/urea-n,84540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.56,,,,5.56,9.17,fee schedule,
Urea-n clearance test,84545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.2,,,,7.2,11.88,fee schedule,
Assay of blood/uric acid,84550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.52,,,,4.52,7.46,fee schedule,
Assay of urine/uric acid,84560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.08,,,,5.08,8.38,fee schedule,
Assay of feces/urobilinogen,84577,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.8,,,,16.8,27.72,fee schedule,
Test urine urobilinogen,84578,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.47,,,,4.47,7.38,fee schedule,
Assay of urine urobilinogen,84580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.55,,,,9.55,15.76,fee schedule,
Assay of urine urobilinogen,84583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.05,,,,6.05,9.98,fee schedule,
Assay of urine vma,84585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.5,,,,15.5,25.58,fee schedule,
Assay of vip,84586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.33,,,,35.33,58.29,fee schedule,
Assay of vasopressin,84588,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.94,,,,33.94,56,fee schedule,
Assay of vitamin a,84590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.61,,,,11.61,19.16,fee schedule,
Assay of nos vitamin,84591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.06,,,,17.06,28.15,fee schedule,
Assay of vitamin k,84597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.72,,,,13.72,22.64,fee schedule,
Assay of volatiles,84600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.11,,,,17.11,28.23,fee schedule,
Xylose tolerance test,84620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.91,,,,12.91,21.3,fee schedule,
Assay of zinc,84630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.39,,,,11.39,18.79,fee schedule,
Assay of c-peptide,84681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.81,,,,20.81,34.34,fee schedule,
Chorionic gonadotropin test,84702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.05,,,,15.05,24.83,fee schedule,
Chorionic gonadotropin assay,84703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.52,,,,7.52,12.41,fee schedule,
Hcg free betachain test,84704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.29,,,,15.29,25.23,fee schedule,
Ovulation tests,84830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.7,,,,12.7,20.96,fee schedule,
Bleeding time test,85002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.82,,,,4.82,7.95,fee schedule,
Automated diff wbc count,85004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Bl smear w/diff wbc count,85007,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.8,,,,3.8,6.27,fee schedule,
Bl smear w/o diff wbc count,85008,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.43,,,,3.43,5.66,fee schedule,
Manual diff wbc count b-coat,85009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.07,,,,5.07,8.37,fee schedule,
Spun microhematocrit,85013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7,,,,7,11.55,fee schedule,
Hematocrit,85014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.37,,,,2.37,3.91,fee schedule,
Hemoglobin,85018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.37,,,,2.37,3.91,fee schedule,
Complete cbc w/auto diff wbc,85025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.77,,,,7.77,12.82,fee schedule,
Complete cbc automated,85027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Manual cell count each,85032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.31,,,,4.31,7.11,fee schedule,
Automated rbc count,85041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.02,,,,3.02,4.98,fee schedule,
Manual reticulocyte count,85044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.31,,,,4.31,7.11,fee schedule,
Automated reticulocyte count,85045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.99,,,,3.99,6.58,fee schedule,
Reticyte/hgb concentrate,85046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.57,,,,5.57,9.19,fee schedule,
Automated leukocyte count,85048,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.54,,,,2.54,4.19,fee schedule,
Automated platelet count,85049,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.48,,,,4.48,7.39,fee schedule,
Reticulated platelet assay,85055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.74,,,,35.74,58.97,fee schedule,
Bone marrow interpretation,85097,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,67.85,2942.97,case rate,
Chromogenic substrate assay,85130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.89,,,,11.89,19.62,fee schedule,
Blood clot retraction,85170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.3,,,,16.3,26.9,fee schedule,
Blood clot lysis time,85175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.37,,,,20.37,33.61,fee schedule,
Clot factor ii prothrom spec,85210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.98,,,,12.98,21.42,fee schedule,
Blooc clot factor v test,85220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.65,,,,17.65,29.12,fee schedule,
Clot factor vii proconvertin,85230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.9,,,,17.9,29.54,fee schedule,
Clot factor viii ahg 1 stage,85240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.9,,,,17.9,29.54,fee schedule,
Clot factor viii reltd antgn,85244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.42,,,,20.42,33.69,fee schedule,
Clot factor viii vw ristoctn,85245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.94,,,,22.94,37.85,fee schedule,
Clot factor viii vw antigen,85246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.94,,,,22.94,37.85,fee schedule,
Clot factor viii multimetric,85247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.94,,,,22.94,37.85,fee schedule,
Clot factor ix ptc/chrstmas,85250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.04,,,,19.04,31.42,fee schedule,
Clot factor x stuart-power,85260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.9,,,,17.9,29.54,fee schedule,
Clot factor xi pta,85270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.9,,,,17.9,29.54,fee schedule,
Clot factor xii hageman,85280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.35,,,,19.35,31.93,fee schedule,
Clot factor xiii fibrin stab,85290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.34,,,,16.34,26.96,fee schedule,
Clot factor xiii fibrin scrn,85291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.11,,,,9.11,15.03,fee schedule,
Clot factor fletcher fact,85292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.93,,,,18.93,31.23,fee schedule,
Clot factor wght kininogen,85293,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.93,,,,18.93,31.23,fee schedule,
Antithrombin iii activity,85300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.85,,,,11.85,19.55,fee schedule,
Antithrombin iii antigen,85301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.81,,,,10.81,17.84,fee schedule,
Clot inhibit prot c antigen,85302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.01,,,,12.01,19.82,fee schedule,
Clot inhibit prot c activity,85303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.84,,,,13.84,22.84,fee schedule,
Clot inhibit prot s total,85305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.61,,,,11.61,19.16,fee schedule,
Clot inhibit prot s free,85306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.32,,,,15.32,25.28,fee schedule,
Assay activated protein c,85307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.32,,,,15.32,25.28,fee schedule,
Factor inhibitor test,85335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.87,,,,12.87,21.24,fee schedule,
Thrombomodulin,85337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.27,,,,17.27,28.5,fee schedule,
Coagulation time lee & white,85345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.69,,,,4.69,7.74,fee schedule,
Coagulation time activated,85347,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.28,,,,4.28,7.06,fee schedule,
Coagulation time otr method,85348,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.49,,,,4.49,7.41,fee schedule,
Euglobulin lysis,85360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.41,,,,8.41,13.88,fee schedule,
Fibrin degradation products,85362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.89,,,,6.89,11.37,fee schedule,
Fibrinogen test,85366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,80.46,,,,80.46,132.76,fee schedule,
Fibrinogen test,85370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.43,,,,12.43,20.51,fee schedule,
Fibrin degrade semiquant,85378,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.72,,,,9.72,16.04,fee schedule,
Fibrin degradation quant,85379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.18,,,,10.18,16.8,fee schedule,
Fibrin degradj d-dimer,85380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.18,,,,10.18,16.8,fee schedule,
Fibrinogen activity,85384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.72,,,,9.72,16.04,fee schedule,
Fibrinogen antigen,85385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.46,,,,14.46,23.86,fee schedule,
Fibrinolysins screen i&r,85390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.48,,,,15.48,54.82,fee schedule,
Clotting funct activity,85397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.86,,,,30.86,50.92,fee schedule,
Fibrinolytic plasmin,85400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.71,,,,7.71,12.72,fee schedule,
Fibrinolytic antiplasmin,85410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.71,,,,7.71,12.72,fee schedule,
Fibrinolytic plasminogen,85415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.19,,,,17.19,28.36,fee schedule,
Fibrinolytic plasminogen,85420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.53,,,,6.53,10.77,fee schedule,
Fibrinolytic plasminogen,85421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.18,,,,10.18,16.8,fee schedule,
Heinz bodies direct,85441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.2,,,,4.2,6.93,fee schedule,
Heinz bodies induced,85445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.82,,,,6.82,11.25,fee schedule,
Hemoglobin fetal,85460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.73,,,,7.73,12.75,fee schedule,
Hemoglobin fetal,85461,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.36,,,,9.36,15.44,fee schedule,
Hemolysin acid,85475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.87,,,,8.87,14.64,fee schedule,
Heparin assay,85520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.09,,,,13.09,21.6,fee schedule,
Heparin neutralization,85525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.84,,,,11.84,19.54,fee schedule,
Heparin-protamine tolerance,85530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.09,,,,13.09,21.6,fee schedule,
Iron stain peripheral blood,85536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.88,,,,6.88,11.35,fee schedule,
Wbc alkaline phosphatase,85540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.6,,,,8.6,14.19,fee schedule,
Rbc mechanical fragility,85547,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.6,,,,8.6,14.19,fee schedule,
Muramidase,85549,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.75,,,,18.75,30.94,fee schedule,
Rbc osmotic fragility,85555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.47,,,,7.47,12.33,fee schedule,
Rbc osmotic fragility,85557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.36,,,,13.36,22.04,fee schedule,
Blood platelet aggregation,85576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.91,,,,24.91,41.1,fee schedule,
Phospholipid pltlt neutraliz,85597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.98,,,,17.98,29.67,fee schedule,
Hexagnal phosph pltlt neutrl,85598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.98,,,,17.98,29.67,fee schedule,
Prothrombin time,85610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.29,,,,4.29,7.08,fee schedule,
Prothrombin test,85611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.94,,,,3.94,6.5,fee schedule,
Viper venom prothrombin time,85612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.49,,,,17.49,28.86,fee schedule,
Russell viper venom diluted,85613,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.58,,,,9.58,15.81,fee schedule,
Reptilase test,85635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.85,,,,9.85,16.25,fee schedule,
Rbc sed rate nonautomated,85651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Rbc sed rate automated,85652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.7,,,,2.7,4.46,fee schedule,
Rbc sickle cell test,85660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.51,,,,5.51,9.09,fee schedule,
Thrombin time plasma,85670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.77,,,,5.77,9.52,fee schedule,
Thrombin time titer,85675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.85,,,,6.85,11.3,fee schedule,
Thromboplastin inhibition,85705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.63,,,,9.63,15.89,fee schedule,
Thromboplastin time partial,85730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.01,,,,6.01,9.92,fee schedule,
Thromboplastin time partial,85732,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Blood viscosity examination,85810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.67,,,,11.67,19.26,fee schedule,
Agglutinins febrile antigen,86000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.98,,,,6.98,11.52,fee schedule,
Allergen specific igg,86001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.82,,,,7.82,12.9,fee schedule,
Allg spec ige crude xtrc ea,86003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.22,,,,5.22,8.61,fee schedule,
Allg spec ige multiallg scr,86005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.97,,,,7.97,13.15,fee schedule,
Allg spec ige recomb ea,86008,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.93,,,,17.93,29.58,fee schedule,
Actin antibody each,86015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,19.88,fee schedule,
Wbc antibody identification,86021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.05,,,,15.05,24.83,fee schedule,
Platelet antibodies,86022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.37,,,,18.37,30.31,fee schedule,
Immunoglobulin assay,86023,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.46,,,,12.46,20.56,fee schedule,
Anca screen each antibody,86036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,12.05,fee schedule,
Anca titer each antibody,86037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,12.05,fee schedule,
Antinuclear antibodies,86038,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.09,,,,12.09,19.95,fee schedule,
Antinuclear antibodies (ana),86039,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.16,,,,11.16,18.41,fee schedule,
Acetylcholn rcptr bndng antb,86041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.4,,,,18.4,30.36,fee schedule,
Acetylcholn rcptr blckg antb,86042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.4,,,,18.4,30.36,fee schedule,
Acetylcholn rcptr modlg antb,86043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,19.88,fee schedule,
Aquaporin-4 antb elisa,86051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,11.53,fee schedule,
Aquaporin-4 antb cba each,86052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,12.05,fee schedule,
Aqaprn-4 antb flo cytmtry ea,86053,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.73,,,,37.73,37.73,fee schedule,
Antistreptolysin o titer,86060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.3,,,,7.3,12.05,fee schedule,
Antistreptolysin o screen,86063,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.77,,,,5.77,9.52,fee schedule,
Phys blood bank serv xmatch,86077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Phys blood bank serv reactj,86078,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,51.07,595.98,case rate,
Phys blood bank serv authrj,86079,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
C-reactive protein,86140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.18,,,,5.18,8.55,fee schedule,
C-reactive protein hs,86141,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.95,,,,12.95,21.37,fee schedule,
Beta-2 glycoprotein antibody,86146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.45,,,,25.45,41.99,fee schedule,
Cardiolipin antibody ea ig,86147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.45,,,,25.45,41.99,fee schedule,
Anti-phospholipid antibody,86148,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.07,,,,16.07,26.52,fee schedule,
Cell enumeration & id,86152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.78,,,,250.78,273,fee schedule,
Chemotaxis assay,86155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.99,,,,15.99,26.38,fee schedule,
Cold agglutinin screen,86156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.07,,,,8.07,13.32,fee schedule,
Cold agglutinin titer,86157,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.06,,,,8.06,13.3,fee schedule,
Complement antigen,86160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12,,,,12,19.8,fee schedule,
Complement/function activity,86161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12,,,,12,19.8,fee schedule,
Complement total (ch50),86162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.32,,,,20.32,33.53,fee schedule,
Complement fixation each,86171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.01,,,,10.01,16.52,fee schedule,
Ccp antibody,86200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.95,,,,12.95,21.37,fee schedule,
Deoxyribonuclease antibody,86215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Dna antibody native,86225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.74,,,,13.74,22.67,fee schedule,
Dna antibody single strand,86226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.11,,,,12.11,19.98,fee schedule,
Ema each ig class,86231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.09,,,,12.09,12.09,fee schedule,
Nuclear antigen antibody,86235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.93,,,,17.93,29.58,fee schedule,
Fluorescent antibody screen,86255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,26.89,fee schedule,
Fluorescent antibody titer,86256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,26.89,fee schedule,
Dgp antibody each ig class,86258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,12.05,fee schedule,
Growth hormone antibody,86277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.74,,,,15.74,25.97,fee schedule,
Hemagglutination inhibition,86280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.19,,,,8.19,9.1,fee schedule,
Immunoassay tumor qual,86294,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.57,,,,25.57,42.19,fee schedule,
Immunoassay tumor ca 15-3,86300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.81,,,,20.81,34.34,fee schedule,
Immunoassay tumor ca 19-9,86301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.81,,,,20.81,34.34,fee schedule,
Immunoassay tumor ca 125,86304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.81,,,,20.81,34.34,fee schedule,
Human epididymis protein 4,86305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.81,,,,20.81,23.13,fee schedule,
Heterophile antibody screen,86308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.18,,,,5.18,8.55,fee schedule,
Heterophile antibody titer,86309,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Heterophile antibody absrbj,86310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.37,,,,7.37,12.16,fee schedule,
Immunoassay tumor other,86316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.81,,,,20.81,34.34,fee schedule,
Immunoassay infectious agent,86317,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.99,,,,14.99,24.73,fee schedule,
Ia infectious agent antibody,86318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.09,,,,18.09,29.85,fee schedule,
Serum immunoelectrophoresis,86320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.92,,,,26.89,49.37,fee schedule,
Other immunoelectrophoresis,86325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.13,,,,23.13,38.16,fee schedule,
Immunoelectrophoresis assay,86327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.92,,,,29.92,49.37,fee schedule,
Ia nfct ab sarscov2 covid19,86328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,45.28,,,,45.28,74.71,fee schedule,
Immunodiffusion nes,86329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.05,,,,14.05,23.18,fee schedule,
Immunodiffusion ouchterlony,86331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Immune complex assay,86332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.37,,,,24.37,40.21,fee schedule,
Immunofix e-phoresis serum,86334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.34,,,,22.34,36.86,fee schedule,
Immunfix e-phorsis/urine/csf,86335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.35,,,,26.89,48.43,fee schedule,
Inhibin a,86336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.59,,,,15.59,25.72,fee schedule,
Insulin antibodies,86337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.41,,,,21.41,35.33,fee schedule,
Intrinsic factor antibody,86340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.08,,,,15.08,24.88,fee schedule,
Islet cell antibody,86341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.57,,,,23.57,38.89,fee schedule,
Leukocyte histamine release,86343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.46,,,,12.46,20.56,fee schedule,
Leukocyte phagocytosis,86344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.39,,,,10.39,17.14,fee schedule,
Cell function assay w/stim,86352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,135.86,,,,135.86,224.17,fee schedule,
Lymphocyte transformation,86353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.03,,,,49.03,80.9,fee schedule,
B cells total count,86355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.73,,,,37.73,62.25,fee schedule,
Mononuclear cell antigen,86356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.78,,,,26.78,44.19,fee schedule,
Nk cells total count,86357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.73,,,,37.73,62.25,fee schedule,
T cells total count,86359,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.73,,,,37.73,62.25,fee schedule,
T cell absolute count/ratio,86360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.98,,,,46.98,77.52,fee schedule,
T cell absolute count,86361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.78,,,,26.78,44.19,fee schedule,
Mog-igg1 antb cba each,86362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,12.05,fee schedule,
Mog-igg1 antb flo cytmtry ea,86363,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.73,,,,37.73,37.73,fee schedule,
Tiss trnsgltmnase ea ig clas,86364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,11.53,fee schedule,
Muscle-specific kinase antb,86366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.4,,,,18.4,30.36,fee schedule,
Stem cells total count,86367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.78,,,,77.78,128.34,fee schedule,
Microsomal antibody each,86376,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.55,,,,14.55,24.01,fee schedule,
Mitochondrial antibody each,86381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.45,,,,25.45,25.45,fee schedule,
Neutralization test viral,86382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.91,,,,16.91,27.9,fee schedule,
Nitroblue tetrazolium dye,86384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.61,,,,13.61,22.46,fee schedule,
Nuclear matrix protein 22,86386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.78,,,,21.78,35.94,fee schedule,
Particle agglut antbdy scrn,86403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.54,,,,11.54,19.04,fee schedule,
Particle agglut antbdy titr,86406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.64,,,,10.64,17.56,fee schedule,
Neutrlzg antb sarscov2 scr,86408,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.13,,,,42.13,69.51,fee schedule,
Neutrlzg antb sarscov2 titer,86409,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,79.61,,,,79.61,173.79,fee schedule,
Sars-cov-2 antb quantitative,86413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.43,,,,42.13,84.86,fee schedule,
Rheumatoid factor test qual,86430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.14,,,,6.14,10.13,fee schedule,
Rheumatoid factor quant,86431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.67,,,,5.67,9.36,fee schedule,
Tb test cell immun measure,86480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.98,,,,61.98,102.27,fee schedule,
Tb ag response t-cell susp,86481,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100,,,,100,165,fee schedule,
Skin test candida,86485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,11.38,94.6,case rate,
Skin test unlisted antign ea,86486,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,6.14,94.6,case rate,
Coccidioidomycosis skin test,86490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Histoplasmosis skin test,86510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,7.48,217.85,case rate,
Tb intradermal test,86580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,10.17,94.6,case rate,
Streptokinase antibody,86590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.66,,,,12.66,20.89,fee schedule,
Syphilis test non-trep qual,86592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Syphilis test non-trep quant,86593,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.4,,,,4.4,7.26,fee schedule,
Voltage-gtd ca chnl antb ea,86596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,12.05,fee schedule,
Antinomyces antibody,86602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.18,,,,10.18,16.8,fee schedule,
Adenovirus antibody,86603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.87,,,,12.87,21.24,fee schedule,
Aspergillus antibody,86606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.05,,,,15.05,24.83,fee schedule,
Bacterium antibody,86609,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.88,,,,12.88,21.25,fee schedule,
Bartonella antibody,86611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.18,,,,10.18,16.8,fee schedule,
Blastomyces antibody,86612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.9,,,,12.9,21.29,fee schedule,
Bordetella antibody,86615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Lyme disease antibody,86617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.49,,,,15.49,25.56,fee schedule,
Lyme disease antibody,86618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.03,,,,17.03,28.1,fee schedule,
Borrelia antibody,86619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.38,,,,13.38,22.08,fee schedule,
Brucella antibody,86622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.93,,,,8.93,14.73,fee schedule,
Campylobacter antibody,86625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.12,,,,13.12,21.65,fee schedule,
Candida antibody,86628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.01,,,,12.01,19.82,fee schedule,
Chlamydia antibody,86631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.82,,,,11.82,19.5,fee schedule,
Chlamydia igm antibody,86632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.68,,,,12.68,20.92,fee schedule,
Coccidioides antibody,86635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.47,,,,11.47,18.93,fee schedule,
Q fever antibody,86638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.12,,,,12.12,20,fee schedule,
Cryptococcus antibody,86641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.41,,,,14.41,23.78,fee schedule,
Cmv antibody,86644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.39,,,,14.39,23.74,fee schedule,
Cmv antibody igm,86645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.85,,,,16.85,27.8,fee schedule,
Diphtheria antibody,86648,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.21,,,,15.21,25.1,fee schedule,
Encephalitis californ antbdy,86651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Encephaltis east eqne anbdy,86652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Encephaltis st louis antbody,86653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Encephaltis west eqne antbdy,86654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Enterovirus antibody,86658,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.03,,,,13.03,21.5,fee schedule,
Epstein-barr antibody,86663,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.12,,,,13.12,21.65,fee schedule,
Epstein-barr nuclear antigen,86664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.29,,,,15.29,25.23,fee schedule,
Epstein-barr capsid vca,86665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.14,,,,18.14,29.93,fee schedule,
Ehrlichia antibody,86666,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.18,,,,10.18,16.8,fee schedule,
Francisella tularensis,86668,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.16,,,,14.16,23.36,fee schedule,
Fungus nes antibody,86671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.25,,,,12.25,20.21,fee schedule,
Giardia lamblia antibody,86674,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.72,,,,14.72,24.29,fee schedule,
Helicobacter pylori antibody,86677,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.85,,,,16.85,27.8,fee schedule,
Helminth antibody,86682,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.01,,,,13.01,21.47,fee schedule,
Hemophilus influenza antibdy,86684,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.84,,,,15.84,26.14,fee schedule,
Htlv-i antibody,86687,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.09,,,,9.09,15,fee schedule,
Htlv-ii antibody,86688,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14,,,,14,23.1,fee schedule,
Htlv/hiv confirmj antibody,86689,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.35,,,,19.35,31.93,fee schedule,
Hepatitis delta agent antbdy,86692,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.16,,,,17.16,28.31,fee schedule,
Herpes simplex nes antbdy,86694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.39,,,,14.39,23.74,fee schedule,
Herpes simplex type 1 test,86695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Herpes simplex type 2 test,86696,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.35,,,,19.35,31.93,fee schedule,
Histoplasma antibody,86698,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.79,,,,13.79,22.75,fee schedule,
Hiv-1antibody,86701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.89,,,,8.89,14.67,fee schedule,
Hiv-2 antibody,86702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.52,,,,13.52,22.31,fee schedule,
Hiv-1/hiv-2 1 result antbdy,86703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.71,,,,13.71,22.62,fee schedule,
Hep b core antibody total,86704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,19.88,fee schedule,
Hep b core antibody igm,86705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.77,,,,11.77,19.42,fee schedule,
Hep b surface antibody,86706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.74,,,,10.74,17.72,fee schedule,
Hepatitis be antibody,86707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.57,,,,11.57,19.09,fee schedule,
Hepatitis a antibody,86708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.39,,,,12.39,20.44,fee schedule,
Hepatitis a igm antibody,86709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.26,,,,11.26,18.58,fee schedule,
Influenza virus antibody,86710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.55,,,,13.55,22.36,fee schedule,
John cunningham antibody,86711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.89,,,,16.89,27.87,fee schedule,
Legionella antibody,86713,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.3,,,,15.3,25.25,fee schedule,
Leishmania antibody,86717,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.25,,,,12.25,20.21,fee schedule,
Leptospira antibody,86720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.2,,,,16.2,26.73,fee schedule,
Listeria monocytogenes,86723,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Lymph choriomeningitis ab,86727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.87,,,,12.87,21.24,fee schedule,
Mucormycosis antibody,86732,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15,,,,15,24.75,fee schedule,
Mumps antibody,86735,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.05,,,,13.05,21.53,fee schedule,
Mycoplasma antibody,86738,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.24,,,,13.24,21.85,fee schedule,
Neisseria meningitidis,86741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Nocardia antibody,86744,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.99,,,,15.99,26.38,fee schedule,
Parvovirus antibody,86747,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.03,,,,15.03,24.8,fee schedule,
Malaria antibody,86750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Protozoa antibody nos,86753,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.39,,,,12.39,20.44,fee schedule,
Respiratory virus antibody,86756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.89,,,,15.89,26.22,fee schedule,
Rickettsia antibody,86757,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.35,,,,19.35,31.93,fee schedule,
Rotavirus antibody,86759,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.23,,,,18.23,30.08,fee schedule,
Rubella antibody,86762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.39,,,,14.39,23.74,fee schedule,
Rubeola antibody,86765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.88,,,,12.88,21.25,fee schedule,
Salmonella antibody,86768,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Sars-cov-2 covid-19 antibody,86769,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.13,,,,42.13,69.51,fee schedule,
Shigella antibody,86771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.48,,,,24.48,40.39,fee schedule,
Tetanus antibody,86774,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.8,,,,14.8,24.42,fee schedule,
Toxoplasma antibody,86777,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.39,,,,14.39,23.74,fee schedule,
Toxoplasma antibody igm,86778,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.41,,,,14.41,23.78,fee schedule,
Treponema pallidum,86780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.24,,,,13.24,21.85,fee schedule,
Trichinella antibody,86784,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.56,,,,12.56,20.72,fee schedule,
Varicella-zoster antibody,86787,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.88,,,,12.88,21.25,fee schedule,
West nile virus ab igm,86788,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.85,,,,16.85,27.8,fee schedule,
West nile virus antibody,86789,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.39,,,,14.39,23.74,fee schedule,
Virus antibody nos,86790,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.88,,,,12.88,21.25,fee schedule,
Yersinia antibody,86793,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.19,,,,13.19,21.76,fee schedule,
Zika virus igm antibody,86794,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.85,,,,16.85,27.8,fee schedule,
Thyroglobulin antibody,86800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.91,,,,15.91,26.25,fee schedule,
Hepatitis c ab test,86803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.27,,,,14.27,23.55,fee schedule,
Hep c ab test confirm,86804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.49,,,,15.49,25.56,fee schedule,
Lymphocytotoxicity assay,86805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,189.51,,,,189.51,312.69,fee schedule,
Lymphocytotoxicity assay,86806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.59,,,,47.59,78.52,fee schedule,
Cytotoxic antibody screening,86807,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,78.65,,,,78.65,129.77,fee schedule,
Cytotoxic antibody screening,86808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.68,,,,29.68,48.97,fee schedule,
Hla typing a b or c,86812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.81,,,,25.81,42.59,fee schedule,
Hla typing a b or c,86813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58,,,,58,95.7,fee schedule,
Hla typing dr/dq,86816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,30.17,49.78,fee schedule,
Hla typing dr/dq,86817,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,106.14,,,,106.14,175.13,fee schedule,
Lymphocyte culture mixed,86821,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.56,,,,36.56,60.32,fee schedule,
Hla x-math non-cytotoxic,86825,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,109.49,,,,109.49,180.66,fee schedule,
Hla x-match noncytotoxc addl,86826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.53,,,,36.53,60.27,fee schedule,
Hla class i&ii antibody qual,86828,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.19,,,,64.19,105.91,fee schedule,
Hla class i/ii antibody qual,86829,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.19,,,,64.19,105.91,fee schedule,
Hla class i phenotype qual,86830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.52,,,,95.52,157.61,fee schedule,
Hla class ii phenotype qual,86831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,81.88,,,,81.88,135.1,fee schedule,
Hla class i high defin qual,86832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,323.75,,,,323.75,534.19,fee schedule,
Hla class ii high defin qual,86833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,325.8,,,,325.8,537.57,fee schedule,
Hla class i semiquant panel,86834,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,357.56,,,,357.56,589.97,fee schedule,
Hla class ii semiquant panel,86835,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,322.96,,,,322.96,532.88,fee schedule,
Rbc antibody screen,86850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,9.77,190.03,case rate,
Rbc antibody elution,86860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Rbc antibody identification,86870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,37.25,1228.38,case rate,
Coombs test direct,86880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,5.39,217.85,case rate,
Coombs test indirect qual,86885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,5.72,595.98,case rate,
Coombs test indirect titer,86886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,5.18,595.98,case rate,
Autologous blood process,86890,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Autologous blood op salvage,86891,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,379.71,2942.97,case rate,
Blood typing serologic abo,86900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,2.99,440.06,case rate,
Blood typing serologic rh(d),86901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,2.99,128.71,case rate,
Blood type antigen donor ea,86902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,6.35,1228.38,case rate,
Blood typing patient serum,86904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.34,128.71,case rate,
Blood typing rbc antigens,86905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,3.83,1228.38,case rate,
Bld typing serologic rh phnt,86906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,7.75,128.71,case rate,
Compatibility test spin,86920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,18.92,595.98,case rate,
Compatibility test incubate,86921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,11.06,595.98,case rate,
Compatibility test antiglob,86922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,18.45,595.98,case rate,
Compatibility test electric,86923,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Plasma fresh frozen,86927,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,fee schedule,
Frozen blood prep,86930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,158.49,1228.38,case rate,
Frozen blood thaw,86931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,158.49,1228.38,case rate,
Frozen blood freeze/thaw,86932,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Hemolysins/agglutinins auto,86940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.77,,,,8.77,14.47,fee schedule,
Hemolysins/agglutinins,86941,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.11,,,,12.11,19.98,fee schedule,
Blood product/irradiation,86945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Leukacyte transfusion,86950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Vol reduction of blood/prod,86960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Pooling blood platelets,86965,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Rbc pretx incubatj w/chemicl,86970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Rbc pretx incubatj w/enzymes,86971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,158.49,1228.38,case rate,
Rbc pretx incubatj w/density,86972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Rbc serum pretx incubj drugs,86975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,35.99,1430.99,case rate,
Rbc serum pretx id dilution,86976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Rbc serum pretx incubj/inhib,86977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Rbc pretreatment serum,86978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Split blood or products,86985,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Unlisted transfusion med px,86999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Small animal inoculation,87003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.84,,,,16.84,18.71,fee schedule,
Specimen infect agnt concntj,87015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.68,,,,6.68,11.02,fee schedule,
Blood culture for bacteria,87040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.32,,,,10.32,17.03,fee schedule,
Feces culture aerobic bact,87045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.44,,,,9.44,15.58,fee schedule,
Stool cultr aerobic bact ea,87046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.44,,,,9.44,15.58,fee schedule,
Culture othr specimn aerobic,87070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.62,,,,8.62,14.22,fee schedule,
Culture aerobic quant other,87071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.89,,,,9.89,16.32,fee schedule,
Culture bacteria anaerobic,87073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.66,,,,9.66,15.94,fee schedule,
Cultr bacteria except blood,87075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.47,,,,9.47,15.63,fee schedule,
Culture anaerobe ident each,87076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.08,,,,8.08,13.33,fee schedule,
Culture aerobic identify,87077,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.08,,,,8.08,13.33,fee schedule,
Culture screen only,87081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.63,,,,6.63,10.94,fee schedule,
Culture of specimen by kit,87084,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.07,,,,27.07,44.67,fee schedule,
Urine culture/colony count,87086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.07,,,,8.07,13.32,fee schedule,
Urine bacteria culture,87088,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.09,,,,8.09,13.35,fee schedule,
Skin fungi culture,87101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.71,,,,7.71,12.72,fee schedule,
Fungus isolation culture,87102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.41,,,,8.41,13.88,fee schedule,
Blood fungus culture,87103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.46,,,,20.46,33.76,fee schedule,
Fungi identification yeast,87106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.32,,,,10.32,17.03,fee schedule,
Fungi identification mold,87107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.32,,,,10.32,17.03,fee schedule,
Mycoplasma,87109,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.39,,,,15.39,25.39,fee schedule,
Chlamydia culture,87110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.6,,,,19.6,32.34,fee schedule,
Mycobacteria culture,87116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.8,,,,10.8,17.82,fee schedule,
Mycobacteric identification,87118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.61,,,,14.61,24.11,fee schedule,
Culture type immunofluoresc,87140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.57,,,,5.57,9.19,fee schedule,
Culture typing glc/hplc,87143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.52,,,,12.52,20.66,fee schedule,
Culture type immunologic,87147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.18,,,,5.18,8.55,fee schedule,
Dna/rna direct probe,87149,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Dna/rna amplified probe,87150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Culture type pulse field gel,87152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.74,,,,7.74,12.77,fee schedule,
Dna/rna sequencing,87153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,115.36,,,,115.36,190.34,fee schedule,
Cul typ id bld pthgn 6+ trgt,87154,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,218.06,,,,218.06,218.06,fee schedule,
Culture typing added method,87158,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.74,,,,7.74,12.77,fee schedule,
Dark field examination,87164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.74,,,,10.74,28.96,fee schedule,
Dark field examination,87166,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.3,,,,11.3,18.65,fee schedule,
Macroscopic exam arthropod,87168,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Macroscopic exam parasite,87169,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.31,,,,4.31,7.11,fee schedule,
Pinworm exam,87172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Tissue homogenization cultr,87176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.88,,,,5.88,9.7,fee schedule,
Ova and parasites smears,87177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.9,,,,8.9,14.69,fee schedule,
Microbe susceptible diffuse,87181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.75,,,,4.75,7.84,fee schedule,
Microbe susceptible disk,87184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.48,,,,7.48,12.34,fee schedule,
Microbe susceptible enzyme,87185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.75,,,,4.75,7.84,fee schedule,
Microbe susceptible mic,87186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.65,,,,8.65,14.27,fee schedule,
Microbe susceptible mlc,87187,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.17,,,,40.17,66.28,fee schedule,
Microbe suscept macrobroth,87188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.64,,,,6.64,10.96,fee schedule,
Microbe suscept mycobacteri,87190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.31,,,,7.31,12.06,fee schedule,
Bactericidal level serum,87197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.02,,,,15.02,24.78,fee schedule,
Smear gram stain,87205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Smear fluorescent/acid stai,87206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.39,,,,5.39,8.89,fee schedule,
Smear special stain,87207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.99,,,,5.99,26.89,fee schedule,
Smear complex stain,87209,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.98,,,,17.98,29.67,fee schedule,
Smear wet mount saline/ink,87210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.82,,,,5.82,9.6,fee schedule,
Tissue exam for fungi,87220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Assay toxin or antitoxin,87230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.74,,,,19.74,32.57,fee schedule,
Virus inoculate eggs/animal,87250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.56,,,,19.56,32.27,fee schedule,
Virus inoculation tissue,87252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.07,,,,26.07,43.02,fee schedule,
Virus inoculate tissue addl,87253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.2,,,,20.2,33.33,fee schedule,
Virus inoculation shell via,87254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.56,,,,19.56,32.27,fee schedule,
Genet virus isolate hsv,87255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.86,,,,33.86,55.87,fee schedule,
Adenovirus ag if,87260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.43,,,,14.43,23.81,fee schedule,
Pertussis ag if,87265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Enterovirus antibody dfa,87267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.42,,,,13.42,22.14,fee schedule,
Giardia ag if,87269,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.61,,,,13.61,22.46,fee schedule,
Chlamydia trachomatis ag if,87270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Cytomegalovirus dfa,87271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.42,,,,13.42,22.14,fee schedule,
Cryptosporidium ag if,87272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Herpes simplex 2 ag if,87273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Herpes simplex 1 ag if,87274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Influenza b ag if,87275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.25,,,,12.25,20.21,fee schedule,
Influenza a ag if,87276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.07,,,,16.07,26.52,fee schedule,
Legion pneumophilia ag if,87278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.6,,,,15.6,25.74,fee schedule,
Parainfluenza ag if,87279,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.43,,,,16.43,27.11,fee schedule,
Respiratory syncytial ag if,87280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.42,,,,13.42,22.14,fee schedule,
Pneumocystis carinii ag if,87281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Rubeola ag if,87283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,60.8,,,,60.8,100.32,fee schedule,
Treponema pallidum ag if,87285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.18,,,,12.18,20.1,fee schedule,
Varicella zoster ag if,87290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.42,,,,13.42,22.14,fee schedule,
Antibody detection nos if,87299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.1,,,,16.1,26.57,fee schedule,
Ag detection polyval if,87300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Adenovirus ag ia,87301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Aspergillus ag ia,87305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Chlmyd trach ag ia,87320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15,,,,15,24.75,fee schedule,
Clostridium ag ia,87324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Cryptococcus neoform ag ia,87327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.42,,,,13.42,22.14,fee schedule,
Cryptosporidium ag ia,87328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.82,,,,13.82,22.8,fee schedule,
Giardia ag ia,87329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Cytomegalovirus ag ia,87332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
E coli 0157 ag ia,87335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.66,,,,12.66,20.89,fee schedule,
Entamoeb hist dispr ag ia,87336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16,,,,16,26.4,fee schedule,
Entamoeb hist group ag ia,87337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Hpylori stool ag ia,87338,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.38,,,,14.38,23.73,fee schedule,
H pylori ag ia,87339,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16,,,,16,26.4,fee schedule,
Hepatitis b surface ag ia,87340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.33,,,,10.33,17.04,fee schedule,
Hep b surface ag neutrlzj ia,87341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.33,,,,10.33,17.04,fee schedule,
Hepatitis be ag ia,87350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,11.53,19.02,fee schedule,
Hepatitis delta agent ag ia,87380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.36,,,,18.36,30.29,fee schedule,
Histoplasma capsul ag ia,87385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.25,,,,13.25,21.86,fee schedule,
Hiv-1 ag w/hiv-1&-2 ab ag ia,87389,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.08,,,,24.08,39.73,fee schedule,
Hiv-1 ag ia,87390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.06,,,,24.06,39.7,fee schedule,
Hiv-2 ag ia,87391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.9,,,,21.9,36.14,fee schedule,
Influenza a/b each ag ia,87400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.13,,,,14.13,23.31,fee schedule,
Resp syncytial virus ag ia,87420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.91,,,,13.91,22.95,fee schedule,
Rotavirus ag ia,87425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Sarscov coronavirus ag ia,87426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.33,,,,35.33,58.29,fee schedule,
Shiga-like toxin ag ia,87427,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Sarscov & inf vir a&b ag ia,87428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.29,,,,30.94,70.29,fee schedule,
Strep a ag ia,87430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.81,,,,16.81,27.74,fee schedule,
Nos each organism ag ia,87449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Polyvalent mult org ea ag ia,87451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.51,,,,10.51,17.34,fee schedule,
Anaplsma phgcytophlm amp prb,87468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Babesia microti amp prb,87469,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Bartonella dna amp probe,87471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Bartonella dna quant,87472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Lyme dis dna dir probe,87475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Lyme dis dna amp probe,87476,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Borrelia miyamotoi amp prb,87478,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Candida dna dir probe,87480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Candida dna amp probe,87481,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Candida dna quant,87482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.74,,,,55.74,91.97,fee schedule,
Cns dna amp probe type 12-25,87483,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,687.69,fee schedule,
Ehrlicha chaffeensis amp prb,87484,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Chlmyd pneum dna dir probe,87485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Chlmyd pneum dna amp probe,87486,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Chlmyd pneum dna quant,87487,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Chlmyd trach dna dir probe,87490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.75,,,,22.75,37.54,fee schedule,
Chlmyd trach dna amp probe,87491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Chlmyd trach dna quant,87492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,53.47,,,,53.47,88.23,fee schedule,
C diff amplified probe,87493,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.27,,,,37.27,61.5,fee schedule,
Cytomeg dna dir probe,87495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.03,,,,30.03,49.55,fee schedule,
Cytomeg dna amp probe,87496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Cytomeg dna quant,87497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Enterovirus probe&revrs trns,87498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Vanomycin dna amp probe,87500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Influenza dna amp prob 1+,87501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.31,,,,51.31,84.66,fee schedule,
Influenza dna amp probe,87502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.8,,,,95.8,158.07,fee schedule,
Influenza dna amp prob addl,87503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.22,,,,29.22,48.21,fee schedule,
Nfct agent detection gi,87505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,128.29,,,,128.29,211.68,fee schedule,
Iadna-dna/rna probe tq 6-11,87506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,262.99,,,,262.99,433.93,fee schedule,
Iadna-dna/rna probe tq 12-25,87507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,687.69,fee schedule,
Gardner vag dna dir probe,87510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Gardner vag dna amp probe,87511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Gardner vag dna quant,87512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.76,,,,41.76,68.9,fee schedule,
Hepatitis b dna amp probe,87516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hepatitis b dna quant,87517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Hepatitis c rna dir probe,87520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.22,,,,31.22,51.51,fee schedule,
Hepatitis c probe&rvrs trnsc,87521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hepatitis c revrs trnscrpj,87522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Hepatitis d quantification,87523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Hepatitis g dna dir probe,87525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.8,,,,29.8,49.17,fee schedule,
Hepatitis g dna amp probe,87526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.26,,,,39.26,64.78,fee schedule,
Hepatitis g dna quant,87527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.76,,,,41.76,68.9,fee schedule,
Hsv dna dir probe,87528,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Hsv dna amp probe,87529,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hsv dna quant,87530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Hhv-6 dna dir probe,87531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58,,,,58,95.7,fee schedule,
Hhv-6 dna amp probe,87532,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hhv-6 dna quant,87533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.76,,,,41.76,68.9,fee schedule,
Hiv-1 dna dir probe,87534,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.92,,,,21.92,36.17,fee schedule,
Hiv-1 probe&reverse trnscrpj,87535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hiv-1 quant&revrse trnscrpj,87536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,85.1,,,,85.1,140.42,fee schedule,
Hiv-2 dna dir probe,87537,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.92,,,,21.92,36.17,fee schedule,
Hiv-2 probe&revrse trnscripj,87538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hiv-2 quant&revrse trnscripj,87539,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.62,,,,58.62,96.72,fee schedule,
Legion pneumo dna dir prob,87540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Legion pneumo dna amp prob,87541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Legion pneumo dna quant,87542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.76,,,,41.76,68.9,fee schedule,
Mycobacteria dna dir probe,87550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Mycobacteria dna amp probe,87551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.24,,,,48.24,79.6,fee schedule,
Mycobacteria dna quant,87552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
M.tuberculo dna dir probe,87555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.88,,,,26.88,44.35,fee schedule,
M.tuberculo dna amp probe,87556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.68,,,,41.68,68.77,fee schedule,
M.tuberculo dna quant,87557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
M.avium-intra dna dir prob,87560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.29,,,,27.29,45.03,fee schedule,
M.avium-intra dna amp prob,87561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
M.avium-intra dna quant,87562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
M. genitalium amp probe,87563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
M.pneumon dna dir probe,87580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
M.pneumon dna amp probe,87581,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
M.pneumon dna quant,87582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,302.62,499.32,fee schedule,
N.gonorrhoeae dna dir prob,87590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.88,,,,26.88,44.35,fee schedule,
N.gonorrhoeae dna amp prob,87591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
N.gonorrhoeae dna quant,87592,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Hpv low-risk types,87623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hpv high-risk types,87624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Hpv types 16 & 18 only,87625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.55,,,,40.55,66.91,fee schedule,
Resp virus 3-5 targets,87631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,235.34,fee schedule,
Resp virus 6-11 targets,87632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,218.06,,,,218.06,359.8,fee schedule,
Resp virus 12-25 targets,87633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,416.78,,,,416.78,687.69,fee schedule,
Rsv dna/rna amp probe,87634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.2,,,,70.2,115.83,fee schedule,
Sars-cov-2 covid-19 amp prb,87635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.31,,,,51.31,84.66,fee schedule,
Sarscov2 & inf a&b amp prb,87636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,235.34,fee schedule,
Sarscov2&inf a&b&rsv amp prb,87637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.63,,,,142.63,235.34,fee schedule,
Staph a dna amp probe,87640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Mr-staph dna amp probe,87641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Strep a dna dir probe,87650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Strep a dna amp probe,87651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Strep a dna quant,87652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.76,,,,41.76,68.9,fee schedule,
Strep b dna amp probe,87653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Trichomonas vagin dir probe,87660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.05,,,,20.05,33.08,fee schedule,
Trichomonas vaginalis amplif,87661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Zika virus dna/rna amp probe,87662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.31,,,,51.31,84.66,fee schedule,
Detect agent nos dna dir,87797,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.03,,,,30.03,49.55,fee schedule,
Detect agent nos dna amp,87798,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Detect agent nos dna quant,87799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.84,,,,42.84,70.69,fee schedule,
Detect agnt mult dna direc,87800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.67,,,,43.67,72.06,fee schedule,
Detect agnt mult dna ampli,87801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.2,,,,70.2,115.83,fee schedule,
Strep b assay w/optic,87802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.73,,,,12.73,21,fee schedule,
Clostridium toxin a w/optic,87803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16,,,,16,26.4,fee schedule,
Influenza assay w/optic,87804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.55,,,,16.55,27.31,fee schedule,
Hiv ag w/hiv1&2 antb w/optic,87806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.77,,,,32.77,54.07,fee schedule,
Rsv assay w/optic,87807,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.1,,,,13.1,21.62,fee schedule,
Trichomonas assay w/optic,87808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.29,,,,15.29,25.23,fee schedule,
Adenovirus assay w/optic,87809,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.76,,,,21.76,35.9,fee schedule,
Chlmyd trach assay w/optic,87810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.29,,,,35.29,58.23,fee schedule,
Sars-cov-2 covid19 w/optic,87811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.38,,,,41.38,68.28,fee schedule,
N. gonorrhoeae assay w/optic,87850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.56,,,,24.56,40.52,fee schedule,
Strep a assay w/optic,87880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.53,,,,16.53,27.27,fee schedule,
Agent nos assay w/optic,87899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.07,,,,16.07,26.52,fee schedule,
Phenotype infect agent drug,87900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,130.35,,,,130.35,215.08,fee schedule,
Nfct agt gntyp alys hiv1 rev,87901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,257.45,,,,257.45,424.79,fee schedule,
Nfct agt gntyp alys hep c,87902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,257.45,,,,257.45,424.79,fee schedule,
Phenotype dna hiv w/culture,87903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,488.66,,,,488.66,806.29,fee schedule,
Phenotype dna hiv w/clt add,87904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.07,,,,26.07,43.02,fee schedule,
Sialidase enzyme assay,87905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.22,,,,12.22,20.16,fee schedule,
Nfct agt gntyp alys hiv1,87906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,128.73,,,,128.73,212.4,fee schedule,
Nfct agt gntyp alys cmv,87910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,257.45,,,,257.45,424.79,fee schedule,
Nfct agt gntyp alys hep b,87912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,257.45,,,,257.45,424.79,fee schedule,
Nfct agt gntyp alys sarscov2,87913,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,257.45,,,,257.45,257.45,fee schedule,
Cytopath fl nongyn smears,88104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Cytopath fl nongyn filter,88106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,116.84,case rate,
Cytopath concentrate tech,88108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Cytopath cell enhance tech,88112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Cytp urne 3-5 probes ea spec,88120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,959.46,case rate,
Cytp urine 3-5 probes cmptr,88121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,693.74,case rate,
Forensic cytopathology,88125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Sex chromatin identification,88130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.98,,,,17.98,29.67,fee schedule,
Sex chromatin identification,88140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.99,,,,7.99,13.18,fee schedule,
Cytopath c/v thin layer,88142,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.26,,,,20.26,33.43,fee schedule,
Cytopath c/v thin layer redo,88143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.04,,,,23.04,38.02,fee schedule,
Cytopath c/v automated,88147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.56,,,,50.56,83.42,fee schedule,
Cytopath c/v auto rescreen,88148,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,16.88,29.3,fee schedule,
Cytopath c/v manual,88150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,14.99,29.3,fee schedule,
Cytopath c/v auto redo,88152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.64,,,,27.64,45.61,fee schedule,
Cytopath c/v redo,88153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.03,,,,24.03,39.65,fee schedule,
Cytopath c/v index add-on,88155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.65,,,,14.65,24.17,fee schedule,
Cytopath smear other source,88160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,130.5,case rate,
Cytopath smear other source,88161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,133.27,case rate,
Cytopath smear other source,88162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,211.17,case rate,
Cytopath tbs c/v manual,88164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,14.99,29.3,fee schedule,
Cytopath tbs c/v redo,88165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.22,,,,42.22,69.66,fee schedule,
Cytopath tbs c/v auto redo,88166,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,14.99,29.3,fee schedule,
Cytopath tbs c/v select,88167,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,14.99,29.3,fee schedule,
Cytp dx eval fna 1st ea site,88172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,55.01,595.98,case rate,
Cytopath eval fna report,88173,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,274.16,case rate,
Cytopath c/v auto in fluid,88174,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.37,,,,25.37,41.86,fee schedule,
Cytopath c/v auto fluid redo,88175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.61,,,,26.61,43.91,fee schedule,
Cell marker study,88182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,274.05,case rate,
Flowcytometry/ tc 1 marker,88184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,78.06,1228.38,case rate,
Unlisted cytopathology px,88199,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Tissue culture lymphocyte,88230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,116.49,,,,116.49,192.21,fee schedule,
Tissue culture skin/biopsy,88233,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,140.73,,,,140.73,232.2,fee schedule,
Tissue culture placenta,88235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,150.3,,,,150.3,248,fee schedule,
Tissue culture bone marrow,88237,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,143.75,,,,143.75,237.19,fee schedule,
Tissue culture tumor,88239,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,147.52,,,,147.52,243.41,fee schedule,
Cell cryopreserve/storage,88240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.07,,,,13.07,21.57,fee schedule,
Frozen cell preparation,88241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.09,,,,12.09,19.95,fee schedule,
Chromosome analysis 20-25,88245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.17,,,,173.17,285.73,fee schedule,
Chromosome analysis 50-100,88248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.17,,,,173.17,285.73,fee schedule,
Chromosome analysis 100,88249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.17,,,,173.17,285.73,fee schedule,
Chromosome analysis 5,88261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,264.34,,,,264.34,436.16,fee schedule,
Chromosome analysis 15-20,88262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,125.49,,,,125.49,207.06,fee schedule,
Chromosome analysis 45,88263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,150.29,,,,150.29,247.98,fee schedule,
Chromosome analysis 20-25,88264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,144.61,,,,144.61,238.61,fee schedule,
Chromosome analys placenta,88267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,188.57,,,,188.57,311.14,fee schedule,
Chromosome analys amniotic,88269,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.66,,,,173.66,286.54,fee schedule,
Cytogenetics dna probe,88271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.42,,,,21.42,35.34,fee schedule,
Cytogenetics 3-5,88272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.7,,,,40.7,67.16,fee schedule,
Cytogenetics 10-30,88273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.81,,,,34.81,57.44,fee schedule,
Cytogenetics 25-99,88274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.38,,,,42.38,69.93,fee schedule,
Cytogenetics 100-300,88275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.19,,,,51.19,84.46,fee schedule,
Chromosome karyotype study,88280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.47,,,,33.47,55.23,fee schedule,
Chromosome banding study,88283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.6,,,,68.6,113.19,fee schedule,
Chromosome count additional,88285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.91,,,,26.91,44.4,fee schedule,
Chromosome study additional,88289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.43,,,,34.43,56.81,fee schedule,
Unlisted cytogenetic study,88299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Surgical path gross,88300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Tissue exam by pathologist,88302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Tissue exam by pathologist,88304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Tissue exam by pathologist,88305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Tissue exam by pathologist,88307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,158.49,1228.38,case rate,
Tissue exam by pathologist,88309,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,379.71,2942.97,case rate,
Special stains group 1,88312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Special stains group 2,88313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,136.79,case rate,
Enzyme histochemistry,88319,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,136.46,2942.97,case rate,
Consltj&reprt sld prep elswr,88321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,154.7,case rate,
Consltj&reprt matrl prep sld,88323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Consltj compre rvw rec reprt,88325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,57.13,595.98,case rate,
Path consltj drg surg,88329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Path consltj surg 1 blk 1spc,88331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Path consltj surg cyto xm 1,88333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,90.27,2942.97,case rate,
Imhchem/imcytchm 1st antb,88342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Imhchem/imcytchm ea mlt antb,88344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,158.49,1228.38,case rate,
Imfluor 1st 1antb stain px,88346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,149.71,1228.38,case rate,
Electron microscopy dx,88348,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,379.71,2942.97,case rate,
M/phmtrc alys skeletal musc,88355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Analysis nerve,88356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,384.05,case rate,
Analysis tumor,88358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Tumor immunohistochem/manual,88360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Tumor immunohistochem/comput,88361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,118.9,1228.38,case rate,
Nerve teasing preparations,88362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,226.9,2942.97,case rate,
Xm archive tissue molec anal,88363,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Insitu hybridization (fish),88365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Insitu hybridization (fish),88366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,158.49,1228.38,case rate,
Insitu hybridization auto,88367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,111.36,1228.38,case rate,
Insitu hybridization manual,88368,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,147.59,1228.38,case rate,
M/phmtrc alys ishquant/semiq,88374,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
M/phmtrc alys ishquant/semiq,88377,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,653.33,case rate,
Unlisted surgical path px,88399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Bilirubin total transcut,88720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.02,,,,5.02,8.28,fee schedule,
Hgb quant transcutaneous,88738,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.02,,,,5.02,8.28,fee schedule,
Transcutaneous carboxyhb,88740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.37,,,,9.37,15.46,fee schedule,
Transcutaneous methb,88741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.37,,,,9.37,15.46,fee schedule,
Chct for mal hyperthermia,89049,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Body fluid cell count,89050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.72,,,,4.72,7.79,fee schedule,
Body fluid cell count,89051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.6,,,,5.6,9.24,fee schedule,
Leukocyte assessment fecal,89055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Exam synovial fluid crystals,89060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.33,,,,7.33,26.89,fee schedule,
Specimen fat stain,89125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.88,,,,5.88,9.7,fee schedule,
Exam feces for meat fibers,89160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.85,,,,4.85,8,fee schedule,
Nasal smear for eosinophils,89190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.79,,,,5.79,9.55,fee schedule,
Sputum specimen collection,89220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,19.23,595.98,case rate,
Collect sweat for test,89230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,2.78,190.03,case rate,
Unlisted misc path test,89240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Cultr oocyte/embryo <4 days,89250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Cultr oocyte/embryo <4 days,89251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Embryo hatching,89253,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Oocyte identification,89254,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Prepare embryo for transfer,89255,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Sperm identification,89257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Cryopreservation embryo(s),89258,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,379.71,2942.97,case rate,
Cryopreservation sperm,89259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Sperm isolation simple,89260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Sperm isolation complex,89261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Identify sperm tissue,89264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Insemination of oocytes,89268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Extended culture of oocytes,89272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,379.71,2942.97,case rate,
Assist oocyte fertilization,89280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,871.2,,,,379.71,2942.97,case rate,
Assist oocyte fertilization,89281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Biopsy oocyte polar body <=5,89290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Biopsy oocyte polar body,89291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Semen analysis w/huhner,89300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.84,,,,9.84,16.24,fee schedule,
Semen analysis w/count,89310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.61,,,,8.61,14.21,fee schedule,
Semen anal vol/count/mot,89320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.31,,,,12.31,20.31,fee schedule,
Semen anal sperm detection,89321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.05,,,,12.05,19.88,fee schedule,
Semen anal strict criteria,89322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.5,,,,15.5,25.58,fee schedule,
Sperm antibody test,89325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.67,,,,10.67,17.61,fee schedule,
Sperm evaluation test,89329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.59,,,,19.59,32.32,fee schedule,
Evaluation cervical mucus,89330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.38,,,,10.38,17.13,fee schedule,
Retrograde ejaculation anal,89331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.59,,,,19.59,32.32,fee schedule,
Cryopreserve testicular tiss,89335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Cryopreservation oocyte(s),89337,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Storage/year embryo(s),89342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Storage/year sperm/semen,89343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Storage/year reprod tissue,89344,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Storage/year oocyte(s),89346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,158.49,1228.38,case rate,
Thawing cryopresrved embryo,89352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Thawing cryopresrved sperm,89353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Thaw cryoprsvrd reprod tiss,89354,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Thawing cryopresrved oocyte,89356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,173.05,,,,76.9,595.98,case rate,
Unlisted reprod med lab proc,89398,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.9,,,,24.52,190.03,case rate,
Hep b ig im,90371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,139.93,,,,118.2,197.22,fee schedule,
Rabies ig im/sc,90375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,287.71,,,,278.24,506.58,fee schedule,
Rabies ig heat treated,90376,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.72,,,,226.79,479.72,fee schedule,
Rabies ig ht&sol human im/sc,90377,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,265.51,,,,247.29,265.51,fee schedule,
Rsv mab im 50mg,90378,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,339.68,,,,339.68,2224.27,fee schedule,
Varicella-zoster ig im,90396,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2250.71,,,,110.41,2250.71,fee schedule,
Immunization admin,90471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Immune admin oral/nasal,90473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Adenovirus vaccine type 4,90476,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46,,,,46,1356.74,fee schedule,
Admn sarscov2 vacc 1 dose,90480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,44.15,,,,42.02,44.15,fee schedule,
Smallpox&monkeypox vac 0.5ml,90611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.01,,,,0.01,445.5,fee schedule,
Vaccinia vrs vac 0.3 ml perq,90622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.01,,,,0.01,0.04,fee schedule,
Flu vacc iiv4 no preserv id,90630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,20.34,20.34,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv adjuvant vaccine im,90653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,113.28,53.27,98.21,percent of total billed charges,
Flu vacc iiv3 no preserv id,90654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,18.92,18.92,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv3 vacc no prsv 0.25 ml im,90655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,17.24,17.24,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv3 vacc no prsv 0.5 ml im,90656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,19.77,32.62,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv3 vaccine splt 0.25 ml im,90657,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,6.02,6.02,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Laiv3 vaccine intranasal,90660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,20.99,20.99,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Cciiv3 vac no prsv 0.5 ml im,90661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,22.29,22.29,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv no prsv increased ag im,90662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,69.94,121.11,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Pcv13 vaccine im,90670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,257.98,425.67,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Pcv15 vaccine im,90671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,246.2,418.37,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Laiv4 vaccine intranasal,90672,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,26.87,44.34,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Riv3 vaccine no preserv im,90673,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,40.61,40.61,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Cciiv4 vac no prsv 0.5 ml im,90674,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,32.28,56.38,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Rabies vaccine im,90675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,350.14,,,,173.7,1346.27,fee schedule,
Rabies vaccine id,90676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,279.15,,,,124.76,966.98,fee schedule,
Pcv20 vaccine im,90677,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,283.72,476.29,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Riv4 vacc recombinant dna im,90682,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,69.94,121.11,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Pcv21 vaccine im,90684,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv4 vacc no prsv 0.25 ml im,90685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,19.45,35.69,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv4 vacc no prsv 0.5 ml im,90686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,21.52,36.88,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv4 vaccine splt 0.25 ml im,90687,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,10.24,17.21,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Iiv4 vaccine splt 0.5 ml im,90688,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,20.48,34.44,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Vacc iiv4 no prsrv 0.25ml im,90689,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Vacc aiiv4 no prsrv 0.5ml im,90694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,84.45,71.68,127.63,percent of total billed charges,
Mmrv vaccine sc,90710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,132.69,,,,78.24,606.4,fee schedule,
Ppsv23 vacc 2 yrs+ subq/im,90732,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,133.47,220.23,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Hepb vacc 2/4 dose adult im,90739,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,152.08,264.46,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Hepb vacc 3 dose immunsup im,90740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,146.33,251,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Hepb vacc 2 dose adolesc im,90743,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,73.85,73.85,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Hepb vacc 3 dose ped/adol im,90744,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,29.89,29.89,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Hepb vaccine 3 dose adult im,90746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,70.37,116.11,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Hepb vacc 4 dose immunsup im,90747,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,140.75,232.24,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Cciiv4 vacc abx free im,90756,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,30.58,53.41,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Hep b vac 3ag 10mcg 3 dos im,90759,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,73.81,121.79,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Psych diagnostic evaluation,90791,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Psych diag eval w/med srvcs,90792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Psytx w pt 30 minutes,90832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Psytx w pt 45 minutes,90834,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Psytx w pt 60 minutes,90837,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Psytx crisis initial 60 min,90839,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Psychoanalysis,90845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Family psytx w/o pt 50 min,90846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Family psytx w/pt 50 min,90847,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Multiple family group psytx,90849,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Group psychotherapy,90853,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Narcosynthesis,90865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Tcranial magn stim tx plan,90867,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Tcranial magn stim tx deli,90868,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Tcran magn stim redetemine,90869,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Electroconvulsive therapy,90870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Hypnotherapy,90880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Unlisted psyc svc/therapy,90899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Biofeedback train any meth,90901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.62,,,,18.62,32.68,fee schedule,
Bfb training 1st 15 min,90912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.04,,,,41.04,73.52,fee schedule,
Bfb training ea addl 15 min,90913,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.08,,,,23.08,42.01,fee schedule,
Hemodialysis one evaluation,90935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,707.99,,,,308.32,2389.67,fee schedule,
Dialysis one evaluation,90945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,448.74,,,,186.61,1446.3,fee schedule,
Esophagus motility study,91010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Gastric motility studies,91020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Duodenal motility study,91022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Acid perfusion of esophagus,91030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Gastroesophageal reflux test,91034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
G-esoph reflx tst w/electrod,91035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Esoph imped function test,91037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Esoph imped funct test > 1hr,91038,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Esoph balloon distension tst,91040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Breath hydrogen/methane test,91065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Gi trc img intral esoph-ile,91110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Gi trc img intral esophagus,91111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Gi wireless capsule measure,91112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,918.41,,,,403.67,3128.68,fee schedule,
Gi trc img intral colon i&r,91113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Colon motility 6 hr study,91117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Rectal sensation test,91120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Anal pressure record,91122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Electrogastrography,91132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Electrogastrography w/test,91133,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Liver elastography,91200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Unlisted dx gi procedure,91299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Sarscov2 vac 5mcg/0.5ml im,91304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,148.2,244.53,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Sarscov2 vac 3mcg trs-suc im,91318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,65.36,107.84,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Sarscv2 vac 10mcg trs-suc im,91319,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,87.78,144.84,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Sarscv2 vac 30mcg trs-suc im,91320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,131.1,216.32,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Sarscov2 vac 25 mcg/.25ml im,91321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,145.92,240.77,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Sarscov2 vac 50 mcg/0.5ml im,91322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,145.92,240.77,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Intrm oph exam new patient,92002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Compre oph exam new pt 1/>,92004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Intrm oph exam est patient,92012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Compre oph exam est pt 1/>,92014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Compl oph exam general anes,92018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Lmtd oph exam general anes,92019,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2367.54,,,,1033.85,8012.89,case rate,
Gonioscopy,92020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Cptrized corneal topography,92025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Sensorimotor examination,92060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Orthop traing supvj phys/qhp,92066,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Limited visual field xm,92081,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Intermediate visual field xm,92082,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Extended visual field xm,92083,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Cmptr ophth dx img ant segmt,92132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Cmptr ophth img optic nerve,92133,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Cptr ophth dx img post segmt,92134,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Ophthalmic biometry,92136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Corneal hysteresis deter,92145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Opscpy extnd rta draw uni/bi,92201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Opscpy extnd on/mac draw,92202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Img rta detcj/mntr ds staff,92227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Img rta detc/mntr ds phy/qhp,92228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,390.1,case rate,
Img rta detc/mntr ds poc aly,92229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Fluorescein angioscopy i&r,92230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,case rate,
Fluorescein angrph mltiframe,92235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Icg angiography i&r uni/bi,92240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Fluorescein&icg angiography,92242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Fundus photography w/i&r,92250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Ophthalmodynamometry,92260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Ndl oculoelectromyography 1+,92265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Electro-oculography w/i&r,92270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Full field erg w/i&r,92273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Multifocal erg w/i&r,92274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Extnd color vision xm,92283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Dx dark adaptation exam i&r,92284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
External ocular photography,92285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,28.11,217.85,case rate,
Ant sgm img i&r speclr mic,92286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Ant sgm img ir flrscn angrph,92287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Contact lens fitg aphakia 1,92311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Contact lens fitg aphakia ou,92312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
C-lens fitg corneosclrl lens,92313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
C-lens fitg tech aphakia 1,92315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
C-lens fitg tech aphakia ou,92316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
C-lens fitg tech corneosclrl,92317,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Modification of contact lens,92325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Replacement of contact lens,92326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Fit aphakia spectcl monofocl,92352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Fit aphakia spectcl multifoc,92353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Fitg spect low vis 1system,92354,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Fitg spect lw vis cmpnd lens,92355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Aphakia prosth service temp,92358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Rpr&refit spct prsth aphakia,92371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Unlisted oph svc/procedure,92499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Ear and throat examination,92502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.44,,,,223.38,1731.35,fee schedule,
Speech/hearing therapy,92507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,76.33,,,,58.81,551.18,fee schedule,
Speech/hearing therapy,92508,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.39,,,,18.4,41.43,fee schedule,
Nasopharyngoscopy,92511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200.68,,,,87.41,677.46,fee schedule,
Nasal function studies,92512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Facial nerve function test,92516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Vemp test i&r cervical,92517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Vemp test i&r ocular,92518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Vemp tst i&r cervical&ocular,92519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Laryngeal function studies,92520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Evaluation of speech fluency,92521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,132.83,,,,71.12,551.18,fee schedule,
Evaluate speech production,92522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,110.67,,,,71.12,551.18,fee schedule,
Speech sound lang comprehen,92523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,227.77,,,,71.12,551.18,fee schedule,
Behavral qualit analys voice,92524,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,108.97,,,,71.12,551.18,fee schedule,
Oral function therapy,92526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,84.82,,,,65.3,147.63,fee schedule,
Caloric vstblr test w/rec,92537,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Caloric vstblr test w/rec,92538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Basic vestibular evaluation,92540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Spontaneous nystagmus test,92541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Positional nystagmus test,92542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Optokinetic nystagmus test,92544,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Oscillating tracking test,92545,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Sinusoidal rotational test,92546,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Cdp-sot 6 cond w/i&r,92548,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Cdp-sot 6 cond w/i&r mct&adt,92549,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Tympanometry & reflex thresh,92550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Pure tone audiometry air,92552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Audiometry air & bone,92553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Speech threshold audiometry,92555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Speech audiometry complete,92556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Comprehensive hearing test,92557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Loudness balance test,92562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,71.12,551.18,case rate,
Tone decay hearing test,92563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Stenger test pure tone,92565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,16.61,128.71,case rate,
Tympanometry,92567,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Acoustic refl threshold tst,92568,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Acoustic immitance testing,92570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Filtered speech hearing test,92571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Staggered spondaic word test,92572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Sensorineural acuity test,92575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Synthetic sentence test,92576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Stenger test speech,92577,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,case rate,
Visual audiometry (vra),92579,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Conditioning play audiometry,92582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Select picture audiometry,92583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Electrocochleography,92584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Evoked auditory test limited,92587,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Evoked auditory tst complete,92588,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Ear protector evaluation,92596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Oral speech device eval,92597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.03,,,,54.93,551.18,fee schedule,
Cochlear implt f/up exam <7,92601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Reprogram cochlear implt <7,92602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Cochlear implt f/up exam 7/>,92603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Reprogram cochlear implt 7/>,92604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Ex for speech device rx 1hr,92607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,124.18,,,,71.12,551.18,fee schedule,
Ex for speech device rx addl,92608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.75,,,,37.56,551.18,fee schedule,
Use of speech device service,92609,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,103.56,,,,79.81,179.72,fee schedule,
Evaluate swallowing function,92610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69.6,,,,65.3,551.18,fee schedule,
Motion fluoroscopy/swallow,92611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.37,,,,69.96,159.3,fee schedule,
Endoscopy swallow (fees) vid,92612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.71,,,,64.71,153.4,fee schedule,
Laryngoscopic sensory vid,92614,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63.45,,,,63.45,114.01,fee schedule,
Fees w/laryngeal sense test,92616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,96.68,,,,96.68,174.12,fee schedule,
Auditory function 60 min,92620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Dx aly aud oi snd prcsr 1st,92622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,150.6,158.26,fee schedule,
Tinnitus assessment,92625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Eval aud funcj 1st hour,92626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Aud brainstem implt programg,92640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Aep hearing status deter i&r,92651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,71.12,551.18,fee schedule,
Aep thrshld est mlt freq i&r,92652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Aep neurodiagnostic i&r,92653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Unlisted orl service/px,92700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Prq cardiac angioplast 1 art,92920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Prq card angio/athrect 1 art,92924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Prq card stent w/angio 1 vsl,92928,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Prq card stent/ath/angio,92933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Prq revasc byp graft 1 vsl,92937,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Prq card revasc mi 1 vsl,92941,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2550.33,19766.37,case rate,
Prq card revasc chronic 1vsl,92943,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Heart/lung resuscitation cpr,92950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Temporary external pacing,92953,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,659.38,,,,287.6,2229.05,fee schedule,
Cardioversion electric ext,92960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,659.38,,,,287.6,2229.05,fee schedule,
Cardioversion electric int,92961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,659.38,,,,287.6,2229.05,fee schedule,
Cardioassist internal,92970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,129.04,8759.27,case rate,
Cardioassist external,92971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,69.18,8759.27,case rate,
Dissolve clot heart vessel,92975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,257.3,11290.3,case rate,
Dissolve clot heart vessel,92977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Revision of aortic valve,92986,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5790.85,,,,2550.33,19766.37,case rate,
Revision of mitral valve,92987,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Revision of pulmonary valve,92990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Pul art balloon repr percut,92997,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Electrocardiogram tracing,93005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Cardiovascular stress test,93017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Cardiac drug stress test,93024,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Microvolt t-wave assess,93025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Rhythm ecg tracing,93041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Art pressure waveform analys,93050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Therapy activation ipnss,93150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,93.33,98.07,fee schedule,
Interrog&prgrmg ipnss,93151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,93.33,98.07,fee schedule,
Interrog&prgrmg ipnss polysm,93152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,287.97,302.62,fee schedule,
Interrog w/o prgrmg ipnss,93153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,93.33,98.07,fee schedule,
Ecg monit/reprt up to 48 hrs,93225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Ecg monit/reprt up to 48 hrs,93226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,56.78,440.06,case rate,
Remote 30 day ecg tech supp,93229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,71.12,551.18,fee schedule,
Ext ecg>48hr<7d recording,93242,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Ext ecg>48hr<7d scan a/r,93243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Ext ecg>7d<15d recording,93246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,28.11,217.85,case rate,
Ext ecg>7d<15d scan a/r,93247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Prgrmg dev eval impltbl sys,93260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interrogate subq defib,93261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Remote 30 day ecg rev/report,93270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Ecg/monitoring and analysis,93271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,fee schedule,
Ecg/signal-averaged,93278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Prgrmg dev eval pm/ldls pm,93279,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Pm device progr eval dual,93280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Pm device progr eval multi,93281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Prgrmg eval implantable dfb,93282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Prgrmg eval implantable dfb,93283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Prgrmg eval implantable dfb,93284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Prgrmg dev eval scrms ip,93285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interrog evl pm/ldls pm ip,93288,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interrog device eval heart,93289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interrog dev eval icpms ip,93290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Interrog dev eval scrms ip,93291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Wcd device interrogate,93292,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Pm phone r-strip device eval,93293,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Rem interrog evl pm/ids,93296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Rem interrog dev eval icpms,93297,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,36.36,44.35,case rate,
Rem interrog dev eval scrms,93298,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,36.36,44.93,case rate,
Echo transthoracic,93303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Echo transthoracic,93304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Tte w/doppler complete,93306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Tte w/o doppler complete,93307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Tte f-up or lmtd,93308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Echo transesophageal,93312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Echo transesophageal,93313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Echo transesophageal,93315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Echo transesophageal,93316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Echo transesophageal intraop,93318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Stress tte only,93350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Stress tte complete,93351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,fee schedule,
Right heart cath,93451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
Left hrt cath w/ventrclgrphy,93452,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R&l hrt cath w/ventriclgrphy,93453,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
Coronary artery angio s&i,93454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
Coronary art/grft angio s&i,93455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R hrt coronary artery angio,93456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R hrt art/grft angio,93457,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
L hrt artery/ventricle angio,93458,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
L hrt art/grft angio,93459,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R&l hrt art/ventricle angio,93460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R&l hrt art/ventricle angio,93461,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
Insert/place heart catheter,93503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.61,,,,727.56,5638.95,case rate,
Biopsy of heart lining,93505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3229.42,,,,1456.72,11290.3,case rate,
Transcath closure of asd,93580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Transcath closure of vsd,93581,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Perq transcath closure pda,93582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Perq transcath septal reduxn,93583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,508.65,65103.1,case rate,
Perq transcath cls mitral,93590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Perq transcath cls aortic,93591,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
R hrt cath chd nml nt cnj,93593,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R hrt cath chd abnl nt cnj,93594,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
L hrt cath chd nm/abn nt cnj,93595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R&l hrt cath chd nml nt cnj,93596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
R&l hrt cath chd abnl nt cnj,93597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3301.42,,,,1446.69,11212.56,case rate,
Bundle of his recording,93600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Intra-atrial recording,93602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Right ventricular recording,93603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1205.79,,,,546.24,4233.66,case rate,
Intra-atrial pacing,93610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Intraventricular pacing,93612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Esophageal recording,93615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1205.79,,,,546.24,4233.66,case rate,
Esophageal recording,93616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1205.79,,,,546.24,4233.66,case rate,
Heart rhythm pacing,93618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1205.79,,,,546.24,4233.66,case rate,
Electrophysiology evaluation,93619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Electrophysiology evaluation,93620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Electrophysiologic study,93624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Electrophysiology evaluation,93642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1205.79,,,,546.24,4233.66,case rate,
Ablate heart dysrhythm focus,93650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7566.42,,,,3292.31,25517.12,case rate,
Compre ep eval tx svt,93653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24062.82,,,,11482.35,88994.09,case rate,
Compre ep eval tx vt,93654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24062.82,,,,11482.35,88994.09,case rate,
Compre ep eval abltj atr fib,93656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24062.82,,,,11482.35,88994.09,case rate,
Tilt table evaluation,93660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Peripheral vascular rehab,93668,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Bioimpedance cv analysis,93701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Bis xtracell fluid analysis,93702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Analyze pacemaker system,93724,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,fee schedule,
Temperature gradient studies,93740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Set-up cardiovert-defibrill,93745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,135.28,1048.5,fee schedule,
Interrogation vad in person,93750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,fee schedule,
Ambl bp mntr w/sw rec only,93786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Ambl bp mntr w/sw a/r,93788,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Cardiac rehab,93797,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.88,,,,58.71,455.07,fee schedule,
Cardiac rehab/monitor,93798,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.88,,,,58.71,455.07,fee schedule,
Unlisted cv svc/procedure,93799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Extracranial bilat study,93880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Extracranial uni/ltd study,93882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Intracranial complete study,93886,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Intracranial limited study,93888,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Tcd vasoreactivity study,93890,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Tcd emboli detect w/o inj,93892,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Tcd emboli detect w/inj,93893,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Upr/l xtremity art 2 levels,93922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Upr/lxtr art stdy 3+ lvls,93923,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Lwr xtr vasc stdy bilat,93924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,136.95,1061.43,fee schedule,
Lower extremity study,93925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Lower extremity study,93926,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Upper extremity study,93930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Upper extremity study,93931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Extremity study,93970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Extremity study,93971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Vascular study,93975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Vascular study,93976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Vascular study,93978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Vascular study,93979,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Penile vascular study,93980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Penile vascular study,93981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Dup-scan hemo compl bi std,93985,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,fee schedule,
Dup-scan hemo compl uni std,93986,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Doppler flow testing,93990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,case rate,
Unlistd noninvas vasc dx std,93998,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Vent mgmt inpat init day,94002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,634.91,,,,272.24,2109.97,fee schedule,
Vent mgmt inpat subq day,94003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,634.91,,,,272.24,2109.97,fee schedule,
Breathing capacity test,94010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Spirometry up to 2 yrs old,94011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Spirmtry w/brnchdil inf-2 yr,94012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Meas lung vol thru 2 yrs,94013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Patient recorded spirometry,94014,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Patient recorded spirometry,94015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Review patient spirometry,94016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.65,,,,18.14,42.01,fee schedule,
Evaluation of wheezing,94060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Evaluation of wheezing,94070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Vital capacity test,94150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Lung function test (mbc/mvv),94200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Respiratory flow volume loop,94375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Hypoxia response curve,94450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,136.95,1061.43,case rate,
Hast w/report,94452,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Hast w/oxygen titrate,94453,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Surfactant admin thru tube,94610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.1,,,,93.64,725.79,case rate,
Exercise tst brncspsm w/ecg,94617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Pulmonary stress testing,94618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Exercise tst brncspsm wo ecg,94619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Cardiopulm exercise testing,94621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Phy/qhp op pulm rhb w/o mntr,94625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Phy/qhp op pulm rhb w/mntr,94626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Airway inhalation treatment,94640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.1,,,,93.64,725.79,case rate,
Aerosol inhalation treatment,94642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.1,,,,93.64,725.79,case rate,
Cbt 1st hour,94644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Pos airway pressure cpap,94660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.1,,,,93.64,725.79,case rate,
Neg press ventilation cnp,94662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,634.91,,,,272.24,2109.97,fee schedule,
Evaluate pt use of inhaler,94664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.1,,,,93.64,725.79,case rate,
Chest wall manipulation,94667,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Chest wall manipulation,94668,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Mechanical chest wall oscill,94669,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.1,,,,93.64,725.79,case rate,
Exhaled air analysis o2,94680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Exhaled air analysis o2/co2,94681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Exhaled air analysis,94690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Pulm funct tst plethysmograp,94726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Pulm function test by gas,94727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Airwy resist by oscillometry,94728,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,136.95,1061.43,case rate,
Measure blood oxygen level,94762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Breath recording infant,94772,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Ped home apnea rec hk-up,94775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Ped home apnea rec downld,94776,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Cars/bd tst inft-12mo 60 min,94780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Unlisted pulmonary svc/px,94799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Percut allergy skin tests,95004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,case rate,
Exhaled nitric oxide meas,95012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Perq & icut allg test venoms,95017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Perq&ic allg test drugs/biol,95018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Icut allergy test drug/bug,95024,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Icut allergy titrate-airborn,95027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Icut allergy test-delayed,95028,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Allergy patch tests,95044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,case rate,
Photo patch test,95052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Photosensitivity tests,95056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Eye allergy tests,95060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Nose allergy test,95065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Bronchial allergy tests,95070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Ingest challenge ini 120 min,95076,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Immunotherapy one injection,95115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Immunotherapy injections,95117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Antigen therapy services,95144,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Antigen therapy services,95145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Antigen therapy services,95146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Antigen therapy services,95147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Antigen therapy services,95148,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Antigen therapy services,95149,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Antigen therapy services,95165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Antigen therapy services,95170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Rapid desensitization,95180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Unlisted all/immlg svc/px,95199,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Cont gluc mntr pt prov eqp,95249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Cont gluc mntr phys/qhp eqp,95250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Eeg cont rec w/vid eeg tech,95700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Eeg w/o vid 2-12 hr unmntr,95705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,71.12,551.18,fee schedule,
Eeg wo vid 2-12hr intmt mntr,95706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Eeg w/o vid 2-12hr cont mntr,95707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Eeg wo vid ea 12-26hr unmntr,95708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Eeg w/o vid ea 12-26hr intmt,95709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Eeg w/o vid ea 12-26hr cont,95710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Veeg 2-12 hr unmonitored,95711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Veeg 2-12 hr intmt mntr,95712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Veeg 2-12 hr cont mntr,95713,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Veeg ea 12-26 hr unmntr,95714,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Veeg ea 12-26hr intmt mntr,95715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Veeg ea 12-26hr cont mntr,95716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Polysom <6 yrs 4/> paramtrs,95782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Polysom <6 yrs cpap/bilvl,95783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Slp stdy unattended,95800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Slp stdy unatnd w/anal,95801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,56.78,440.06,case rate,
Actigraphy testing,95803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Multiple sleep latency test,95805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Sleep study unatt&resp efft,95806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Sleep study attended,95807,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Polysom any age 1-3> param,95808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Polysom 6/> yrs 4/> param,95810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Polysom 6/>yrs cpap 4/> parm,95811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Eeg 41-60 minutes,95812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Eeg extnd mntr 61-119 min,95813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Eeg awake and drowsy,95816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Eeg awake and asleep,95819,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Eeg coma or sleep only,95822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Eeg cerebral death only,95824,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Ecog impltd brn npgt <30 d,95836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Range of motion measurements,95851,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.47,,,,7.47,16.31,fee schedule,
Range of motion measurements,95852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.13,,,,5.13,13.47,fee schedule,
Cholinesterase challenge,95857,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Muscle test one limb,95860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Muscle test 2 limbs,95861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Muscle test 3 limbs,95863,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Muscle test 4 limbs,95864,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Muscle test larynx,95865,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Muscle test hemidiaphragm,95866,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Muscle test cran nerv unilat,95867,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Muscle test cran nerve bilat,95868,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Muscle test thor paraspinal,95869,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,71.12,551.18,case rate,
Muscle test nonparaspinal,95870,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Muscle test one fiber,95872,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Limb exercise test,95875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Motor &/ sens nrve cndj test,95905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,119.31,1430.99,case rate,
Nvr cndj tst 1-2 studies,95907,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Nrv cndj tst 3-4 studies,95908,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Nrv cndj tst 5-6 studies,95909,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Nrv cndj test 7-8 studies,95910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Nrv cndj test 9-10 studies,95911,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Nrv cndj test 11-12 studies,95912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Nrv cndj test 13/> studies,95913,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Quan puplmtry phy/qhp uni/bi,95919,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Autonomic nrv parasym inervj,95921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Autonomic nrv adrenrg inervj,95922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Autonomic nrv syst funj test,95923,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Ans parasymp & symp w/tilt,95924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Somatosensory testing,95925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Somatosensory testing,95926,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Somatosensory testing,95927,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
C motor evoked uppr limbs,95928,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
C motor evoked lwr limbs,95929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Visual ep test cns w/i&r,95930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Blink reflex test,95933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Neuromuscular junction test,95937,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Somatosensory testing,95938,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
C motor evoked upr&lwr limbs,95939,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Eeg monitoring/giving drugs,95954,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Eeg monitoring/function test,95958,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Electrode stimulation brain,95961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Meg spontaneous,95965,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Meg evoked single,95966,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Alys npgt w/o prgrmg,95970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Alys smpl sp/pn npgt w/prgrm,95971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,fee schedule,
Alys cplx sp/pn npgt w/prgrm,95972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,fee schedule,
Alys smpl cn npgt prgrmg,95976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,fee schedule,
Alys cplx cn npgt prgrmg,95977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,48.81,378.28,fee schedule,
Io anal gast n-stim subsq,95981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,56.78,440.06,case rate,
Io ga n-stim subsq w/reprog,95982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Alys brn npgt prgrmg 15 min,95983,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.07,,,,41.64,378.28,fee schedule,
Spin/brain pump refil & main,95990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Spin/brain pump refil & main,95991,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.08,,,,132.95,1030.46,fee schedule,
Canalith repositioning proc,95992,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.82,,,,32.9,62.43,fee schedule,
Unlisted neurological dx px,95999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,case rate,
Motion analysis video/3d,96000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Motion test w/ft press meas,96001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,456.91,3541.3,fee schedule,
Dynamic surface emg,96002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,71.12,551.18,fee schedule,
Dynamic fine wire emg,96003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,case rate,
Assessment of aphasia,96105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.12,,,,12.21,105.05,fee schedule,
Devel tst phys/qhp 1st hr,96112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,136.95,1061.43,fee schedule,
Nubhvl xm phys/qhp 1st hr,96116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Cognitive test by hc pro,96125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.88,,,,12.21,111.37,fee schedule,
Brief emotional/behav assmt,96127,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Psycl tst eval phys/qhp 1st,96130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Nrpsyc tst eval phys/qhp 1st,96132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,152.33,1832.2,fee schedule,
Psycl/nrpsyc tst phy/qhp 1st,96136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,19.24,440.06,fee schedule,
Psycl/nrpsyc tech 1st,96138,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,19.24,1430.99,fee schedule,
Psycl/nrpsyc tst auto result,96146,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Hlth bhv assmt/reassessment,96156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Hlth bhv ivntj indiv 1st 30,96158,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,37.09,287.47,fee schedule,
Pt-focused hlth risk assmt,96160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Caregiver health risk assmt,96161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Hlth bhv ivntj grp 1st 30,96164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Hlth bhv ivntj fam 1st 30,96167,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Mlt fam grp bhv train 1st 60,96202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.9,,,,14.51,112.49,fee schedule,
Mlt fam grp bhv train ea add,96203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.7,,,,5.7,112.49,fee schedule,
Hydration iv infusion init,96360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Hydrate iv infusion add-on,96361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Ther/proph/diag iv inf init,96365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Ther/proph/diag iv inf addon,96366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Tx/proph/dg addl seq iv inf,96367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,fee schedule,
Sc ther infusion up to 1 hr,96369,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Sc ther infusion addl hr,96370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Sc ther infusion reset pump,96371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Ther/proph/diag inj sc/im,96372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Ther/proph/diag inj ia,96373,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Ther/proph/diag inj iv push,96374,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Tx/pro/dx inj new drug addon,96375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Applicaton on-body injector,96377,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Unl ther/prop/diag inj/inf,96379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Chemo anti-neopl sq/im,96401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Chemo hormon antineopl sq/im,96402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Chemo intralesional up to 7,96405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,case rate,
Chemo intralesional over 7,96406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Chemo iv push sngl drug,96409,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,101.01,782.9,fee schedule,
Chemo iv push addl drug,96411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,fee schedule,
Chemo iv infusion 1 hr,96413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Chemo iv infusion addl hr,96415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,fee schedule,
Chemo prolong infuse w/pump,96416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Chemo iv infus each addl seq,96417,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,32.99,255.71,fee schedule,
Chemo ia push tecnique,96420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Chemo ia infusion up to 1 hr,96422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,101.01,782.9,fee schedule,
Chemo ia infuse each addl hr,96423,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Chemotherapy infusion method,96425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Chmotx admn plrl cav thrcnts,96440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Chemotx admn pertl cav impl,96446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Chemotherapy into cns,96450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Refill/maint portable pump,96521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Refill/maint pump/resvr syst,96522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,217.16,,,,101.01,782.9,fee schedule,
Irrig drug delivery device,96523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Chemotherapy injection,96542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,101.01,782.9,fee schedule,
Unlisted chemotherapy px,96549,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,case rate,
Pdt dstr prmlg les skn,96567,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Pdt dstr prmlg les phys/qhp,96573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Dbrdmt prmlg les w/pdt,96574,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Ultraviolet light therapy,96900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Photochemotherapy with uv-b,96910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Photochemotherapy with uv-a,96912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Photochemotherapy uv-a or b,96913,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Excimer lsr psriasis<250sqcm,96920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Excimer lsr psriasis 250-500,96921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Excimer lsr psriasis>500sqcm,96922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Unlisted spec derm svc/px,96999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Mechanical traction therapy,97012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.88,,,,10.88,18.49,fee schedule,
Vasopneumatic device therapy,97016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.55,,,,8.8,15.05,fee schedule,
Paraffin bath therapy,97018,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.51,,,,4.14,7.31,fee schedule,
Whirlpool therapy,97022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.02,,,,12.95,21.92,fee schedule,
Diathermy eg microwave,97024,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.22,,,,5.44,9.46,fee schedule,
Infrared therapy,97026,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.53,,,,4.92,8.6,fee schedule,
Ultraviolet therapy,97028,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.22,,,,6.21,10.75,fee schedule,
Appl modality 1+estim ea 15,97032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.22,,,,10.88,18.49,fee schedule,
App mdlty 1+iontphrsis ea 15,97033,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.33,,,,15.03,25.36,fee schedule,
App mdlty 1+cntrst bth ea 15,97034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.91,,,,10.88,18.49,fee schedule,
App mdlty 1+ultrasound ea 15,97035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.91,,,,10.88,18.49,fee schedule,
App mdlty 1+hubbrd tnk ea 15,97036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.35,,,,26.95,44.71,fee schedule,
Appl modality 1+lllt po pain,97037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,38.67,40.63,case rate,
Therapeutic exercises,97110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.41,,,,22.8,37.83,fee schedule,
Neuromuscular reeducation,97112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.8,,,,26.16,43.42,fee schedule,
Aquatic therapy/exercises,97113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.89,,,,28.49,47.29,fee schedule,
Gait training therapy,97116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.41,,,,22.8,37.83,fee schedule,
Massage therapy,97124,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.52,,,,23.32,38.69,fee schedule,
Ther ivntj 1st 15 min,97129,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.2,,,,17.1,28.37,fee schedule,
Ther ivntj ea addl 15 min,97130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.2,,,,16.31,27.51,fee schedule,
Manual therapy 1/> regions,97140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.04,,,,20.98,34.82,fee schedule,
Group therapeutic procedures,97150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.94,,,,13.47,22.78,fee schedule,
Bhv id assmt by phys/qhp,97151,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Bhv id suprt assmt by 1 tech,97152,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Adaptive behavior tx by tech,97153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,20.17,287.47,fee schedule,
Grp adapt bhv tx by tech,97154,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,6.72,112.49,fee schedule,
Adapt behavior tx phys/qhp,97155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,20.17,287.47,fee schedule,
Fam adapt bhv tx gdn phy/qhp,97156,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Mult fam adapt bhv tx gdn,97157,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,6.72,112.49,fee schedule,
Grp adapt bhv tx by phy/qhp,97158,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Pt eval low complex 20 min,97161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100.45,,,,77.74,128.97,fee schedule,
Pt eval mod complex 30 min,97162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100.45,,,,77.74,128.97,fee schedule,
Pt eval high complex 45 min,97163,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100.45,,,,77.74,128.97,fee schedule,
Pt re-eval est plan care,97164,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69.79,,,,53.64,89.42,fee schedule,
Ot eval low complex 30 min,97165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.48,,,,77.74,128.97,fee schedule,
Ot eval mod complex 45 min,97166,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.48,,,,77.74,128.97,fee schedule,
Ot eval high complex 60 min,97167,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.48,,,,77.74,128.97,fee schedule,
Ot re-eval est plan care,97168,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.13,,,,53.37,88.99,fee schedule,
Therapeutic activities,97530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.92,,,,28.75,47.72,fee schedule,
Sensory integration,97533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63.16,,,,43.43,81.68,fee schedule,
Self care mngment training,97535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.82,,,,25.39,42.13,fee schedule,
Community/work reintegration,97537,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.77,,,,24.61,40.84,fee schedule,
Wheelchair mngment training,97542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.77,,,,24.61,40.84,fee schedule,
Caregiver traing 1st 30 min,97550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.69,,,,52.69,52.69,fee schedule,
Caregiver traing ea addl 15,97551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.26,,,,26.26,26.26,fee schedule,
Group caregiver training,97552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.43,,,,22.43,22.43,fee schedule,
Dbrdmt opn wnd 1st 20 cm/<,97597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,fee schedule,
Wound(s) care non-selective,97602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Neg prs wnd ther dme<=50sqcm,97605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Neg prs wnd ther dme>50 sqcm,97606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,case rate,
Neg prs wnd thr ndme<=50sqcm,97607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Neg prs wnd ther ndme>50sqcm,97608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.99,,,,182.43,1413.94,fee schedule,
Low frequency non-thermal us,97610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Physical performance test,97750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.19,,,,26.16,43.42,fee schedule,
Assistive technology assess,97755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.24,,,,29.54,49.44,fee schedule,
Orthotic mgmt&traing 1st enc,97760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.13,,,,37.83,62.34,fee schedule,
Prosthetic traing 1st enc,97761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.99,,,,32.39,53.74,fee schedule,
Orthc/prostc mgmt sbsq enc,97763,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.93,,,,41.45,68.35,fee schedule,
Medical nutrition indiv in,97802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.03,,,,28.24,56.02,fee schedule,
Med nutrition indiv subseq,97803,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.03,,,,24.61,47.26,fee schedule,
Medical nutrition group,97804,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.12,,,,12.69,26.84,fee schedule,
Acupunct w/o stimul 15 min,97810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Acupunct w/stimul 15 min,97813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Osteopath manj 1-2 regions,98925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Osteopath manj 3-4 regions,98926,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Osteopath manj 5-6 regions,98927,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Osteopath manj 7-8 regions,98928,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Osteopath manj 9-10 regions,98929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Chiropract manj 1-2 regions,98940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Chiropract manj 3-4 regions,98941,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Chiropractic manj 5 regions,98942,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.29,,,,12.22,94.67,case rate,
Hc pro phone call 5-10 min,98966,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.15,,,,11.15,19.26,fee schedule,
Hc pro phone call 11-20 min,98967,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.62,,,,21.62,37.93,fee schedule,
Hc pro phone call 21-30 min,98968,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.28,,,,30.28,53.68,fee schedule,
Qnhp ol dig assmt&mgmt 5-10,98970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.49,,,,11.49,19.84,fee schedule,
Qnhp ol dig assmt&mgmt 11-20,98971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.31,,,,20.31,34.43,fee schedule,
Qnhp ol dig assmt&mgmt 21+,98972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.99,,,,29.99,53.1,fee schedule,
Rem ther mntr 1st setup&edu,98975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Rem ther mntr dev sply resp,98976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Rem ther mntr dv sply mscskl,98977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Rem ther mntr dev sply cbt,98978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Anogenital exam child w imag,99170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.89,,,,87.11,675.11,fee schedule,
Hypothermia ill neonate,99184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,159.35,8759.27,case rate,
Special pump services,99190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,205.8,8759.27,case rate,
Special pump services,99191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,147.7,8759.27,case rate,
Special pump services,99192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,178.52,8759.27,case rate,
Phlebotomy,99195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Emr dpt vst mayx req phy/qhp,99281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,89.94,,,,36.72,284.59,case rate,
Emergency dept visit sf mdm,99282,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,165.7,,,,68.31,529.43,case rate,
Emergency dept visit low mdm,99283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,289.08,,,,119.82,928.66,case rate,
Emergency dept visit mod mdm,99284,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,448.74,,,,186.61,1446.3,case rate,
Emergency dept visit hi mdm,99285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,650.76,,,,268.03,2077.34,case rate,
Critical care first hour,99291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,899.05,,,,375.42,2909.66,case rate,
Behav chng smoking 3-10 min,99406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Behav chng smoking > 10 min,99407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Prolng ip/obs e/m ea 15 min,99418,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,29.29,8759.27,case rate,
Prin care mgmt staff 1st 30,99426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Rem mntr physiol param setup,99453,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Rem mntr physiol param dev,99454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.21,,,,17.12,132.65,case rate,
Init nb em per day hosp,99460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Sbsq nb em per day hosp,99462,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,30.32,8759.27,case rate,
Same day nb discharge,99463,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Nb resuscitation,99465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,659.38,,,,287.6,2229.05,fee schedule,
Neonate crit care initial,99468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,665.95,8759.27,case rate,
Neonate crit care subsq,99469,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,288.25,8759.27,case rate,
Ped critical care initial,99471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,576.52,8759.27,case rate,
Ped critical care subsq,99472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,291.37,8759.27,case rate,
Self-meas bp pt educaj/train,99473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,case rate,
Ped crit care age 2-5 init,99475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,413.2,8759.27,case rate,
Ped crit care age 2-5 subsq,99476,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,248.86,8759.27,case rate,
Init day hosp neonate care,99477,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,252.49,8759.27,case rate,
Ic lbw inf < 1500 gm subsq,99478,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,99.28,8759.27,case rate,
Ic lbw inf 1500-2500 g subsq,99479,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,90.21,8759.27,case rate,
Ic inf pbw 2501-5000 g subsq,99480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,86.85,8759.27,case rate,
Assmt & care pln pt cog imp,99483,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Care mgmt svc bhvl hlth cond,99484,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Cplx chrnc care 1st 60 min,99487,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Chrnc care mgmt staff 1st 20,99490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
1st psyc collab care mgmt,99492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Sbsq psyc collab care mgmt,99493,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,37.09,287.47,fee schedule,
Transj care mgmt mod f2f 14d,99495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Transj care mgmt high f2f 7d,99496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Advncd care plan 30 min,99497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,case rate,
Ground mileage,A0425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.76,,,,7.4,14.45,fee schedule,
Als 1,A0426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.44,,,,229.91,539.42,case rate,
Als1-emergency,A0427,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.44,,,,229.91,854.09,case rate,
Bls,A0428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.44,,,,229.91,449.53,case rate,
Bls-emergency,A0429,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.44,,,,229.91,719.24,case rate,
Fixed wing air transport,A0430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3697.17,,,,3119.83,6100.33,case rate,
Rotary wing air transport,A0431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4298.52,,,,3627.27,7092.56,case rate,
Pi volunteer ambulance co,A0432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.44,,,,229.91,786.67,case rate,
Als 2,A0433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.44,,,,229.91,1236.2,case rate,
Specialty care transport,A0434,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.44,,,,229.91,1460.96,case rate,
Fixed wing air mileage,A0435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.5,,,,8.85,17.33,fee schedule,
Rotary wing air mileage,A0436,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.99,,,,23.62,46.18,fee schedule,
Home lancing/test cartridges,A4271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.65,,,,32.65,32.65,fee schedule,
Adhesive clip ext ens contr,A4438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.88,,,,1.88,1.88,fee schedule,
Vag inser rectal control sys,A4563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1609.01,,,,127.73,1609.01,fee schedule,
G com garmnt glove nghttime,A6520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,119.54,,,,119.54,197.24,fee schedule,
G com garmnt glove nght cust,A6521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,474.33,,,,474.33,782.64,fee schedule,
G com garment arm nighttime,A6522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,290.47,,,,290.47,479.28,fee schedule,
G com garment arm nght custm,A6523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,689.17,,,,689.17,1137.13,fee schedule,
G com garmnt lwr leg/ft nght,A6524,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,362.39,,,,362.39,597.94,fee schedule,
G com garm lwrleg/ft ngt cus,A6525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,731.6,,,,731.6,1207.14,fee schedule,
G com garmt full leg/ft nght,A6526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,655.18,,,,655.18,1081.05,fee schedule,
G garmt full leg/ft nght cus,A6527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1204.8,,,,1204.8,1987.92,fee schedule,
G com garment bra nighttime,A6528,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,630,,,,630,1039.5,fee schedule,
G com garmt bra night custm,A6529,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,995.5,,,,995.5,1642.58,fee schedule,
Compression stocking bk18-30,A6530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.93,,,,19.6,36.93,fee schedule,
Gc stocking thighlngth 18-30,A6533,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.86,,,,40,66,fee schedule,
Gc stocking thighlngth 30-40,A6534,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,59.22,,,,39.69,65.49,fee schedule,
Gc stocking thighlngth 40+,A6535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.18,,,,23.68,68.18,fee schedule,
Gc stocking full lngth 18-30,A6536,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69.91,,,,13.3,69.91,fee schedule,
Gc stocking full lngth 30-40,A6537,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,82.88,,,,23.75,82.88,fee schedule,
Gc stocking full lngth 40+,A6538,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,97.04,,,,36.76,97.04,fee schedule,
Gc stocking waistlngth 18-30,A6539,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.51,,,,54.49,92.51,fee schedule,
Gc stocking waistlngth 30-40,A6540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,110.3,,,,57.23,110.3,fee schedule,
Gc stocking waistlngth 40+,A6541,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,130.66,,,,87.67,130.66,fee schedule,
Grad com stocking bk 30-40,A6552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.81,,,,54.81,90.44,fee schedule,
G com stcking bk 30-40 custm,A6553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,214.01,,,,214.01,353.12,fee schedule,
Grad com stocking bk 40+,A6554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,75.36,,,,75.36,124.34,fee schedule,
G com stcking bk 40+ custm,A6555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,214.01,,,,214.01,353.12,fee schedule,
G com stcking thgh18-30 cust,A6556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,293.29,,,,293.29,483.93,fee schedule,
G com stcking thgh30-40 cust,A6557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,293.29,,,,293.29,483.93,fee schedule,
G com stcking thgh 40+ cust,A6558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.67,,,,302.67,499.41,fee schedule,
G com stckng waist18-30 cust,A6562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,959.88,,,,959.88,1583.8,fee schedule,
G com stckng waist30-40 cust,A6563,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,959.88,,,,959.88,1583.8,fee schedule,
G com stckng waist 40+ cust,A6564,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1034,,,,1034,1706.1,fee schedule,
Grad comp gauntlet custom,A6565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,165.86,,,,165.86,273.67,fee schedule,
Grad com garment neck/head,A6566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,240.83,,,,240.83,397.37,fee schedule,
G com garment neck/head cust,A6567,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,756.68,,,,756.68,1248.52,fee schedule,
G com garment torso/shldr,A6568,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,157.17,,,,157.17,259.33,fee schedule,
G com garmnt torso/shdr cust,A6569,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,895,,,,895,1476.75,fee schedule,
Grad com garment genital,A6570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,107.09,,,,107.09,176.7,fee schedule,
G com garment genital custm,A6571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,643.63,,,,643.63,1061.99,fee schedule,
Grad com garment toe caps,A6572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,99.37,,,,99.37,163.96,fee schedule,
Grad com garmnt toe cap cust,A6573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,235.8,,,,235.8,389.07,fee schedule,
Custom gradient sleev/glov,A6574,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,300.61,,,,300.61,496.01,fee schedule,
Gradient comp sleev/glov,A6575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,97.42,,,,97.42,160.74,fee schedule,
Custom grad com sleeve med,A6576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,184.5,,,,184.5,304.43,fee schedule,
Custom grad cm sleeve heavy,A6577,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,152.7,,,,152.7,251.96,fee schedule,
Gradient comp sleeve,A6578,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,75.2,,,,75.2,124.08,fee schedule,
Custom grad com glove med,A6579,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,296.14,,,,296.14,488.63,fee schedule,
Custom grad com glove heavy,A6580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,293.96,,,,293.96,485.03,fee schedule,
Gradient comp glove,A6581,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69,,,,69,113.85,fee schedule,
Gradient comp gauntlet,A6582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.02,,,,46.02,75.93,fee schedule,
Grad com wrap w straps bk,A6583,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,151.38,,,,151.38,249.78,fee schedule,
Grad com wrap w straps ak,A6585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,179.24,,,,179.24,295.75,fee schedule,
Grad com wrap w straps leg,A6586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,528.06,,,,528.06,871.3,fee schedule,
Grad com wrap w straps foot,A6587,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69.17,,,,69.17,114.13,fee schedule,
Grad com wrap w straps arm,A6588,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,230.54,,,,230.54,380.39,fee schedule,
Grad com wrap w straps bra,A6589,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.01,,,,91.01,150.17,fee schedule,
G comp bandge liner lwr extr,A6594,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.14,,,,33.14,54.68,fee schedule,
G comp bandge liner upr extr,A6595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.59,,,,32.59,53.77,fee schedule,
G comp bandge conform gauze,A6596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.17,,,,0.17,0.28,fee schedule,
G comp bandage long stretch,A6597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.47,,,,1.47,2.43,fee schedule,
G comp bandage med stretch,A6598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.71,,,,0.71,1.17,fee schedule,
G comp bandage short stretch,A6599,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.61,,,,1.61,2.66,fee schedule,
G com bandge hgh dn foam sht,A6600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.9,,,,2.9,4.79,fee schedule,
G com bandge hgh dn foam pad,A6601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.26,,,,3.26,5.38,fee schedule,
G com bandge hgh dn foamroll,A6602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.76,,,,4.76,7.85,fee schedule,
G com bandge low dn foamchnl,A6603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.23,,,,2.23,3.68,fee schedule,
G com bandge low dn foam flt,A6604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.3,,,,1.3,2.15,fee schedule,
G com bandage padded foam,A6605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.49,,,,1.49,2.46,fee schedule,
G com bandage padded textile,A6606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.42,,,,4.42,7.29,fee schedule,
G com bandage tub protct lyr,A6607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.18,,,,1.18,1.95,fee schedule,
G com bandage tub protct pad,A6608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.92,,,,4.92,8.12,fee schedule,
G com stcking bk 18-30 custm,A6610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,214.01,,,,214.01,353.12,fee schedule,
Tc-99m graphite crucible,A9506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,328.6,,,,328.6,328.6,fee schedule,
Lutetium lu 177 dotatat ther,A9513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,296.25,,,,259.17,296.25,fee schedule,
I131 iodide cap rx,A9517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.34,,,,20.76,58.91,fee schedule,
Iodine i-125 sodium iodide,A9527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.99,,,,13.25,68.99,fee schedule,
I131 iodide sol rx,A9530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.4,,,,6.49,22.71,fee schedule,
Y90 ibritumomab rx,A9543,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65476.58,,,,31500,65476.58,fee schedule,
Iodine i-131 iobenguane 1mci,A9590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,339.61,,,,156.54,1213.25,fee schedule,
Piflu f-18 dia 1 millicurie,A9595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,615.12,,,,272.88,2114.94,fee schedule,
Gallium illuccix 1 millicure,A9596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1026.05,,,,487.24,3776.36,fee schedule,
Sr89 strontium,A9600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4146.34,,,,1629.41,5232.68,fee schedule,
Flortaucipir inj 1 millicuri,A9601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3710,,,,3710,3710,fee schedule,
Fluorodopa f-18 diag per mci,A9602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,446.88,,,,203.19,1574.82,fee schedule,
Sm 153 lexidronam,A9604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17259.85,,,,7546.46,17259.85,fee schedule,
Radium ra223 dichloride ther,A9606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,165.25,,,,128.37,211.81,fee schedule,
Lutetium lu 177 vipivotide,A9607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,241.24,,,,225.25,241.24,fee schedule,
Flotufolastat f18 diag 1 mci,A9608,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,651.67,,,,596.87,984.84,fee schedule,
Gallium locametz 1 millicuri,A9800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,873.44,,,,414.67,3213.92,fee schedule,
Cath bladed vasc prep,C1600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Endo single pulmonary,C1601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Orth/matrx/bn fill drug-elut,C1602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Ret dev laser ivc filter,C1603,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Grft trnsmurl/trnsvens byps,C1604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Pmkr- dual- leadless,C1605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Adapter- us to endoscope,C1606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Brachytx non-str gold-198,C1716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,310.74,,,,37.31,310.74,fee schedule,
Brachytx non-strhdr ir-192,C1717,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,398,,,,272.38,449.43,fee schedule,
Brachytx ns non-hdrir-192,C1719,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,399.65,,,,53.73,399.65,fee schedule,
Endo single urinary tract,C1747,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Gen neuro clo loop rechg,C1826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Gen neuro imp led ex cntr,C1827,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Auto cell process sys,C1832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Cardiac monitor sys,C1833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Brachytx non-stryttrium-90,C2616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19702.73,,,,15582.68,25711.42,fee schedule,
Brachytx non-str ha i-125,C2634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,172.99,,,,85.81,182,fee schedule,
Brachytx non-str ha p-103,C2635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,67.82,,,,25.81,67.82,fee schedule,
Brachy linear non-strp-103,C2636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62,,,,19.44,62,fee schedule,
Brachytx stranded i-125,C2638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.92,,,,38.15,69.99,fee schedule,
Brachytx non-strandedi-125,C2639,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.09,,,,34.95,61.13,fee schedule,
Brachytx stranded p-103,C2640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,87.39,,,,65.5,108.08,fee schedule,
Brachytx non-strandedp-103,C2641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,84.72,,,,64.4,112.08,fee schedule,
Brachytx stranded c-131,C2642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.85,,,,85.62,173.89,fee schedule,
Brachytx non-strandedc-131,C2643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.14,,,,54.71,92.14,fee schedule,
Brachytx planar p-103,C2645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.38,,,,4.69,5.38,fee schedule,
Brachytx stranded nos,C2698,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.92,,,,38.15,69.99,fee schedule,
Brachytx non-stranded nos,C2699,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.09,,,,19.44,40.09,fee schedule,
Low cost skin substitute app,C5271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Low cost skin substitute app,C5273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Low cost skin substitute app,C5275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Low cost skin substitute app,C5277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,636.31,,,,284.08,2201.8,fee schedule,
Hopd mntl hlt 15-29 min,C7900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Hopd mntl hlt 30-60 min,C7901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Hopd mntl hlt grp,C7903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,27.34,45.11,fee schedule,
Suprt dev- a-v fistula- imp,C8000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Mra w/cont abd,C8900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/o cont abd,C8901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mra w/o fol w/cont abd,C8902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri w/cont breast uni,C8903,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,case rate,
Mri w/o fol w/cont brst un,C8905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri w/cont breast bi,C8906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mri w/o fol w/cont breast,C8908,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/cont chest,C8909,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/o cont chest,C8910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mra w/o fol w/cont chest,C8911,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/cont lwr ext,C8912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/o cont lwr ext,C8913,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mra w/o fol w/cont lwr ext,C8914,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/cont pelvis,C8918,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/o cont pelvis,C8919,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mra w/o fol w/cont pelvis,C8920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Tte w or w/o fol w/cont com,C8921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
Tte w or w/o fol w/cont f/u,C8922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
2d tte w or w/o fol w/conco,C8923,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
2d tte w or w/o fol w/confu,C8924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,fee schedule,
2d tee w or w/o fol w/conin,C8925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
Tee w or w/o fol w/contcong,C8926,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
Tee w or w/o fol w/cont mon,C8927,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
Tte w or w/o fol w/constres,C8928,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
Tte w or wo fol wcondoppler,C8929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
Tte w or w/o contr cont ecg,C8930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,811.21,,,,362.23,2807.44,fee schedule,
Mra w/dye spinal canal,C8931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/o dye spinal canal,C8932,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mra w/o&w/dye spinal canal,C8933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/dye upper extremity,C8934,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Mra w/o dye upper extr,C8935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,114.19,885.04,case rate,
Mra w/o&w/dye upper extr,C8936,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
Prolonged iv inf req pump,C8957,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Injection caplacizumab-yhdp,C9047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,770.68,,,,650.36,1073.09,fee schedule,
Instill bupivac and meloxic,C9088,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.77,,,,0.66,1.09,fee schedule,
Inj oliceridine 0.1 mg,C9101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.23,,,,0.39,2.11,fee schedule,
Inj bupivacaine (posimir),C9144,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.5,,,,0.49,0.5,fee schedule,
Inj aponvie 1 mg,C9145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.86,,,,1.81,2.99,fee schedule,
Inj- nogapendekin pmln 1 mcg,C9169,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.19,,,,92.19,92.19,fee schedule,
Inj- tarlatamab-dlle- 1 mg,C9170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545,,,,1545,1545,fee schedule,
Inj- pegulicianine- 1 mg,C9171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.51,,,,37.51,37.51,fee schedule,
Inj- beqvez- per tx dose,C9172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3605000,,,,3605000,3605000,fee schedule,
Artiss fibrin sealant,C9250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,138.35,,,,88.28,684.25,fee schedule,
Bevacizumab injection,C9257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.82,,,,1.48,2.44,fee schedule,
Injection cangrelor,C9460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.82,,,,14.98,24.72,fee schedule,
Sotalol hydrochloride iv,C9482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.83,,,,9.42,22.83,fee schedule,
Conivaptan hcl,C9488,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.24,,,,29.87,49.29,fee schedule,
Covid-19 convalescent plasma,C9507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,562.2,,,,490.13,729.81,fee schedule,
Perc drug-el cor stent sing,C9600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Perc d-e cor stent ather s,C9602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Perc d-e cor revasc t cabg s,C9604,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Perc d-e cor revasc w ami s,C9606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,2550.33,27567.06,case rate,
Perc d-e cor revasc chro sin,C9607,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Place endorectal app,C9725,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Insert palate implants,C9727,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Place device/marker non pro,C9728,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1403.85,,,,655.59,5081.14,fee schedule,
Non-ophthalmic fva,C9733,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,case rate,
U/s trtmt not leiomyomata,C9734,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Cystoscopy prostatic imp 1-3,C9739,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5242.42,,,,2299.37,17821.26,case rate,
Cysto impl 4 or more,C9740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Microwave bronch 3d ebus,C9751,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3988.1,,,,1833.99,14214.4,fee schedule,
Spine device implant surgery,C9757,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Blind interatrial shunt ide,C9758,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18609.21,,,,8557.74,66326.9,fee schedule,
Non-blind interatrial shunt,C9760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29242.74,,,,13447.74,104226.9,fee schedule,
Cysto litho vacuum kidney,C9761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Cardiac mri seg dys strain,C9762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
Cardiac mri seg dys stress,C9763,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,558.93,,,,246.03,1906.86,case rate,
Revasc intravasc lithotripsy,C9764,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Revasc intra lithotrip-stent,C9765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Revasc intra lithotrip-ather,C9766,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Revasc lithotrip-stent-ather,C9767,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Cysto w/temp pros implant,C9769,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9333.48,,,,4184.63,32433.04,case rate,
Revasc lithotrip tibi/perone,C9772,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Revasc lithotr-stent tib/per,C9773,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Revasc lithotr-ather tib/per,C9774,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Revasc lith-sten-ath tib/per,C9775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,8399.85,65103.1,case rate,
Esophag mucosal integ add-on,C9777,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Colpopexy min/inv ex-perit,C9778,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5039.34,,,,2266.57,17567.07,case rate,
Esd endoscopy or colonoscopy,C9779,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3880.13,,,,1594.48,12358.02,case rate,
Insert cv cath inf & sup app,C9780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8773.2,,,,4034.49,31269.4,fee schedule,
Arthro/shoul surg w/spacer,C9781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13334.26,,,,6380.51,49452.22,case rate,
Blind myocar trpl bon marrow,C9782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18609.21,,,,8557.74,66326.9,fee schedule,
Blind cor sinus reducer impl,C9783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11145.87,,,,5190.89,40232.02,case rate,
Endo sleeve gastro w/tube,C9784,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,9807.76,16182.8,case rate,
Endo outlet restrict w/tube,C9785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,9807.76,16182.8,case rate,
Echo cad for hf preserved ef,C9786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,302.62,,,,284.59,469.57,fee schedule,
Instill pharm renal pelvis,C9789,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2393.07,,,,2250.5,3713.33,fee schedule,
Mri hyperpolarized xenon129,C9791,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1329.72,,,,1250.5,2063.33,fee schedule,
Blind/nonblind trans atrial,C9792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10368.23,,,,9750.5,16088.33,fee schedule,
Pre-plan 3d model w/ccta,C9793,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1059.29,,,,996.18,1643.7,fee schedule,
Complex simulation w/pet-ct,C9794,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2074.07,,,,1950.5,3218.33,fee schedule,
Sbrt w/positron emission del,C9795,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3988.1,,,,3750.5,6188.33,fee schedule,
Rpr intst excl anrect fist,C9796,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2844.73,,,,2707.03,2844.73,case rate,
Vasc emb/occ w/prs cath,C9797,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17765.77,,,,16905.79,17765.77,case rate,
Endo defect closure GI tract,C9901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10429.12,,,,9924.28,10429.12,case rate,
Periodic oral evaluation,D0120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,12.22,133.93,case rate,
Limit oral eval problm focus,D0140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,15.93,133.93,case rate,
Comprehensve oral evaluation,D0150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,25.5,6528.01,case rate,
Extensv oral eval prob focus,D0160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,19.12,203.01,case rate,
Re-evalest ptproblem focus,D0170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,25.76,133.93,case rate,
Re-eval post-op visit,D0171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,66.49,133.93,case rate,
Comp periodontal evaluation,D0180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,38.1,154.32,case rate,
Assessment of a patient,D0191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,55.4,133.93,case rate,
Intraor comprehensive series,D0210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,38.75,248.26,case rate,
Intraoral periapical first,D0220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,6.1,92.06,case rate,
Intraoral occlusal film,D0240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,17,6528.01,case rate,
Extraoral 2d project image,D0250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,14.5,6528.01,case rate,
Extraoral posterior image,D0251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,42.48,329.28,case rate,
Dental bitewing single image,D0270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,10.2,6528.01,case rate,
Dental bitewings two images,D0272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,17,6528.01,case rate,
Bitewings - three images,D0273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,16.94,248.26,case rate,
Bitewings four images,D0274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,23.8,6528.01,case rate,
Vert bitewings 7 to 8 images,D0277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,35.97,6528.01,case rate,
Dental saliography,D0310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,236.24,475,case rate,
Dental tmj arthrogram incl i,D0320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,236.24,843,case rate,
Other tmj images by report,D0321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,222.66,case rate,
Dental tomographic survey,D0322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,679.73,case rate,
Panoramic image,D0330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.26,,,,35.69,248.26,case rate,
2d cephalometric image,D0340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,44.68,178.06,case rate,
Oral/facial photo images,D0350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,25.4,178.06,case rate,
Cone beam ct capt & interp,D0364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,625.56,case rate,
Cone beam ct interprete man,D0365,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,625.56,case rate,
Cone beam ct interprete max,D0366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,625.56,case rate,
Cone beam ct interp both jaw,D0367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,625.56,case rate,
Cone beam ct interprete tmj,D0368,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,625.56,case rate,
Max mri capture & interprete,D0369,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,42.48,329.28,case rate,
Max ultrasound capt & interp,D0370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,558.68,case rate,
Sialoendoscopy capt & interp,D0371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,1444.23,case rate,
Cone beam ct capture limited,D0380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,385.19,case rate,
Cone beam ct capt mandible,D0381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,385.19,case rate,
Cone beam ct capt maxilla,D0382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,385.19,case rate,
Cone beam ct both jaws,D0383,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,385.19,case rate,
Cone beam ct capture tmj,D0384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,385.19,case rate,
Max mri image capture,D0385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,42.48,329.28,case rate,
Max ultrasound image capture,D0386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,106,577.29,case rate,
Trtmnt simulation 3d image,D0393,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,520.97,case rate,
Digital sub 2 or more images,D0394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,520.97,case rate,
Fusion 2 or more 3d images,D0395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,520.97,case rate,
Pulp vitality test,D0460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Non-ionizing diag proc,D0600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Pano radio image,D0701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,153.54,case rate,
2d cephal radio image,D0702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,153.54,case rate,
2d oral/facial photo image,D0703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,153.54,case rate,
Extra oral post radio image,D0705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,154.11,case rate,
Intraoral occlus radio image,D0706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,143.93,case rate,
Intraoral periap radio image,D0707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,143.93,case rate,
Intraoral bite radio image,D0708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,143.93,case rate,
Intraoral comp image capture,D0709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.06,,,,87.61,143.93,case rate,
Dental prophylaxis adult,D1110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,26.52,133.93,case rate,
Space maintainer fxd unilat,D1510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Fixed bilat space maint max,D1516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Fixed bilat space maint man,D1517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Remove unilat space maintain,D1520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Remove bilat space main max,D1526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Remove bilat space main man,D1527,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Recement space maint - max,D1551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Recement space maint - man,D1552,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Recement unilat space maint,D1553,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dist space maint fixed unil,D1575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Amalgam one surface permanen,D2140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,32.57,6528.01,fee schedule,
Amalgam two surfaces permane,D2150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,41.65,6528.01,fee schedule,
Amalgam three surfaces perma,D2160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,50.73,892.05,fee schedule,
Amalgam 4 or > surfaces perm,D2161,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,61.41,892.05,fee schedule,
Resin one surface-anterior,D2330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,36.7,6528.01,fee schedule,
Resin two surfaces-anterior,D2331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,48.95,6528.01,fee schedule,
Resin three surfaces-anterio,D2332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,60.19,6528.01,fee schedule,
Resin 4/> surf or w incis an,D2335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,61.21,892.05,fee schedule,
Ant resin-based cmpst crown,D2390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,95.5,6528.01,fee schedule,
Post 1 srfc resinbased cmpst,D2391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,32.57,6528.01,fee schedule,
Post 2 srfc resinbased cmpst,D2392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,41.65,6528.01,fee schedule,
Post 3 srfc resinbased cmpst,D2393,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,50.73,6528.01,fee schedule,
Post >=4srfc resinbase cmpst,D2394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,61.41,6528.01,fee schedule,
Dental gold foil one surface,D2410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental gold foil two surface,D2420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental gold foil three surfa,D2430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental inlay metalic 1 surf,D2510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental inlay metallic 2 surf,D2520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental inlay metl 3/more sur,D2530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay metallic 2 surf,D2542,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay metallic 3 surf,D2543,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay metl 4/more sur,D2544,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Inlay porcelain/ceramic 1 su,D2610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Inlay porcelain/ceramic 2 su,D2620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay porc 3/more sur,D2630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1129.36,fee schedule,
Dental onlay porcelin 2 surf,D2642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay porcelin 3 surf,D2643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay porc 4/more sur,D2644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Inlay composite/resin one su,D2650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Inlay composite/resin two su,D2651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental inlay resin 3/mre sur,D2652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay resin 2 surface,D2662,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay resin 3 surface,D2663,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental onlay resin 4/mre sur,D2664,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Crown resin-based indirect,D2710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,149.71,892.05,fee schedule,
Crown 3/4 resin-based compos,D2712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,509.68,892.05,fee schedule,
Crown resin w/ high noble me,D2720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,409.36,1255.99,fee schedule,
Crown resin w/ base metal,D2721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,409.36,1176.84,fee schedule,
Crown resin w/ noble metal,D2722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,409.36,1145.19,fee schedule,
Crown porcelain/ceramic,D2740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1502.16,fee schedule,
Crown porcelain w/ h noble m,D2750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1308.65,fee schedule,
Crown porcelain fused base m,D2751,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1239.66,fee schedule,
Crown porcelain w/ noble met,D2752,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1276.42,fee schedule,
Crown porc fused to titanium,D2753,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1461.3,fee schedule,
Crown 3/4 cast hi noble met,D2780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1256.41,fee schedule,
Crown 3/4 cast base metal,D2781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1152.26,fee schedule,
Crown 3/4 cast noble metal,D2782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1363.5,fee schedule,
Crown 3/4 porcelain/ceramic,D2783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1329.59,fee schedule,
Crown full cast high noble m,D2790,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1305.93,fee schedule,
Crown full cast base metal,D2791,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1152.26,fee schedule,
Crown full cast noble metal,D2792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1256.41,fee schedule,
Crown-titanium,D2794,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1255.99,fee schedule,
Interim crown,D2799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Recement inlay onlay or part,D2910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,24.47,6528.01,fee schedule,
Recement cast or prefab post,D2915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Re-cement or re-bond crown,D2920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,24.47,6528.01,fee schedule,
Reattach tooth fragment,D2921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Prefab porc/cer crown perm,D2928,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,471.5,892.05,fee schedule,
Prefab porc/ceram crown pri,D2929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,470,892.05,fee schedule,
Prefab stnlss steel crwn pri,D2930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,76.51,892.05,fee schedule,
Prefab stnlss steel crown pe,D2931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,81.61,892.05,fee schedule,
Prefabricated resin crown,D2932,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,86.72,892.05,fee schedule,
Prefab stainless steel crown,D2933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,113.24,892.05,fee schedule,
Prefab steel crown primary,D2934,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,116.04,892.05,fee schedule,
Protective restoration,D2940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,23.45,892.05,fee schedule,
Int therapeutic restoration,D2941,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,36.25,892.05,fee schedule,
Restorative foundation,D2949,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,128.21,892.05,fee schedule,
Core build-up incl any pins,D2950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,76.51,892.05,fee schedule,
Tooth pin retention,D2951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,10.18,892.05,fee schedule,
Post and core cast + crown,D2952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,123.68,892.05,fee schedule,
Prefab post/core + crown,D2954,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,81.61,892.05,fee schedule,
Each addtnl prefab post,D2957,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,201.02,892.05,fee schedule,
Labial veneer resin direct,D2960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Labial veneer resin indirect,D2961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Labial veneer porc indirect,D2962,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Add proc construct new crown,D2971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Coping,D2975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Crown repair,D2980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Inlay repair,D2981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Onlay repair,D2982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Veneer repair,D2983,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Resin infiltration of lesion,D2990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Dental unspec restorative pr,D2999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Pulp cap direct,D3110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,case rate,
Pulp cap indirect,D3120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,case rate,
Therapeutic pulpotomy,D3220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,40.8,6528.01,fee schedule,
Gross pulpal debridement,D3221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,47.6,892.05,fee schedule,
Part pulp for apexogenesis,D3222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Pulpal therapy anterior prim,D3230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,64.93,6528.01,fee schedule,
Pulpal therapy posterior pri,D3240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,42.7,892.05,fee schedule,
End thxpy anterior tooth,D3310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,178.55,980.85,fee schedule,
End thxpy premolar tooth,D3320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,214.26,1169.52,fee schedule,
End thxpy molar tooth,D3330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,271.4,6528.01,fee schedule,
Non-surg tx root canal obs,D3331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Incomplete endodontic tx,D3332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Internal root repair,D3333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Retreat root canal anterior,D3346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,133.67,1100,fee schedule,
Retreat root canal premolar,D3347,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,161.51,1300,fee schedule,
Retreat root canal molar,D3348,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,211.64,6528.01,fee schedule,
Apexification/recalc initial,D3351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,131.63,6528.01,fee schedule,
Apexification/recalc interim,D3352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,54.6,6528.01,fee schedule,
Apexification/recalc final,D3353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,143.06,6528.01,fee schedule,
Pulpal regeneration initial,D3355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,583.44,892.05,fee schedule,
Pulpal regeneration interim,D3356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,208.14,892.05,fee schedule,
Pulpal regeneration complete,D3357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,930.16,fee schedule,
Apicoectomy - anterior,D3410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,122.43,997.88,fee schedule,
Root surgery premolar,D3421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,77.97,1103.93,fee schedule,
Root surgery molar,D3425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,77.97,1260.48,fee schedule,
Bone graft peri per tooth,D3428,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1141.23,fee schedule,
Retrograde filling,D3430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,59.16,892.05,fee schedule,
Biological materials,D3431,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1426.93,fee schedule,
Guided tissue regeneration,D3432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1226.72,fee schedule,
Root amputation,D3450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,56.1,6528.01,fee schedule,
Endodontic endosseous implan,D3460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Intentional replantation,D3470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Surg rep root res anterior,D3471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,470.92,892.05,fee schedule,
Surg rep root res premolar,D3472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,614.85,892.05,fee schedule,
Surg rep root res molar,D3473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,758.77,892.05,fee schedule,
Surg exp root surf anterior,D3501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,716,892.05,fee schedule,
Surg exp root surf premolar,D3502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,930.8,fee schedule,
Surg exp root surf molar,D3503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,848.87,1145.6,fee schedule,
Isolation- tooth w rubb dam,D3910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Intraorifice barrier,D3911,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Tooth splitting,D3920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Decor or submerg erupt tooth,D3921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Canal prep/fitting of dowel,D3950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,61.21,6528.01,fee schedule,
Endodontic procedure,D3999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Gingivectomy/plasty 4 or mor,D4210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,842.27,6528.01,case rate,
Gingivectomy/plasty 1 to 3,D4211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,842.27,6528.01,case rate,
Gingivectomy/plasty rest,D4212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,842.27,6528.01,case rate,
Ana crown exp 4 or> per quad,D4230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,842.27,6528.01,case rate,
Ana crown exp 1-3 per quad,D4231,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Gingival flap proc w/ planin,D4240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,842.27,6528.01,case rate,
Gngvl flap w rootplan 1-3 th,D4241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Apically positioned flap,D4245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Crown lengthen hard tissue,D4249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Osseous surgery 4 or more,D4260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,842.27,9206.52,case rate,
Osseous surg 1 to 3 teeth,D4261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,842.27,6528.01,case rate,
Bone replce graft first site,D4263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Bio mtrls to aid soft/os reg,D4265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Guided tiss regen resorble,D4266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Guided tiss regen nonresorb,D4267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Surgical revision procedure,D4268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Pedicle soft tissue graft pr,D4270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Auto tissue graft 1st tooth,D4273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Mesial/distal wedge proc,D4274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Non-auto graft 1st tooth,D4275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Con tissue w pedicle graft,D4276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Soft tissue graft firsttooth,D4277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Splint intra-coronal,D4322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Splint extra-coronal,D4323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Periodontal scaling & root,D4341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,86.15,6528.01,fee schedule,
Periodontal scaling 1-3teeth,D4342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,60.41,6528.01,fee schedule,
Scaling gingiv inflammation,D4346,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Full mouth debridement,D4355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Localized delivery antimicro,D4381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Periodontal maint procedures,D4910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,35.69,6528.01,fee schedule,
Unscheduled dressing change,D4920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,10.18,6528.01,case rate,
Gingival irrigation per quad,D4921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,127.45,6528.01,case rate,
Unspecified periodontal proc,D4999,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.48,,,,235.5,6528.01,fee schedule,
Facial moulage sectional,D5911,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Facial moulage complete,D5912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Radiation applicator,D5983,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Radiation shield,D5984,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Radiation cone locator,D5985,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Commissure splint,D5987,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Surgical splint,D5988,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,678.8,5261.05,fee schedule,
Dental connector bar,D6920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Extraction coronal remnants,D7111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Extraction erupted tooth/exr,D7140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Rem imp tooth w mucoper flp,D7210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,842.27,6528.01,case rate,
Impact tooth remov soft tiss,D7220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Impact tooth remov part bony,D7230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Impact tooth remov comp bony,D7240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Impact tooth rem bony w/comp,D7241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Tooth root removal,D7250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Coronectomy,D7251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,678.8,5261.05,case rate,
Oral antral fistula closure,D7260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Primary closure sinus perf,D7261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Tooth reimplantation,D7270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Tooth transplantation,D7272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Exposure of unerupted tooth,D7280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,137.74,5261.05,fee schedule,
Transseptal fiberotomy,D7291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Alveoplasty w/ extraction,D7310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,101.63,1545.1,case rate,
Alveoloplasty w/extract 1-3,D7311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,101.63,1545.1,case rate,
Vestibuloplasty ridge extens,D7340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,678.8,5933.2,case rate,
Vestibuloplasty exten graft,D7350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,678.8,5933.2,case rate,
Rad exc lesion up to 1.25 cm,D7410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,61.71,1545.1,case rate,
Excision benign lesion>1.25c,D7411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,101.63,1545.1,case rate,
Excision benign lesion compl,D7412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,101.63,1545.1,case rate,
Excision malig lesion<=1.25c,D7413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,101.63,1545.1,case rate,
Excision malig lesion>1.25cm,D7414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,101.63,1545.1,case rate,
Excision malig les complicat,D7415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1545.1,,,,101.63,1545.1,case rate,
Malig tumor exc to 1.25 cm,D7440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,101.63,3261.97,case rate,
Malig tumor > 1.25 cm,D7441,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,101.63,3261.97,case rate,
Rem odontogen cyst to 1.25cm,D7450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,101.63,3261.97,case rate,
Rem odontogen cyst > 1.25 cm,D7451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,101.63,3261.97,case rate,
Rem nonodonto cyst to 1.25cm,D7460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Rem nonodonto cyst > 1.25 cm,D7461,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Removal of torus palatinus,D7472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,678.8,5261.05,fee schedule,
Remove torus mandibularis,D7473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Surg reduct osseoustuberosit,D7485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,101.63,5933.2,case rate,
I&d absc intraoral soft tiss,D7510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,40.8,712.83,fee schedule,
Incision/drain abscess intra,D7511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,101.63,787.68,fee schedule,
I&d abscess extraoral,D7520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,51.01,787.68,fee schedule,
Incision/drain abscess extra,D7521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,712.83,,,,101.63,787.68,fee schedule,
Removal fb skin/areolar tiss,D7530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Removal of fb reaction,D7540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,678.8,5261.05,fee schedule,
Removal of sloughed off bone,D7550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Closd rductn splint alveolus,D7670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,101.63,3261.97,case rate,
Alveolus open reduction,D7671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,101.63,5933.2,case rate,
Open reduc compd alveolus fx,D7770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,101.63,5933.2,case rate,
Alveolus clsd reduc stblz te,D7771,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,101.63,3261.97,case rate,
Tmj arthroscopy disc reposit,D7874,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3279.42,,,,678.8,5261.05,case rate,
Place intra-socket bio dress,D7922,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,101.63,892.05,fee schedule,
Reshaping bone orthognathic,D7940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Mandible graft,D7950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5933.2,,,,678.8,5933.2,case rate,
Treatment of complications,D9930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Occ guard hard full arch,D9944,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Occ guard soft full arch,D9945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Occ guard hard part arch,D9946,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Occlusion analysis,D9950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,842.27,6528.01,fee schedule,
Limited occlusal adjustment,D9951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Complete occlusal adjustment,D9952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,892.05,,,,838.9,6528.01,fee schedule,
Admin influenza virus vac,G0008,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Admin pneumococcal vaccine,G0009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Admin hepatitis b vaccine,G0010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.12,,,,20.72,160.58,fee schedule,
Injection of hiv prep drug,G0012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.37,,,,47.31,71.37,fee schedule,
Hiv prep counsel clin staff,G0013,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,85.94,90.31,fee schedule,
Comm hlth intg svs sdoh 60mn,G0019,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,85.94,90.31,fee schedule,
Pin service 60m per month,G0023,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,85.94,90.31,fee schedule,
Semen analysis,G0027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.5,,,,6.5,10.73,fee schedule,
Ca screenpelvic/breast exam,G0101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Psa screening,G0103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.31,,,,19.31,31.86,fee schedule,
Ca screenflexi sigmoidscope,G0104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Colorectal scrn hi risk ind,G0105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Colon ca screenbarium enema,G0106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.15,,,,88.19,683.49,fee schedule,
Diab manage trn per indiv,G0108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,53.9,,,,41.45,94.53,fee schedule,
Diab manage trn ind/group,G0109,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.59,,,,11.65,26.84,fee schedule,
Glaucoma scrn hgh risk direc,G0117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Glaucoma scrn hgh risk direc,G0118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,fee schedule,
Colon ca scrn barium enema,G0120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,389.63,,,,180.16,1396.35,fee schedule,
Colon ca scrn not hi rsk ind,G0121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,406.38,3149.64,fee schedule,
Screen cerv/vag thin layer,G0123,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.26,,,,20.26,33.43,fee schedule,
Trim nail(s),G0127,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,case rate,
Php/iop ot service,G0129,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,275.55,,,,35.03,275.55,case rate,
Single energy x-ray study,G0130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.39,,,,52.26,405.08,fee schedule,
Adm of soc dtr assess 5-15 m,G0136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,27.67,29.07,fee schedule,
Iv cipaglucosidase alfa-atga,G0138,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,691.71,,,,658.23,691.71,fee schedule,
Nav srv peer sup 60 min pr m,G0140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,85.94,90.31,fee schedule,
Scr c/v cytothinlayerrescr,G0143,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.05,,,,27.05,44.63,fee schedule,
Scr c/v cytothinlayerrescr,G0144,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.97,,,,43.97,72.55,fee schedule,
Scr c/v cytothinlayerrescr,G0145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.49,,,,26.49,43.71,fee schedule,
Scr c/v cyto automated sys,G0147,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,14.99,29.3,fee schedule,
Scr c/v cyto autosys rescr,G0148,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.94,,,,31.94,52.7,fee schedule,
Extrnl counterpulse per tx,G0166,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.42,,,,56.78,440.06,case rate,
Opps servicesched team conf,G0175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,448.74,,,,186.61,1446.3,fee schedule,
Opps/php/iop activity thrpy,G0176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,275.55,,,,262.21,275.55,case rate,
Dstry eye lesnfdr vssl tech,G0186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.91,,,,259.55,2011.62,fee schedule,
Pet not otherwise specified,G0235,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,417.87,,,,190.06,1473.1,fee schedule,
Therapeutic procd strg endur,G0237,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Oth resp proc indiv,G0238,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Oth resp proc group,G0239,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,fee schedule,
Initial foot exam pt lops,G0245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Followup eval of foot pt lop,G0246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Routine footcare pt w lops,G0247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.83,,,,88.3,684.4,case rate,
Demonstrate use home inr mon,G0248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Provide inr test mater/equip,G0249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Unsched dialysis esrd pt hos,G0257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,707.99,,,,308.32,2389.67,fee schedule,
Inj for sacroiliac jt anesth,G0260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,700.64,,,,315.08,2442.05,fee schedule,
Mnt subs tx for change dx,G0270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.03,,,,24.61,47.26,fee schedule,
Group mnt 2 or more 30 mins,G0271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.12,,,,12.69,26.84,fee schedule,
Pild/placebo control clin tr,G0276,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,3234.55,25069.45,case rate,
Hbot full body chamber 30m,G0277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,140.58,,,,61.16,474.02,fee schedule,
Tomosynthesis mammo,G0279,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.79,,,,18.91,92.19,fee schedule,
Elec stim unattend for press,G0281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.55,,,,11.55,684.4,fee schedule,
Elec stim other than wound,G0283,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.55,,,,9.06,21.01,fee schedule,
Non-cov surg procclin trial,G0293,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Non-cov proc clinical trial,G0294,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Visit to determ ldct elig,G0296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Pre-op service lvrs complete,G0302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Pre-op service lvrs 10-15dos,G0303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Pre-op service lvrs 1-9 dos,G0304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Post op service lvrs min 6,G0305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Cbc/diffwbc w/o platelet,G0306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.77,,,,7.77,12.82,fee schedule,
Cbc without platelet,G0307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.47,,,,6.47,10.68,fee schedule,
Care manage beh svs 20mins,G0323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Fecal blood scrn immunoassay,G0328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.05,,,,18.05,29.78,fee schedule,
Electromagntic tx for ulcers,G0329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.63,,,,8.29,684.4,fee schedule,
Facility svs dental rehab,G0330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3261.97,,,,842.27,6528.01,case rate,
Percutaneous islet celltrans,G0341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Laparoscopy islet cell trans,G0342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Laparotomy islet cell transp,G0343,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,1732,13423.91,case rate,
Direct refer hospital observ,G0379,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,650.76,,,,268.03,2077.34,case rate,
Lev 1 hosp type b ed visit,G0380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,76,,,,29.91,231.83,case rate,
Lev 2 hosp type b ed visit,G0381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,123.4,,,,54.49,422.32,case rate,
Lev 3 hosp type b ed visit,G0382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,202.65,,,,95.21,737.95,case rate,
Lev 4 hosp type b ed visit,G0383,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,298.44,,,,136.78,1060.14,case rate,
Lev 5 hosp type b ed visit,G0384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,386.18,,,,168.77,1308.08,case rate,
Trauma respons w/hosp criti,G0390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1387.12,,,,563.1,4364.34,fee schedule,
Alcohol/subs interv 15-30mn,G0396,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Alcohol/subs interv >30 min,G0397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Home sleep test/type 2 porta,G0398,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Home sleep test/type 3 porta,G0399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.26,,,,71.12,551.18,fee schedule,
Home sleep test/type 4 porta,G0400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.01,,,,136.95,1061.43,fee schedule,
Initial preventive exam,G0402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,fee schedule,
Ekg tracing for initial prev,G0404,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Grp psych php/iop 45-50,G0410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,275.55,,,,14.51,275.55,case rate,
Interactive grp psyc php/iop,G0411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,275.55,,,,14.51,275.55,case rate,
Open tx iliac spine uni/bil,G0412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,8759.27,case rate,
Pelvic ring fracture uni/bil,G0413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7248.16,,,,2939.41,25069.45,case rate,
Pelvic ring fx treat int fix,G0414,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,13107.45,case rate,
Open tx post pelvic fxcture,G0415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8759.27,,,,701.48,13107.45,case rate,
Prostate biopsy any mthd,G0416,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,364.17,,,,158.49,1228.38,case rate,
Ed svc ckd ind per session,G0420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,105.65,,,,81.87,188.47,fee schedule,
Ed svc ckd grp per session,G0421,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.5,,,,19.44,45.51,fee schedule,
Intens cardiac rehab w/exerc,G0422,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.88,,,,58.71,455.07,fee schedule,
Intens cardiac rehab no exer,G0423,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.88,,,,58.71,455.07,fee schedule,
Dermal filler injection(s),G0429,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Eia hiv-1/hiv-2 screen,G0432,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.57,,,,19.57,32.29,fee schedule,
Elisa hiv-1/hiv-2 screen,G0433,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.29,,,,18.29,30.18,fee schedule,
Oral hiv-1/hiv-2 screen,G0435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.98,,,,11.98,19.77,fee schedule,
Ppps initial visit,G0438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,163.31,,,,124.89,286.5,fee schedule,
Ppps subseq visit,G0439,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,128.67,,,,98.2,224.06,fee schedule,
Annual alcohol screen 15 min,G0442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Brief alcohol misuse counsel,G0443,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Depression screen annual,G0444,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
High inten beh couns std 30m,G0445,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Intens behave ther cardio dx,G0446,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Behavior counsel obesity 15m,G0447,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Devlopment test interpt&rep,G0451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Fecal microbiota prep instil,G0455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.98,,,,403.67,3128.68,fee schedule,
Autolog prp not diab ulcer,G0460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,843.95,6541.01,fee schedule,
Hospital outpt clinic visit,G0463,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.93,,,,59.1,458.06,case rate,
Autolog prp diab wound ulcer,G0465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1847.61,,,,223.38,1847.61,fee schedule,
Ven blood coll snf/hha,G0471,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.83,,,,5,10.83,fee schedule,
Hep c screen high risk/other,G0472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.35,,,,46.35,76.48,fee schedule,
Group behave couns 2-10,G0473,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.07,,,,14.51,112.49,fee schedule,
Hiv combination assay,G0475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.08,,,,24.08,39.73,fee schedule,
Hpv combo assay ca screen,G0476,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.09,,,,35.09,57.9,fee schedule,
Drug test def 1-7 classes,G0480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.43,,,,114.43,188.81,fee schedule,
Drug test def 8-14 classes,G0481,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,156.59,,,,156.59,258.37,fee schedule,
Drug test def 15-21 classes,G0482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,198.74,,,,198.74,327.92,fee schedule,
Drug test def 22+ classes,G0483,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,246.92,,,,246.92,407.42,fee schedule,
Chemo extend iv infus w/pump,G0498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.12,,,,162.65,1260.63,fee schedule,
Hepb screen high risk indiv,G0499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.27,,,,28.27,46.65,fee schedule,
Insert drug del implant >=4,G0516,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Remove drug implant,G0517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Remove w insert drug implant,G0518,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,403.68,,,,184.63,1430.99,case rate,
Drug test def simple all cl,G0659,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62.14,,,,62.14,102.53,fee schedule,
Blinded conv. tx mdd clin tr,G2000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,543.03,,,,236.4,1832.2,fee schedule,
Alcohol/sub misuse assess,G2011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Visit esketamine 56m or less,G2082,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1223.39,,,,513.69,3981.4,fee schedule,
Visit esketamine > 56m,G2083,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1967.73,,,,709.29,5497.4,fee schedule,
Off base opioid tx 70min,G2086,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Off base opioid tx 60 m,G2087,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,161.54,,,,71.25,552.2,fee schedule,
Init/sub psych care m 1st 30,G2214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.31,,,,37.09,287.47,fee schedule,
Remot img sub by pt non e/m,G2250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.82,,,,8.82,16.16,fee schedule,
Brief chkin 5-10 non-e/m,G2251,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.27,,,,10.36,22.14,fee schedule,
Brief chkin by md/qhp 11-20,G2252,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.11,,,,19.69,44.88,fee schedule,
Inj. omadacycline 1 mg,J0121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.8,,,,3.65,6.02,fee schedule,
Inj. eravacycline 1 mg,J0122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.21,,,,1,1.65,fee schedule,
Abatacept injection,J0129,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.44,,,,43.16,71.21,fee schedule,
Inj acetaminophen -fresenius,J0134,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.04,,,,0.04,0.14,fee schedule,
Adalimumab injection,J0135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1834.49,,,,861.44,1834.49,fee schedule,
Inj acetaminophen (b braun),J0136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.05,,,,0.05,0.08,fee schedule,
Inj acetaminophen (hikma),J0137,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.05,,,,0.05,0.08,fee schedule,
Inj aducanumab-avwa 2 mg,J0172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.98,,,,5.64,9.31,fee schedule,
Inj epinephrine (belcher),J0173,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.01,,,,0.81,2.01,fee schedule,
Inj lecanemab-irmb 1 mg,J0174,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.34,,,,1.34,1.34,fee schedule,
Inj- donanemab-azbt- 2 mg,J0175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.09,,,,4.09,4.09,fee schedule,
Inj- aflibercept hd- 1 mg,J0177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,333.7,,,,333.7,333.7,fee schedule,
Aflibercept injection,J0178,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,821.98,,,,821.98,1422.76,fee schedule,
Inj brolucizumab-dbll 1 mg,J0179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,332.57,,,,308,508.2,fee schedule,
Agalsidase beta injection,J0180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,223.52,,,,182.43,360.26,fee schedule,
Inj amisulpride 1 mg,J0184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.06,,,,9,14.85,fee schedule,
Inj. aprepitant 1 mg,J0185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.77,,,,1.72,2.84,fee schedule,
Injection alemtuzumab,J0202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2337.69,,,,1639.25,2704.76,fee schedule,
Inj allopurinol sodium 1 mg,J0206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5,,,,5,9.14,fee schedule,
Inj sodium thiosulfate 100mg,J0208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,96.08,,,,91.33,150.69,fee schedule,
Inj- nithiodote- 3mg / 125mg,J0211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.17,,,,2.17,2.17,fee schedule,
Inj velmanase alfa-tycv 1 mg,J0217,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,442,,,,400,660,fee schedule,
Inj olipudase alfa-rpcp 1mg,J0218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,382.56,,,,357.1,589.22,fee schedule,
Inj aval alfa-nqpt 4mg,J0219,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.75,,,,68.6,113.19,fee schedule,
Alglucosidase alfa injection,J0220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,148.86,,,,122.56,320.46,fee schedule,
Lumizyme injection,J0221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.97,,,,170.08,325.5,fee schedule,
Inj. patisiran 0.1 mg,J0222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.88,,,,95,156.75,fee schedule,
Inj givosiran 0.5 mg,J0223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,112.14,,,,103,169.95,fee schedule,
Inj. lumasiran 0.5 mg,J0224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,317.88,,,,291.01,480.17,fee schedule,
Inj vutrisiran 1 mg,J0225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4926,,,,4635,7647.75,fee schedule,
Inj remdesivir 1 mg,J0248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.35,,,,5.2,8.58,fee schedule,
Alpha 1 proteinase inhibitor,J0256,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.94,,,,4.51,8.05,fee schedule,
Glassia injection,J0257,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.58,,,,4.89,8.83,fee schedule,
Amphotericin b lipid complex,J0287,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.13,,,,7.12,18.36,fee schedule,
Amphotericin b liposome inj,J0289,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.33,,,,18.33,43.97,fee schedule,
Inj. plazomicin 5 mg,J0291,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.59,,,,3,4.95,fee schedule,
Amobarbital 125 mg inj,J0300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.24,,,,6.33,171.17,fee schedule,
Inj rezafungin 1 mg,J0349,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.12,,,,9.75,16.09,fee schedule,
Inj artesunate 1mg,J0391,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.83,,,,45.27,74.7,fee schedule,
Inj aripiprazole ext rel 1mg,J0401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.07,,,,5.45,11.22,fee schedule,
Inj abilify asimtufii 1 mg,J0402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.95,,,,5.66,9.34,fee schedule,
Injection aztreonam 100 mg,J0457,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.97,,,,1.97,4.17,fee schedule,
Dimecaprol injection,J0470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,59.81,,,,37.81,98.67,fee schedule,
Baclofen 10 mg injection,J0475,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,174.58,,,,173.39,293.37,fee schedule,
Basiliximab,J0480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4588.77,,,,3789.63,7385.83,fee schedule,
Belatacept injection,J0485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.81,,,,3.78,6.39,fee schedule,
Belimumab injection,J0490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.15,,,,36.78,60.69,fee schedule,
Inj anifrolumab-fnia 1mg,J0491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.29,,,,15.34,25.31,fee schedule,
Inj. benralizumab 1 mg,J0517,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,167.3,,,,167.3,279.68,fee schedule,
Peng benzathine/procaine inj,J0558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.52,,,,11.02,28.99,fee schedule,
Penicillin g benzathine inj,J0561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.37,,,,13.85,35.85,fee schedule,
Inj bezlotoxumab 10 mg,J0565,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.86,,,,37.85,62.45,fee schedule,
Buprenorphine implant 74.2mg,J0570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1311.75,,,,1232.5,2033.63,fee schedule,
Inj- brixadi- 7 days or less,J0577,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,429.16,,,,429.16,429.16,fee schedule,
Inj brixadi- more than 7 day,J0578,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1716.62,,,,1716.62,1716.62,fee schedule,
Injection burosumab-twza 1m,J0584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,469.58,,,,340,561,fee schedule,
Injectiononabotulinumtoxina,J0585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.41,,,,6.01,9.92,fee schedule,
Abobotulinumtoxina,J0586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.63,,,,8.24,13.6,fee schedule,
Inj rimabotulinumtoxinb,J0587,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.99,,,,10.43,17.21,fee schedule,
Incobotulinumtoxin a,J0588,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.34,,,,5.05,8.55,fee schedule,
Inj daxibotulinumtoxina-lanm,J0589,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.12,,,,3.12,3.12,fee schedule,
Busulfan injection,J0594,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.27,,,,1.15,5.78,fee schedule,
Injection ruconest,J0596,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.72,,,,22.52,37.16,fee schedule,
C-1 esterase berinert,J0597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.36,,,,51.35,106.18,fee schedule,
C-1 esterase cinryze,J0598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.21,,,,42.94,70.85,fee schedule,
Edetate calcium disodium inj,J0600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6086.32,,,,5594.42,9419.17,fee schedule,
Inj etelcalcetide 0.1 mg,J0606,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.57,,,,2.57,5.71,fee schedule,
Calcium glucon (fresenius),J0612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.04,,,,0.04,0.08,fee schedule,
Calcium glucon (wg critical),J0613,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.09,,,,0.09,0.09,fee schedule,
Calcitonin salmon injection,J0630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1173.06,,,,1069.49,2647.26,fee schedule,
Canakinumab injection,J0638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,127.81,,,,87.61,144.56,fee schedule,
Inj levoleucovorin nos 0.5mg,J0641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.21,,,,0.06,0.27,fee schedule,
Injection khapzory 0.5 mg,J0642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.38,,,,1.38,2.52,fee schedule,
Inj- levothyroxine- freskabi,J0651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.75,,,,3.75,3.75,fee schedule,
Inj- levothyroxine- hikma,J0652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.14,,,,5.14,5.14,fee schedule,
Inj bupivacaine nos 0.5mg,J0665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.01,,,,0.01,0.02,fee schedule,
Inj cefazolin (wg crit care),J0687,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.04,,,,1.04,1.04,fee schedule,
Inj cefazolin sodium baxter,J0689,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.26,,,,1.16,2.01,fee schedule,
Inj lefamulin 1 mg,J0691,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.72,,,,0.72,1.19,fee schedule,
Inj ceftolozane tazobactam,J0695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.23,,,,5.59,12.16,fee schedule,
Inj cefiderocol 10 mg,J0699,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.28,,,,1.89,3.12,fee schedule,
Inj. cefepime hcl (baxter),J0701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.83,,,,5.43,9.29,fee schedule,
Inj cefepime hcl (b braun),J0703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.97,,,,4.97,8.68,fee schedule,
Ceftaroline fosamil inj,J0712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.94,,,,3.16,6.32,fee schedule,
Ceftazidime and avibactam,J0714,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100.58,,,,71.25,117.56,fee schedule,
Centruroides immune f(ab),J0716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4804.24,,,,3486,5751.9,fee schedule,
Certolizumab pegol inj 1mg,J0717,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.65,,,,4.65,8.13,fee schedule,
Inj clindamycin phosp 300mg,J0736,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.47,,,,1.9,3.14,fee schedule,
Inj clindamycin (baxter),J0737,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.82,,,,1.68,2.82,fee schedule,
Hiv prep inj cabotegravir,J0739,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.81,,,,6.16,10.16,fee schedule,
Cidofovir injection,J0740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,528,,,,528,914.41,fee schedule,
Inj cabote rilpivir 2mg 3mg,J0741,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.9,,,,19.8,32.67,fee schedule,
Inj imip 4 cilas 4 releb 2mg,J0742,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.51,,,,2.14,3.53,fee schedule,
Hiv prep ftc/tdf 200/300mg,J0750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.87,,,,4.87,4.87,fee schedule,
Hiv prep ftc/taf 200/25mg,J0751,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.82,,,,77.82,77.82,fee schedule,
Collagenase clost hist inj,J0775,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.16,,,,35.96,71.16,fee schedule,
Inj crizanlizumab-tmca 5mg,J0791,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,128.54,,,,120,198,fee schedule,
Inj. acthar gel to 40 units,J0801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3750.08,,,,3389.78,5593.14,fee schedule,
Inj. (ani) up to 40 units,J0802,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3416.97,,,,3136.34,5174.96,fee schedule,
Crotalidae poly immune fab,J0840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1762.35,,,,1762.35,3237.01,fee schedule,
Inj crotalidae im f(ab)2 eq,J0841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1040.11,,,,912.07,1504.92,fee schedule,
Cytomegalovirus imm iv /vial,J0850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1814.94,,,,1129.15,2982.99,fee schedule,
Daptomycin (xellia) unrefrig,J0872,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.04,,,,0.04,0.04,fee schedule,
Injection dalbavancin,J0875,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.61,,,,14.62,25.23,fee schedule,
Inj daptomycin (hospira),J0877,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.06,,,,0.06,0.1,fee schedule,
Darbepoetin alfa non-esrd,J0881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.04,,,,2.93,4.83,fee schedule,
Darbepoetin alfa esrd use,J0882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.04,,,,2.93,4.83,fee schedule,
Argatroban nonesrd use 1mg,J0883,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.26,,,,1.26,7.38,fee schedule,
Argatroban esrd dialysis 1mg,J0884,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.26,,,,1.26,7.38,fee schedule,
Epoetin alfa non-esrd,J0885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.53,,,,7.53,14.65,fee schedule,
Epoetin beta esrd use,J0887,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.21,,,,1.21,2.66,fee schedule,
Epoetin beta non esrd,J0888,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.16,,,,1.16,2.66,fee schedule,
Argatroban nonesrd (accord),J0891,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.2,,,,0.57,4.2,fee schedule,
Argatroban dialysis (accord),J0892,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.2,,,,0.57,4.2,fee schedule,
Inj decitabine (sun pharma),J0893,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.12,,,,0.77,2.12,fee schedule,
Inj luspatercept-aamt 0.25mg,J0896,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.62,,,,38.47,65.95,fee schedule,
Denosumab injection,J0897,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.96,,,,13.69,26.96,fee schedule,
Argatroban nonesrd (auromed),J0898,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.49,,,,1.49,2.71,fee schedule,
Argatroban dialysis auromed,J0899,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.49,,,,1.49,2.71,fee schedule,
Inst tauro 1.35mg/hep 100u,J0911,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.58,,,,8.58,8.58,fee schedule,
Dexmedetomidine film 1 mcg,J1105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.78,,,,0.78,1.44,fee schedule,
Digoxin immune fab (ovine),J1162,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4888.1,,,,3780.26,7882.78,fee schedule,
Dexrazoxane hcl injection,J1190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,87.49,,,,87.49,194.72,fee schedule,
Inj. cetirizine hcl 0.5mg,J1201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.87,,,,14.87,24.75,fee schedule,
Inj- cipaglucosidase- 5 mg,J1203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,88.06,,,,88.06,88.06,fee schedule,
Dimethyl sulfoxide 50% 50 ml,J1212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,715.9,,,,558.87,1123.35,fee schedule,
Ecallantide injection,J1290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,565.83,,,,480.55,889.88,fee schedule,
Eculizumab injection,J1300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,224.63,,,,217.43,358.76,fee schedule,
Injection edaravone 1 mg,J1301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.14,,,,18.03,29.75,fee schedule,
Inj sutimlimab-jome 10 mg,J1302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.13,,,,16.36,26.99,fee schedule,
Inj. ravulizumab-cwvz 10 mg,J1303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,220.75,,,,212.61,350.81,fee schedule,
Inj tofersen intrathec 1 mg,J1304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,153.66,,,,142.3,234.8,fee schedule,
Inj evinacumab-dgnb 5mg,J1305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.31,,,,172.25,284.21,fee schedule,
Injection inclisiran 1 mg,J1306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.19,,,,5.08,12.19,fee schedule,
Elosulfase alfa injection,J1322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,293.92,,,,236.76,463.49,fee schedule,
Inj- elranatamab-bcmm- 1 mg,J1323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,178.85,,,,178.85,178.85,fee schedule,
Eptifibatide injection,J1327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.15,,,,4.15,45.49,fee schedule,
Erythro lactobionate /500 mg,J1364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65.38,,,,65.38,133.27,fee schedule,
Inj estrogen conjugate 25 mg,J1410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,382.79,,,,309.33,614.03,fee schedule,
Inj hemgenix per tx dose,J1411,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3672900,,,,3672900,3672900,fee schedule,
Inj roctavian ml 2x10^13vc g,J1412,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12007.81,,,,12007.81,149531.25,fee schedule,
Inj delandistrogene mox rokl,J1413,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3325454.76,,,,3200000,5280000,fee schedule,
Injection casimersen 10 mg,J1426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,166.23,,,,160,264,fee schedule,
Inj. viltolarsen,J1427,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.79,,,,58.79,111.67,fee schedule,
Inj golodirsen 10 mg,J1429,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,166.22,,,,160,264,fee schedule,
Ethanolamine oleate 100 mg,J1430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,491.68,,,,444.1,781.98,fee schedule,
Inj- focinvez- 1mg,J1434,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.14,,,,3.14,3.14,fee schedule,
Inj. fe derisomaltose 10 mg,J1437,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.05,,,,18.86,31.12,fee schedule,
Etanercept injection,J1438,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,790.78,,,,254.53,790.78,fee schedule,
Inj ferric carboxymaltos 1mg,J1439,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.1,,,,1.09,1.88,fee schedule,
Fecal microbiota jslm 1 ml,J1440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63.3,,,,60,99,fee schedule,
Inj filgrastim excl biosimil,J1442,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1,,,,0.85,1.4,fee schedule,
Inj tbo filgrastim 1 microg,J1447,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.39,,,,0.39,0.71,fee schedule,
Injection trilaciclib 1mg,J1448,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.36,,,,4.72,7.79,fee schedule,
Inj eflapegrastim-xnst 0.1mg,J1449,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.75,,,,22.75,48.96,fee schedule,
Fomepizole 15 mg,J1451,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.44,,,,6.44,11.06,fee schedule,
Inj fosnetupitant palonoset,J1454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,679.51,,,,173.54,679.51,fee schedule,
Foscarnet sodium injection,J1455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.32,,,,3.49,82.27,fee schedule,
Inj fosaprepitant (teva),J1456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.04,,,,0.44,2.05,fee schedule,
Galsulfase injection,J1458,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,484.75,,,,339.43,560.06,fee schedule,
Inj ivig privigen 500 mg,J1459,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.58,,,,40.6,79.68,fee schedule,
Gamma globulin 1 cc inj,J1460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.85,,,,40.54,83.69,fee schedule,
Inj cutaquig 100 mg,J1551,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.5,,,,1.62,14.5,fee schedule,
Inj. asceniv,J1554,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,491.4,,,,454.5,749.93,fee schedule,
Inj cuvitru 100 mg,J1555,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.82,,,,13.86,26.27,fee schedule,
Inj imm glob bivigam 500mg,J1556,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,75.17,,,,70.49,120.38,fee schedule,
Gammaplex injection,J1557,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,57.93,,,,46.03,91,fee schedule,
Inj. xembify 100 mg,J1558,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.3,,,,12.98,23.4,fee schedule,
Hizentra injection,J1559,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.23,,,,10.19,21.35,fee schedule,
Gamma globulin > 10 cc inj,J1560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,498.52,,,,405.36,836.96,fee schedule,
Gamunex-c/gammaked,J1561,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.81,,,,38.64,82.14,fee schedule,
Immune globulin powder,J1566,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,82.19,,,,62.22,129.53,fee schedule,
Octagam injection,J1568,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49,,,,38.68,74.2,fee schedule,
Gammagard liquid injection,J1569,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.69,,,,40.97,72.85,fee schedule,
Hepagam b im injection,J1571,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.66,,,,59.61,98.36,fee schedule,
Flebogamma injection,J1572,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,56.12,,,,35.86,92.58,fee schedule,
Hepagam b intravenous inj,J1573,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.66,,,,51.28,84.61,fee schedule,
Hyqvia 100mg immuneglobulin,J1575,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.5,,,,14.02,28.18,fee schedule,
Inj panzyga 500 mg,J1576,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,67.46,,,,66.44,109.63,fee schedule,
Injection glatiramer acetate,J1595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,172.88,,,,67.64,175.77,fee schedule,
Golimumab for iv use 1mg,J1602,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.1,,,,11.1,21.89,fee schedule,
Glucagon hydrochloride/1 mg,J1610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,192.3,,,,173.78,310.79,fee schedule,
Inj glucagon hcl fresenius,J1611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,108.93,,,,108.93,162.01,fee schedule,
Inj granisetron xr 0.1 mg,J1627,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.71,,,,3.05,9.36,fee schedule,
Inj. guselkumab 1 mg,J1628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.47,,,,74.47,99.3,fee schedule,
Inj. brexanolone 1 mg,J1632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72,,,,71.18,123.75,fee schedule,
Hemin 1 mg,J1640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.2,,,,23.76,51.71,fee schedule,
Inj heparin pfizer 1000u,J1643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.73,,,,0.25,3.73,fee schedule,
Tetanus immune globulin inj,J1670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,581.78,,,,418.84,954.71,fee schedule,
Makena 10 mg,J1726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.46,,,,14.46,23.46,fee schedule,
Inj hydroxyprogst capoat nos,J1729,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.18,,,,8.85,22.51,fee schedule,
Ibutilide fumarate injection,J1742,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,241.4,,,,152.86,338.35,fee schedule,
Idursulfase injection,J1743,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,537.93,,,,537.93,895.8,fee schedule,
Icatibant injection,J1744,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,151.64,,,,151.64,404.15,fee schedule,
Infliximab not biosimil 10mg,J1745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.22,,,,32.16,64.96,fee schedule,
Inj. ibalizumab-uiyk 10 mg,J1746,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.06,,,,58.71,123.12,fee schedule,
Inj spesolimab-sbzo 1 mg,J1747,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.43,,,,56.81,93.74,fee schedule,
Inj iron dextran,J1750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.67,,,,14.41,28.58,fee schedule,
Imuglucerase injection,J1786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.62,,,,39.49,65.16,fee schedule,
Inj esmolol hcl 10mg,J1805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.19,,,,0.19,0.43,fee schedule,
Inj esmolol hcl wg crit care,J1806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.36,,,,0.36,0.74,fee schedule,
Fiasp for insulin pump use,J1811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.41,,,,7.41,7.41,fee schedule,
Lyumjev for insulin pump use,J1813,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.53,,,,15.53,15.53,fee schedule,
Inj. inebilizumab-cdon 1 mg,J1823,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,484.4,,,,436.67,720.51,fee schedule,
Interferon beta-1a inj,J1826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1910.69,,,,949.35,2785.97,fee schedule,
Injection isavuconazonium,J1833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.98,,,,0.64,1.06,fee schedule,
Inj metronidazole 10 mg,J1836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.03,,,,0.02,0.03,fee schedule,
Inj labetalol hcl 5mg,J1920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.27,,,,0.17,0.28,fee schedule,
Inj labetalol hcl hikma 5mg,J1921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.63,,,,0.7,1.63,fee schedule,
Lanreotide injection,J1930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.97,,,,48.44,79.93,fee schedule,
Laronidase injection,J1931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.7,,,,28.78,47.49,fee schedule,
Inj lanreotide (cipla) 1mg,J1932,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.8,,,,33.65,60.38,fee schedule,
Inj. aristada initio 1 mg,J1943,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.19,,,,2.97,5.1,fee schedule,
Aripiprazole lauroxil 1 mg,J1944,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.23,,,,2.98,5.12,fee schedule,
Leuprolide acetate /3.75 mg,J1950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1617.65,,,,726.59,1617.65,fee schedule,
Inj fensolvi 0.25 mg,J1951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,140.62,,,,131.82,217.5,fee schedule,
Leuprolide inj camcevi 1mg,J1952,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55,,,,55,98.67,fee schedule,
Leuprolide depot cipla 7.5mg,J1954,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,257.7,,,,257.7,460.72,fee schedule,
Inj lenacapavir 1 mg,J1961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.99,,,,21.03,34.7,fee schedule,
Inj linezolid (hospira),J2021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.76,,,,14.76,33.1,fee schedule,
Injection mepolizumab 1mg,J2182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.44,,,,25.64,42.31,fee schedule,
Inj. meropenem vaborbactam,J2186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.09,,,,1.65,2.72,fee schedule,
Methylnaltrexone injection,J2212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.94,,,,0.5,1.31,fee schedule,
Inj micafungin (par pharm),J2247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.35,,,,0.33,0.54,fee schedule,
Minocycline hydrochloride,J2265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.59,,,,0.59,2.59,fee schedule,
Inj- mirikizumab-mrkz- 1 mg,J2267,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.54,,,,39.54,39.54,fee schedule,
Inj- motixafortide- 0.25 mg,J2277,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.22,,,,25.22,25.22,fee schedule,
Ziconotide injection,J2278,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.65,,,,7.91,14.92,fee schedule,
Inj moxifloxacin (fres kabi),J2281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.22,,,,5.8,9.73,fee schedule,
Inj nitroglycerin 5 mg,J2305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.41,,,,1.28,2.11,fee schedule,
Inj naloxone hcl (zimhi),J2311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.5,,,,1.5,12.75,fee schedule,
Naltrexone depot form,J2315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.12,,,,3.23,6.52,fee schedule,
Natalizumab injection,J2323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.15,,,,20.29,40.34,fee schedule,
Inj nusinersen 0.1mg,J2326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1231.9,,,,1101.54,1840.79,fee schedule,
Inj risankizumab-rzaa 1 mg,J2327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.63,,,,14.63,25.11,fee schedule,
Inj ublituximab-xiiy 1 mg,J2329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69.44,,,,65.55,108.16,fee schedule,
Injection ocrelizumab 1 mg,J2350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,59.8,,,,53.95,89.02,fee schedule,
Octreotide injection depot,J2353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,214.88,,,,121.58,214.88,fee schedule,
Inj tezepelumab-ekko 1mg,J2356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.11,,,,17.3,28.55,fee schedule,
Omalizumab injection,J2357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.29,,,,22.93,38.29,fee schedule,
Olanzapine long-acting inj,J2358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.92,,,,2.63,4.34,fee schedule,
Inj. olanzapine 0.5mg,J2359,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.92,,,,0.92,1.55,fee schedule,
Inj biorphen 20 micrograms,J2372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.17,,,,0.17,0.28,fee schedule,
Chloroprocaine hcl injection,J2401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.03,,,,0.03,0.05,fee schedule,
Chloroprocaine opht gel 1mg,J2403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.63,,,,0.63,0.63,fee schedule,
Injection oritavancin 10 mg,J2406,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.5,,,,40.7,67.16,fee schedule,
Injection oritavancin,J2407,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.46,,,,24.14,45.52,fee schedule,
Palifermin injection,J2425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.99,,,,21.3,41.45,fee schedule,
Inj invega sustenna 1 mg,J2426,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.76,,,,11.48,23.61,fee schedule,
Inj invega hafyera/trinza,J2427,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.66,,,,12.21,20.15,fee schedule,
Inj pasireotide long acting,J2502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.84,,,,314.34,884.9,fee schedule,
Inj pegfilgrast ex bio 0.5mg,J2506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.14,,,,31.14,135.17,fee schedule,
Pegloticase injection,J2507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3482.15,,,,2485.24,5562.27,fee schedule,
Pegunigalsidase alfa-iwxj,J2508,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,223.55,,,,206.75,341.14,fee schedule,
Penicillin g procaine inj,J2510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.94,,,,38.12,71.56,fee schedule,
Injection peramivir,J2547,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.68,,,,1.58,2.61,fee schedule,
Plerixafor injection,J2562,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.47,,,,50.47,401.92,fee schedule,
Inj desmopressin acetate,J2597,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.42,,,,5.42,11.97,fee schedule,
Inj vasopressin 1 unit,J2598,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.62,,,,1.62,2.99,fee schedule,
Inj- vasopressin (baxter),J2601,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.77,,,,3.77,3.77,fee schedule,
Procainamide hcl injection,J2690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,546.07,,,,95.44,546.07,fee schedule,
Protein c concentrate,J2724,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.05,,,,15.05,24.87,fee schedule,
Phentolaine mesylate inj,J2760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,367.12,,,,367.12,737.2,fee schedule,
Quinupristin/dalfopristin,J2770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.23,,,,6.23,815.05,fee schedule,
Inj faricimab-svoa 0.1mg,J2777,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.25,,,,34.25,59.55,fee schedule,
Ranibizumab injection,J2778,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.14,,,,137.14,357.34,fee schedule,
Inj susvimo 0.1 mg,J2779,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,79.08,,,,79.08,133.29,fee schedule,
Inj pegcetacoplan 1mg,J2781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,147.36,,,,4.2,147.36,fee schedule,
Inj avacincaptad pegol 0.1mg,J2782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,109.53,,,,109.53,109.53,fee schedule,
Rasburicase,J2783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,371.29,,,,287.64,605.98,fee schedule,
Injection reslizumab 1mg,J2786,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.31,,,,8.31,13.71,fee schedule,
Rho(d) immune globulin h sd,J2792,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.34,,,,30.1,54.38,fee schedule,
Inj risperdal consta 0.5 mg,J2794,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.3,,,,9.95,20.05,fee schedule,
Romiplostim injection,J2796,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.05,,,,73.51,158.43,fee schedule,
Inj. perseris 0.5 mg,J2798,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.19,,,,9.31,15.36,fee schedule,
Inj uzedy 1 mg,J2799,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.77,,,,24.64,40.66,fee schedule,
Inj- rykindo- 0.5 mg,J2801,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.03,,,,13.03,13.03,fee schedule,
Sargramostim injection,J2820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,60.28,,,,42.4,97.86,fee schedule,
Inj sebelipase alfa 1 mg,J2840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,539.42,,,,498,821.7,fee schedule,
Inj secretin synthetic human,J2850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.57,,,,34.78,57.39,fee schedule,
Injection siltuximab,J2860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,157.07,,,,82.96,157.07,fee schedule,
Somatropin injection,J2941,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,163.55,,,,51.96,169.57,fee schedule,
Reteplase injection,J2993,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2777.14,,,,2301.9,3798.14,fee schedule,
Alteplase recombinant,J2997,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.47,,,,76.82,126.75,fee schedule,
Inj plasminogen tvmh 1mg,J2998,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.55,,,,30,49.5,fee schedule,
Inj. fremanezumab-vfrm 1 mg,J3031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.85,,,,1.85,4.95,fee schedule,
Inj. eptinezumab-jjmr 1 mg,J3032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.69,,,,14.95,24.67,fee schedule,
Inj talquetamab-tgvs 0.25 mg,J3055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,67.65,,,,67.65,67.65,fee schedule,
Inj taliglucerase alfa 10 u,J3060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.58,,,,29.63,48.89,fee schedule,
Inj tedizolid phosphate,J3090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.81,,,,1.48,2.94,fee schedule,
Telavancin injection,J3095,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.38,,,,5.85,11.62,fee schedule,
Tenecteplase injection,J3101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,157.72,,,,121.79,252.63,fee schedule,
Inj. romosozumab-aqqg 1 mg,J3111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.17,,,,9,14.85,fee schedule,
Testosterone undecanoate 1mg,J3145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.95,,,,1.41,3.02,fee schedule,
Thyrotropin injection,J3240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2073.34,,,,1690.3,3334.93,fee schedule,
Inj. teprotumumab-trbw 10 mg,J3241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.89,,,,321.88,541.18,fee schedule,
Inj. tigecycline (accord),J3244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.65,,,,0.59,2.87,fee schedule,
Inj. tildrakizumab 1 mg,J3245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,135.92,,,,126.88,218.72,fee schedule,
Tirofiban hcl,J3246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.83,,,,3.83,10.98,fee schedule,
Inj secukinumab intrav 1mg,J3247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.54,,,,17.54,17.54,fee schedule,
Tocilizumab injection,J3262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.96,,,,3.43,5.99,fee schedule,
Inj- toripalimab-tpzi- 1 mg,J3263,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.87,,,,38.87,38.87,fee schedule,
Treprostinil injection,J3285,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.82,,,,55.53,93.03,fee schedule,
Inj xipere 1 mg,J3299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.4,,,,47.61,80.16,fee schedule,
Inj triamcinolone ace xr 1mg,J3304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.75,,,,16.95,28.94,fee schedule,
Triptorelin pamoate,J3315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,466.73,,,,248.39,682.41,fee schedule,
Inj. triptorelin xr 3.75 mg,J3316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3418.49,,,,2656,4382.4,fee schedule,
Ustekinumab sub cu inj 1 mg,J3357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.91,,,,153.95,254.02,fee schedule,
Ustekinumab iv inject 1 mg,J3358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.97,,,,12,20.81,fee schedule,
Inj vancomycin hcl (mylan),J3371,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.67,,,,5.67,9.85,fee schedule,
Inj vancomycin hcl (xellia),J3372,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.42,,,,6.42,10.84,fee schedule,
Injection vedolizumab,J3380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.26,,,,15.99,26.38,fee schedule,
Velaglucerase alfa,J3385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,370.2,,,,345.14,606.21,fee schedule,
Inj- betibeglogene autotemce,J3393,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2968000,,,,2968000,2968000,fee schedule,
Inj- lovotibeglogene autotem,J3394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3286000,,,,3286000,3286000,fee schedule,
Verteporfin injection,J3396,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.53,,,,10.74,17.72,fee schedule,
Inj luxturna 1 billion vec g,J3398,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3084.46,,,,2833.33,4674.99,fee schedule,
Inj onase abepar-xioi treat,J3399,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2388614.23,,,,2254412,2388614.23,fee schedule,
Vyjuvek 5x10^9pfu/ml 0.1 ml,J3401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,996.96,,,,970,1600.5,fee schedule,
Inj hydroxocobalamin iv 25mg,J3424,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.03,,,,5.03,5.03,fee schedule,
Inj- human-lans- per i.u,J7165,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2,,,,2,2,fee schedule,
Prothrombin complex kcentra,J7168,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.24,,,,2.09,4.32,fee schedule,
Inj andexxa 10 mg,J7169,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,131.99,,,,101.09,453.75,fee schedule,
Inj. emicizumab-kxwh 0.5 mg,J7170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.82,,,,47.37,83.57,fee schedule,
Inj- adzynma- 10 iu,J7171,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.6,,,,34.6,34.6,fee schedule,
Inj factor x (human) 1iu,J7175,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.11,,,,6.52,10.76,fee schedule,
Inj. fibryga 1 mg,J7177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.11,,,,1.1,1.82,fee schedule,
Inj human fibrinogen con nos,J7178,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.45,,,,0.09,1.45,fee schedule,
Vonvendi inj 1 iu vwf:rco,J7179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.87,,,,1.8,3,fee schedule,
Factor xiii anti-hem factor,J7180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.16,,,,6.33,10.44,fee schedule,
Factor xiii recomb a-subunit,J7181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.26,,,,13.24,21.85,fee schedule,
Factor viii recomb novoeight,J7182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.38,,,,1.02,1.68,fee schedule,
Wilate injection,J7183,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.28,,,,0.78,1.29,fee schedule,
Xyntha inj,J7185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.48,,,,0.97,1.6,fee schedule,
Antihemophilic viii/vwf comp,J7186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.23,,,,0.79,1.3,fee schedule,
Humate-p inj,J7187,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.4,,,,0.75,1.4,fee schedule,
Factor viii recomb obizur,J7188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.22,,,,2.95,4.87,fee schedule,
Factor viia recomb novoseven,J7189,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.52,,,,1.17,2.52,fee schedule,
Factor viii,J7190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.17,,,,0.71,1.17,fee schedule,
Factor viii recombinant nos,J7192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.55,,,,1.17,1.93,fee schedule,
Factor ix non-recombinant,J7193,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.41,,,,0.79,1.41,fee schedule,
Factor ix complex,J7194,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.65,,,,0.62,1.65,fee schedule,
Factor ix recombinant nos,J7195,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.85,,,,0.9,1.85,fee schedule,
Antithrombin iii injection,J7197,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.85,,,,3.17,6.39,fee schedule,
Anti-inhibitor,J7198,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.34,,,,1.48,2.44,fee schedule,
Factor ix recombinan rixubis,J7200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.67,,,,1.1,1.82,fee schedule,
Factor ix alprolix recomb,J7201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.59,,,,2.83,4.67,fee schedule,
Factor ix idelvion inj,J7202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.05,,,,3.94,6.5,fee schedule,
Factor ix recomb gly rebinyn,J7203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.57,,,,3.34,5.51,fee schedule,
Inj recombin esperoct per iu,J7204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.17,,,,2.04,3.42,fee schedule,
Factor viii fc fusion recomb,J7205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.34,,,,1.72,2.84,fee schedule,
Factor viii pegylated recomb,J7207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.1,,,,1.63,3.27,fee schedule,
Inj. jivi 1 iu,J7208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.44,,,,2.02,3.86,fee schedule,
Factor viii nuwiq recomb 1iu,J7209,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.24,,,,1.21,2,fee schedule,
Inj afstyla 1 i.u.,J7210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.46,,,,1.25,2.06,fee schedule,
Inj kovaltry 1 i.u.,J7211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.48,,,,0.96,1.58,fee schedule,
Factor viia recomb sevenfact,J7212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.3,,,,1.94,3.33,fee schedule,
Inj ixinity 1 i.u.,J7213,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.81,,,,1.81,2.99,fee schedule,
Altuviiio per factor viii iu,J7214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.69,,,,4.37,7.21,fee schedule,
Aminolevulinic acid hcl top,J7308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,396.97,,,,390.6,647.31,fee schedule,
Inj. retisert 0.01 mg,J7311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,333.48,,,,299.05,20125.83,fee schedule,
Dexamethasone intra implant,J7312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,205.62,,,,199.81,339.26,fee schedule,
Inj. iluvien 0.01 mg,J7313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,495.38,,,,461.3,761.15,fee schedule,
Inj. yutiq 0.01 mg,J7314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,527.97,,,,463,763.95,fee schedule,
Inj durolane 1 mg,J7318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7,,,,7,17.23,fee schedule,
Genvisc 850 inj 1mg,J7320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.9,,,,5.74,16.92,fee schedule,
Hymovis injection 1 mg,J7322,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.45,,,,16.65,28.48,fee schedule,
Euflexxa inj per dose,J7323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.31,,,,121.31,210.05,fee schedule,
Orthovisc inj per dose,J7324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,122.91,,,,122.91,506.68,fee schedule,
Synvisc or synvisc-one,J7325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.16,,,,9.12,15.05,fee schedule,
Gel-one,J7326,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,534.48,,,,497.28,1166,fee schedule,
Monovisc inj per dose,J7327,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,683.17,,,,683.17,1511.15,fee schedule,
Gelsyn-3 injection 0.1 mg,J7328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.58,,,,0.48,2.18,fee schedule,
Inj trivisc 1 mg,J7329,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.67,,,,6.67,9.38,fee schedule,
Synojoynt inj. 1 mg,J7331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.58,,,,9.58,18.02,fee schedule,
Inj. triluron 1 mg,J7332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.36,,,,9.81,10.36,fee schedule,
Capsaicin 8% patch,J7336,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.33,,,,3.15,5.4,fee schedule,
Carbidopa levodopa ent 100ml,J7340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,235.06,,,,201.84,333.04,fee schedule,
Ciprofloxacin otic susp 6 mg,J7342,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.02,,,,28.32,46.73,fee schedule,
Aminolevulinic acid 10% gel,J7345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.72,,,,1.46,2.71,fee schedule,
Inj bimatoprost itc imp1mcg,J7351,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,209.86,,,,195,321.75,fee schedule,
Afamelanotide implant 1 mg,J7352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2873.33,,,,2423.63,3998.99,fee schedule,
Anacaulase-bcdb 8.8% gel 1 g,J7353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.34,,,,58.34,58.34,fee schedule,
Cantharidin top- applicator,J7354,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,711.75,,,,711.75,711.75,fee schedule,
Inj travoprost intra impl,J7355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,197.16,,,,197.16,197.16,fee schedule,
Mometasone sinus sinuva,J7402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11.35,,,,10.17,16.78,fee schedule,
Azathioprine parenteral,J7501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,235.67,,,,217.3,358.55,fee schedule,
Lymphocyte immune globulin,J7504,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3968.45,,,,2072.24,5925.89,fee schedule,
Antithymocyte globuln rabbit,J7511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,956.74,,,,761.12,1532.88,fee schedule,
Inj. mycophenolate mofetil,J7519,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.52,,,,0.52,1.19,fee schedule,
Tacrolimus injection,J7525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,254.78,,,,211.78,410.4,fee schedule,
Etoposide oral 50 mg,J8560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,76.66,,,,74.61,76.66,fee schedule,
Oral methotrexate (jylamvo),J8611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.36,,,,19.36,19.36,fee schedule,
Oral methotrexate (xatmep),J8612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.71,,,,20.71,20.71,fee schedule,
Oral netupitant palonosetro,J8655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,400.24,,,,250.2,676.58,fee schedule,
Rolapitant oral 1mg,J8670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.58,,,,1.58,2.62,fee schedule,
Topotecan oral,J8705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,124.86,,,,104.36,187.26,fee schedule,
Aldesleukin injection,J9015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3943,,,,2110.63,4138.15,fee schedule,
Arsenic trioxide injection,J9017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.2,,,,7.2,51.23,fee schedule,
Inj aspara rylaze 0.1 mg,J9021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.79,,,,43.9,72.44,fee schedule,
Inj atezolizumab10 mg,J9022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.24,,,,71.54,118.04,fee schedule,
Injection avelumab 10 mg,J9023,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.18,,,,74.89,123.57,fee schedule,
Clofarabine injection,J9027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.38,,,,14.38,57.58,fee schedule,
Inj adstiladrin per tx dos,J9029,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63354.77,,,,63354.77,63354.77,fee schedule,
Injection belinostat 10mg,J9032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.09,,,,29.88,50.09,fee schedule,
Inj. treanda 1 mg,J9033,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.43,,,,5.43,28.88,fee schedule,
Inj. bendeka 1 mg,J9034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.95,,,,12.95,24.34,fee schedule,
Bevacizumab injection,J9035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.7,,,,59.44,98.08,fee schedule,
Inj. belrapzo/bendamustine,J9036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.53,,,,13.08,27.53,fee schedule,
Inj belantamab mafodot blmf,J9037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.78,,,,41.39,68.29,fee schedule,
Injection blinatumomab,J9039,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,152.18,,,,90.45,152.18,fee schedule,
Injection bortezomib 0.1mg,J9041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.57,,,,1.57,44.53,fee schedule,
Brentuximab vedotin inj,J9042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,239.86,,,,163.07,380.51,fee schedule,
Cabazitaxel injection,J9043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.46,,,,173.46,347.24,fee schedule,
Inj bortezomib dr. reddys,J9046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.55,,,,10.96,80.09,fee schedule,
Injection carfilzomib 1 mg,J9047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.58,,,,27.52,49.58,fee schedule,
Inj bortezomib freseniuskab,J9048,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.04,,,,2.67,5.04,fee schedule,
Inj bortezomib hospira,J9049,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.49,,,,1.49,7.13,fee schedule,
Carmustine injection,J9050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,330.87,,,,245.96,3534.85,fee schedule,
Inj carmustine (accord),J9052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,259.7,,,,18.4,259.7,fee schedule,
Cetuximab injection,J9055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,75.48,,,,62.11,121.64,fee schedule,
Inj bendamustine 1 mg,J9056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.84,,,,27.84,50.62,fee schedule,
Inj. copanlisib 1 mg,J9057,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.81,,,,72.89,120.27,fee schedule,
Inj apotex/bendamustine 1 mg,J9058,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,15.22,,,,15.22,34.27,fee schedule,
Inj amivantamab-vmjw,J9061,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.67,,,,19,32.95,fee schedule,
Inj elahere 1 mg,J9063,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,66.76,,,,62.2,102.63,fee schedule,
Inj cladribine per 1 mg,J9065,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.25,,,,14.25,26.02,fee schedule,
Inj cyclophosphamd auromedic,J9071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.16,,,,1.16,3.57,fee schedule,
Inj cyclophosphamd (ingenus),J9073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.93,,,,0.93,0.93,fee schedule,
Inj- cyclophosphamd- sandoz,J9074,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.34,,,,4.34,4.34,fee schedule,
Inj- cyclophosphamide- nos,J9075,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.01,,,,1.01,1.01,fee schedule,
Inj. cemiplimab-rwlc 1 mg,J9119,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.24,,,,25.9,42.74,fee schedule,
Dactinomycin injection,J9120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.13,,,,282.13,1103.69,fee schedule,
Daratumumab hyaluronidase,J9144,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.41,,,,42.08,69.43,fee schedule,
Injection daratumumab 10 mg,J9145,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65.12,,,,44.82,73.95,fee schedule,
Daunorubicin injection,J9150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.44,,,,24.44,58.86,fee schedule,
Inj daunorubicin cytarabine,J9153,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,242.5,,,,175.43,289.46,fee schedule,
Degarelix injection,J9155,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.18,,,,3.9,6.9,fee schedule,
Docetaxel (ingenus) 1 mg,J9172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.99,,,,2.09,50.99,fee schedule,
Inj. durvalumab 10 mg,J9173,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,81.82,,,,68.14,112.43,fee schedule,
Injection elotuzumab 1mg,J9176,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.58,,,,5.89,9.72,fee schedule,
Inj enfort vedo-ejfv 0.25mg,J9177,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.74,,,,26.38,43.53,fee schedule,
Eribulin mesylate injection,J9179,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,135.79,,,,115.76,221.12,fee schedule,
Fludarabine phosphate inj,J9185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,134.15,,,,105.6,287.03,fee schedule,
Inj gemcitabine hcl (accord),J9196,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.52,,,,8.52,14.47,fee schedule,
Inj. infugem 100 mg,J9198,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.28,,,,27.29,66.46,fee schedule,
Floxuridine injection,J9200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3858.03,,,,3034.68,6141.35,fee schedule,
Goserelin acetate implant,J9202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,674.77,,,,500.25,1004.85,fee schedule,
Gemtuzumab ozogamicin 0.1 mg,J9203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,229.67,,,,181.49,299.46,fee schedule,
Inj mogamulizumab-kpkc 1 mg,J9204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.85,,,,185.71,306.42,fee schedule,
Inj irinotecan liposome 1 mg,J9205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.77,,,,38.27,64.77,fee schedule,
Ixabepilone injection,J9207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,134.06,,,,89.45,211.32,fee schedule,
Inj. emapalumab-lzsg 1 mg,J9210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,378.03,,,,375.65,619.82,fee schedule,
Interferon alfa-2b inj,J9214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28.66,,,,28.66,53.74,fee schedule,
Leuprolide acetate suspnsion,J9217,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,176.51,,,,176.51,299.15,fee schedule,
Leuprolide acetate injeciton,J9218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.2,,,,9.2,22.67,fee schedule,
Inj. lurbinectedin 0.1 mg,J9223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,203.6,,,,165.83,273.62,fee schedule,
Vantas implant,J9225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1567.97,,,,1567.97,8524.38,fee schedule,
Supprelin la implant,J9226,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,45350.22,,,,34994.49,73550.28,fee schedule,
Inj. isatuximab-irfc 10 mg,J9227,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,78.05,,,,71.95,126.21,fee schedule,
Ipilimumab injection,J9228,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,176.88,,,,119.52,197.21,fee schedule,
Inj inotuzumab ozogam 0.1 mg,J9229,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2618.85,,,,2069.47,3414.63,fee schedule,
Inj melpha hydroch nos 50 mg,J9245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,153.54,,,,148.02,636.13,fee schedule,
Inj. evomela 1 mg,J9246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.35,,,,16.04,27.19,fee schedule,
Inj melphalan (hepzato) 1 mg,J9248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,773.8,,,,773.8,773.8,fee schedule,
Paclitaxel (american regent),J9259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.79,,,,14.79,25.49,fee schedule,
Nelarabine injection,J9261,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.53,,,,72.53,183.12,fee schedule,
Inj omacetaxine mep 0.01mg,J9262,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.03,,,,2.39,4.03,fee schedule,
Paclitaxel protein bound,J9264,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.34,,,,11.98,23.58,fee schedule,
Pegaspargase injection,J9266,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27070.53,,,,13413.3,27070.53,fee schedule,
Pentostatin injection,J9268,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2541.77,,,,2020.3,3750.7,fee schedule,
Inj. tagraxofusp-erzs 10 mcg,J9269,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,339.03,,,,243.32,401.48,fee schedule,
Inj pembrolizumab,J9271,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.22,,,,43.16,71.21,fee schedule,
Inj dostarlimab-gxly 10 mg,J9272,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,236.4,,,,207.38,342.18,fee schedule,
Inj tisotu vedotin-tftv 1mg,J9273,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,181.6,,,,147.13,242.76,fee schedule,
Inj tebentafusp-tebn 1 mcg,J9274,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,214.76,,,,187.6,309.54,fee schedule,
Mitomycin injection,J9280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,42.51,,,,42.51,104.51,fee schedule,
Mitomycin instillation,J9281,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,307.34,,,,267.2,440.88,fee schedule,
Inj glofitamab gxbm 2.5 mg,J9286,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2701.04,,,,2554.74,4215.32,fee schedule,
Mitoxantrone hydrochl / 5 mg,J9293,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.65,,,,27.27,71.89,fee schedule,
Inj pemetrexed hospira 10mg,J9294,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.62,,,,0.62,17.41,fee schedule,
Injection necitumumab 1 mg,J9295,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.73,,,,4.98,8.22,fee schedule,
Inj pemetrexed (accord) 10mg,J9296,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.66,,,,9.65,15.92,fee schedule,
Inj pemetrexed (sandoz) 10mg,J9297,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.28,,,,1.28,2.13,fee schedule,
Inj nivol relatlimab 3mg/1mg,J9298,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,190.46,,,,171.18,282.45,fee schedule,
Injection nivolumab,J9299,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.75,,,,27.8,51.28,fee schedule,
Obinutuzumab inj,J9301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.59,,,,51.39,84.79,fee schedule,
Ofatumumab injection,J9302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63.96,,,,43.82,72.3,fee schedule,
Panitumumab injection,J9303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,159.33,,,,86.22,159.33,fee schedule,
Inj. pemetrexed 10 mg,J9304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.83,,,,50.83,102.81,fee schedule,
Inj. pemetrexed nos 10mg,J9305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.18,,,,4.18,69.54,fee schedule,
Injection pertuzumab 1 mg,J9306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.12,,,,9.67,16.12,fee schedule,
Pralatrexate injection,J9307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,373.77,,,,286.53,477.08,fee schedule,
Injection ramucirumab,J9308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.07,,,,50.79,83.8,fee schedule,
Inj polatuzumab vedotin 1mg,J9309,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,129.78,,,,107,176.55,fee schedule,
Inj rituximab hyaluronidase,J9311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.94,,,,36.94,61.71,fee schedule,
Inj. rituximab 10 mg,J9312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.31,,,,77.31,130.66,fee schedule,
Inj. lumoxiti 0.01 mg,J9313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.39,,,,20.75,34.24,fee schedule,
Inj pemetrexed (teva) 10mg,J9314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.52,,,,5.52,20.3,fee schedule,
Pertuzu trastuzu 10 mg,J9316,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.58,,,,64.58,110.63,fee schedule,
Sacituzumab govitecan-hziy,J9317,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.67,,,,28.79,47.5,fee schedule,
Inj romidepsin non-lyo 0.1mg,J9318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.91,,,,28.78,47.49,fee schedule,
Inj romidepsin lyophil 0.1mg,J9319,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.86,,,,29.86,52.73,fee schedule,
Streptozocin injection,J9320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,370.18,,,,344.84,610.8,fee schedule,
Inj epcoritamab-bysp 0.16 mg,J9321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.17,,,,50.75,83.74,fee schedule,
Inj pemetrexed ditromethamin,J9323,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.55,,,,6.01,10.55,fee schedule,
Inj pemrydi rtu 10 mg,J9324,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,82.3,,,,82.3,82.3,fee schedule,
Inj talimogene laherparepvec,J9325,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.36,,,,43.82,72.3,fee schedule,
Temozolomide injection,J9328,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.4,,,,10.4,17.16,fee schedule,
Temsirolimus injection,J9330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.21,,,,30.99,57.93,fee schedule,
Inj sirolimus prot part 1 mg,J9331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.21,,,,67.85,114.21,fee schedule,
Inj efgartigimod 2mg,J9332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,32.57,,,,29.75,49.09,fee schedule,
Inj ronzanolixizum-noli 1 mg,J9333,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.8,,,,21.6,35.64,fee schedule,
Inj efgart-alfa 2mg hya-qvfc,J9334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.13,,,,31.29,51.63,fee schedule,
Thiotepa injection,J9340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,209.02,,,,209.02,420.43,fee schedule,
Inj retifanlimab-dlwr 1 mg,J9345,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,29.2,,,,28.48,46.99,fee schedule,
Inj tremelimumab-actl 1 mg,J9347,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,135.45,,,,130,214.5,fee schedule,
Inj. naxitamab-gqgk 1 mg,J9348,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,642.15,,,,509.2,840.18,fee schedule,
Inj. tafasitamab-cxix,J9349,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.71,,,,12,19.8,fee schedule,
Inj mosunetuzumab-axgb 1 mg,J9350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,635.47,,,,594.05,980.18,fee schedule,
Injection trabectedin 0.1mg,J9352,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,362.82,,,,268.92,443.72,fee schedule,
Inj. margetuximab-cmkb 5 mg,J9353,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,48.21,,,,41.54,68.54,fee schedule,
Inj ado-trastuzumab emt 1mg,J9354,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.45,,,,27.62,45.57,fee schedule,
Inj trastuzumab excl biosimi,J9355,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.94,,,,77.94,132.76,fee schedule,
Inj. herceptin hylecta 10mg,J9356,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63.79,,,,63.79,108.93,fee schedule,
Valrubicin injection,J9357,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1437.08,,,,1363.84,2250.34,fee schedule,
Inj fam-trastu deru-nxki 1mg,J9358,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.81,,,,22.96,37.88,fee schedule,
Inj lon tesirin-lpyl 0.075mg,J9359,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,206.38,,,,188.98,311.82,fee schedule,
Inj teclistamab cqyv 0.5 mg,J9380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.98,,,,29.5,48.68,fee schedule,
Inj teplizumab mzwv 5 mcg,J9381,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.9,,,,34.62,57.12,fee schedule,
Inj fulvestrant (teva),J9393,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.2,,,,15.44,34.98,fee schedule,
Inj fulvestrant (fresenius),J9394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,53,,,,7.85,87.45,fee schedule,
Injection fulvestrant,J9395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.51,,,,7.51,98.78,fee schedule,
Inj ziv-aflibercept 1mg,J9400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.5,,,,6.5,12.01,fee schedule,
Porfimer sodium injection,J9600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23870.14,,,,21219.57,23870.14,fee schedule,
Removable soft interface le,K0672,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,99.79,,,,84.21,164.65,fee schedule,
Cranial cervical orthosis,L0112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1646.81,,,,1389.65,2717.24,fee schedule,
Cranial cervical torticollis,L0113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,335.55,,,,283.15,553.66,fee schedule,
Cerv flex n/adj foam pre ots,L0120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,31.12,,,,26.26,51.35,fee schedule,
Flex thermoplastic collar mo,L0130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,179.6,,,,151.56,296.34,fee schedule,
Cervical semi-rigid adjustab,L0140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.43,,,,59.43,116.21,fee schedule,
Cerv semi-rig adj molded chn,L0150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,125.94,,,,106.28,207.8,fee schedule,
Cerv sr wire occ/man pre ots,L0160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,183.9,,,,155.18,303.44,fee schedule,
Cervical collar molded to pt,L0170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,946.03,,,,798.31,1560.95,fee schedule,
Cerv col sr foam 2pc pre ots,L0172,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,166.64,,,,140.62,274.96,fee schedule,
Cerv sr 2pc thor ext pre ots,L0174,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,327.67,,,,276.5,540.66,fee schedule,
Cer post col occ/man sup adj,L0180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,530.84,,,,447.95,875.89,fee schedule,
Cerv collar supp adj cerv ba,L0190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,626.07,,,,528.3,1033.02,fee schedule,
Cerv col supp adj bar & thor,L0200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,726.19,,,,612.78,1198.21,fee schedule,
Thor rib belt custom fabrica,L0220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,152,,,,128.27,250.8,fee schedule,
Tlso flex trunk/thor pre ots,L0450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,164.19,,,,134.48,221.89,fee schedule,
Tlso trnk sj-t9 pre cst,L0454,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,408.07,,,,344.35,673.32,fee schedule,
Tlso flex trnk sj-t9 pre ots,L0455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,331.36,,,,249.65,411.92,fee schedule,
Tlso flex trnk sj-ss pre cst,L0456,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1170.25,,,,987.5,1930.91,fee schedule,
Tlso flex trnk sj-ss pre ots,L0457,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,950.24,,,,715.93,1181.28,fee schedule,
Tlso 2mod symphis-xipho pre,L0458,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1049.38,,,,885.51,1731.48,fee schedule,
Tlso 2 shl symphys-stern cst,L0460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1181.14,,,,996.7,1948.88,fee schedule,
Tlso 3mod sacro-scap pre,L0462,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1469.12,,,,1239.71,2424.05,fee schedule,
Tlso 4mod sacro-scap pre,L0464,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1748.99,,,,1475.87,2885.83,fee schedule,
Tlso r fram soft ant pre cst,L0466,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,446.41,,,,376.71,736.58,fee schedule,
Tlso r fram soft pre ots,L0467,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,366,,,,279.99,461.98,fee schedule,
Tlso rig fram pelvic pre cst,L0468,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,559.45,,,,472.09,923.09,fee schedule,
Tlso rig fram pelvic pre ots,L0469,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,461.67,,,,356.76,588.65,fee schedule,
Tlso rigid frame pre subclav,L0470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,774.16,,,,653.27,1277.36,fee schedule,
Tlso rigid frame hyperex pre,L0472,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,476.37,,,,401.98,786.01,fee schedule,
Tlso rigid plastic custom fa,L0480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1777.24,,,,1499.7,2932.45,fee schedule,
Tlso rigid lined custom fab,L0482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1985.19,,,,1675.18,3275.56,fee schedule,
Tlso rigid plastic cust fab,L0484,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2143.91,,,,1809.13,3537.45,fee schedule,
Tlso rigidlined cust fab two,L0486,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2407.7,,,,2031.72,3972.71,fee schedule,
Tlso rigid lined pre one pie,L0488,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1181.14,,,,996.7,1948.88,fee schedule,
Tlso rigid plastic pre one,L0490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,332.83,,,,280.86,549.17,fee schedule,
Tlso 2 piece rigid shell,L0491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,903.64,,,,762.53,1491.01,fee schedule,
Tlso 3 piece rigid shell,L0492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,588.42,,,,496.54,970.89,fee schedule,
Sio flex pelvic/sacr pre ots,L0621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.89,,,,70.9,116.99,fee schedule,
Sio flex pelvisacral custom,L0622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,314.49,,,,265.38,518.91,fee schedule,
Sio rig pnl pelv/sac pre ots,L0623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,168.93,,,,127.1,209.72,fee schedule,
Lo flex l1-below l5 pre ots,L0625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.64,,,,39.66,65.44,fee schedule,
Lo sag rig pnl stays pre cst,L0626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.71,,,,77.39,151.32,fee schedule,
Lo sag ri an/pos pnl pre cst,L0627,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,483.62,,,,408.1,797.97,fee schedule,
Lso flex no ri stays pre ots,L0628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,80.15,,,,60.4,99.66,fee schedule,
Lso r post pnl sj-t9 pre cst,L0630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,190.58,,,,160.82,314.46,fee schedule,
Lso sag r an/pos pnl pre cst,L0631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1207.87,,,,1019.26,1992.99,fee schedule,
Lso sc r pos/lat pnl pre cst,L0633,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,337.4,,,,284.72,556.71,fee schedule,
Lso sagit rigid panel prefab,L0635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1175.72,,,,992.12,1939.94,fee schedule,
Lso sagittal rigid panel cus,L0636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1595.26,,,,1346.14,2632.18,fee schedule,
Lso sc r ant/pos pnl pre cst,L0637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1524.33,,,,1286.29,2515.14,fee schedule,
Lso sag-coronal panel custom,L0638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1551.88,,,,1309.54,2560.6,fee schedule,
Lso s/c shell/panel prefab,L0639,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1524.33,,,,1286.29,2515.14,fee schedule,
Lso s/c shell/panel custom,L0640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1231.2,,,,1038.94,2031.48,fee schedule,
Lo rig pos pnl l1-l5 pre ots,L0641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.48,,,,56.12,92.6,fee schedule,
Lo sag ri an/pos pnl pre ots,L0642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,392.75,,,,295.96,488.33,fee schedule,
Lso sag ctr rigi pos pre ots,L0643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,154.76,,,,116.6,192.39,fee schedule,
Lso sag r an/pos pnl pre ots,L0648,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,980.89,,,,739.13,1219.56,fee schedule,
Lso sc r pos/lat pnl pre ots,L0649,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,274,,,,206.46,340.66,fee schedule,
Lso sc r ant/pos pnl pre ots,L0650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1198.32,,,,855.22,1411.11,fee schedule,
Lso sag-co shell pnl pre ots,L0651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1198.32,,,,855.22,1411.11,fee schedule,
Ctlso a-p-l control molded,L0700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2342.38,,,,1976.59,3864.93,fee schedule,
Ctlso a-p-l control w/ inter,L0710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2574.89,,,,2172.81,4248.57,fee schedule,
Halo cervical into jckt vest,L0810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3145.02,,,,2653.89,5189.28,fee schedule,
Halo cervical into body jack,L0820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2473.97,,,,2087.65,4082.05,fee schedule,
Halo cerv into milwaukee typ,L0830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3785.54,,,,3194.4,6246.14,fee schedule,
Mri compatible system,L0859,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1340.28,,,,1130.99,2211.46,fee schedule,
Halo repl liner/interface,L0861,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,253.61,,,,214.01,418.46,fee schedule,
Tlso corset front,L0970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,125.74,,,,106.11,207.47,fee schedule,
Lso corset front,L0972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.45,,,,96.58,188.84,fee schedule,
Tlso full corset,L0974,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,205.62,,,,173.51,339.27,fee schedule,
Lso full corset,L0976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,175.92,,,,148.45,290.27,fee schedule,
Axillary crutch extension,L0978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,221.41,,,,186.84,365.33,fee schedule,
Peroneal straps pair pre ots,L0980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.1,,,,16.97,33.17,fee schedule,
Stocking sup grips 4 pre ots,L0982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.41,,,,15.53,30.38,fee schedule,
Protect body sock ea pre ots,L0984,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,79.62,,,,67.19,131.37,fee schedule,
Ctlso milwauke initial model,L1000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2385.92,,,,2013.35,3936.77,fee schedule,
Tension based scoliosis orth,L1005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3765.95,,,,3177.87,6213.82,fee schedule,
Ctlso axilla sling,L1010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.45,,,,83.08,162.44,fee schedule,
Kyphosis pad,L1020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,126.79,,,,106.99,209.2,fee schedule,
Kyphosis pad floating,L1025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,182.92,,,,154.36,301.82,fee schedule,
Lumbar bolster pad,L1030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,92.13,,,,77.74,152.01,fee schedule,
Lumbar or lumbar rib pad,L1040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,104.32,,,,88.03,172.13,fee schedule,
Sternal pad,L1050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,118.06,,,,99.62,194.8,fee schedule,
Thoracic pad,L1060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,127.43,,,,107.53,210.26,fee schedule,
Trapezius sling,L1070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,132,,,,111.39,217.8,fee schedule,
Outrigger,L1080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.56,,,,51.95,101.57,fee schedule,
Outrigger bil w/ vert extens,L1085,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,206.1,,,,173.91,340.07,fee schedule,
Lumbar sling,L1090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,118.4,,,,99.91,195.36,fee schedule,
Ring flange plastic/leather,L1100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,223.45,,,,188.56,368.69,fee schedule,
Ring flange plas/leather mol,L1110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.65,,,,316.15,618.17,fee schedule,
Covers for upright each,L1120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,44.75,,,,37.76,73.84,fee schedule,
Furnsh initial orthosis only,L1200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2105.59,,,,1776.79,3474.22,fee schedule,
Lateral thoracic extension,L1210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,287.87,,,,242.92,474.99,fee schedule,
Anterior thoracic extension,L1220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,280.2,,,,236.44,462.33,fee schedule,
Milwaukee type superstructur,L1230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,784.94,,,,662.37,1295.15,fee schedule,
Lumbar derotation pad,L1240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,107.01,,,,90.3,176.57,fee schedule,
Anterior asis pad,L1250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,93.06,,,,78.52,153.55,fee schedule,
Anterior thoracic derotation,L1260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,110.97,,,,93.64,183.1,fee schedule,
Abdominal pad,L1270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,97.52,,,,82.29,160.91,fee schedule,
Rib gusset (elastic) each,L1280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,102.81,,,,86.75,169.64,fee schedule,
Lateral trochanteric pad,L1290,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.43,,,,77.15,150.86,fee schedule,
Body jacket mold to patient,L1300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2027.87,,,,1711.21,3345.99,fee schedule,
Post-operative body jacket,L1310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2112.2,,,,1782.36,3485.13,fee schedule,
Ho flex frejka w/cov pre cst,L1600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,151.62,,,,127.94,250.17,fee schedule,
Ho frejka cov only pre cst,L1610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.4,,,,54.34,106.26,fee schedule,
Ho flex pavlik harns pre cst,L1620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,184.87,,,,156.02,305.04,fee schedule,
Abduct control hip semi-flex,L1630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.57,,,,209.75,410.14,fee schedule,
Pelv band/spread bar thigh c,L1640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.01,,,,470.02,919.07,fee schedule,
Ho abduction hip adjustable,L1650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,290.17,,,,244.86,478.78,fee schedule,
Ho bi thighcuffs w sprdr bar,L1652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,419.43,,,,353.93,692.06,fee schedule,
Ho abduction static plastic,L1660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,212.63,,,,179.43,350.84,fee schedule,
Pelvic & hip control thigh c,L1680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1340.49,,,,1131.16,2211.81,fee schedule,
Ho bilateral hip abduction,L1681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2205.04,,,,2205.04,3638.32,fee schedule,
Post-op hip abduct custom fa,L1685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1308.66,,,,1104.3,2159.29,fee schedule,
Ho post-op hip abduction,L1686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1102.52,,,,930.35,1819.16,fee schedule,
Combination bilateral ho,L1690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2275.3,,,,1920,3754.25,fee schedule,
Leg perthes orth toronto typ,L1700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1830.62,,,,1544.76,2943.98,fee schedule,
Legg perthes orth newington,L1710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2331.1,,,,1967.08,3846.32,fee schedule,
Legg perthes orthosis trilat,L1720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1735.73,,,,1464.68,2863.95,fee schedule,
Legg perthes orth scottish r,L1730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1465.34,,,,1236.51,2417.81,fee schedule,
Legg perthes patten bottom t,L1755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2106.74,,,,1777.76,3476.12,fee schedule,
Ko elastic with joints,L1810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.13,,,,102.21,199.86,fee schedule,
Ko elastic w/joints pre ots,L1812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.07,,,,73.11,120.63,fee schedule,
Ko elas w/ condyle pads & jo,L1820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,167.22,,,,141.11,275.91,fee schedule,
Ko immob canvas long pre ots,L1830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,85.44,,,,65.88,108.7,fee schedule,
Knee orth pos locking joint,L1831,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,346.3,,,,292.22,571.4,fee schedule,
Ko adj jnt pos r sup pre cst,L1832,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,810.46,,,,683.9,1337.26,fee schedule,
Ko adj jnt pos r sup pre ots,L1833,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,668.18,,,,474.58,783.06,fee schedule,
Ko w/0 joint rigid molded to,L1834,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,854.03,,,,720.67,1409.15,fee schedule,
Ko rigid w/o joints pre ots,L1836,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,130.1,,,,93.15,153.7,fee schedule,
Ko derot ant cruciate custom,L1840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1106.5,,,,933.72,1825.73,fee schedule,
Ko single upright pre cst,L1843,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1055.75,,,,890.88,1741.99,fee schedule,
Ko w/adj jt rot cntrl molded,L1844,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1791.81,,,,1512,2956.49,fee schedule,
Ko double upright pre cst,L1845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,985.63,,,,831.71,1626.29,fee schedule,
Ko w adj flex/ext rotat mold,L1846,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1376.69,,,,1161.71,2271.54,fee schedule,
Ko dbl upright w/air pre cst,L1847,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,676.76,,,,571.08,1116.65,fee schedule,
Ko dbl upright w/air pre ots,L1848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,676.76,,,,571.08,1116.65,fee schedule,
Ko swedish type pre ots,L1850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,286.48,,,,214.55,354.01,fee schedule,
Ko single upright prefab ots,L1851,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,874.94,,,,626.41,1033.58,fee schedule,
Ko double upright prefab ots,L1852,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,823.91,,,,597.58,986.01,fee schedule,
Ko supracondylar socket mold,L1860,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1467.23,,,,1238.11,2420.93,fee schedule,
Afo sprng wir drsflx calf bd,L1900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,335.7,,,,283.27,553.91,fee schedule,
Afo ankle gauntlet pre ots,L1902,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,87.83,,,,74.11,144.92,fee schedule,
Afo molded ankle gauntlet,L1904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,531.09,,,,448.16,876.3,fee schedule,
Afo multilig ank sup pre ots,L1906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,132.31,,,,111.65,218.31,fee schedule,
Afo supramalleolar custom,L1907,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,662.1,,,,558.7,1092.47,fee schedule,
Afo sing bar clasp attach sh,L1910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,329.97,,,,278.44,544.45,fee schedule,
Afo sing upright w/ adjust s,L1920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,483.36,,,,407.88,797.54,fee schedule,
Afo plastic,L1930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,296.42,,,,250.14,489.09,fee schedule,
Afo rig ant tib prefab tcf/=,L1932,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1049.94,,,,885.99,1732.4,fee schedule,
Afo molded to patient plasti,L1940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,572.99,,,,483.51,945.43,fee schedule,
Afo molded plas rig ant tib,L1945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1320.74,,,,1114.49,2179.22,fee schedule,
Afo spiral molded to pt plas,L1950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,904.89,,,,763.59,1493.07,fee schedule,
Afo spiral prefabricated,L1951,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,988.13,,,,833.84,1630.41,fee schedule,
Afo pos solid ank plastic mo,L1960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,729.36,,,,615.47,1203.44,fee schedule,
Afo plastic molded w/ankle j,L1970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,814.38,,,,687.21,1343.73,fee schedule,
Afo w/ankle joint prefab,L1971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,551.56,,,,465.42,910.07,fee schedule,
Afo sing solid stirrup calf,L1980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,475.08,,,,400.89,783.88,fee schedule,
Afo doub solid stirrup calf,L1990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,549.84,,,,463.98,907.24,fee schedule,
Kafo sing fre stirr thi/calf,L2000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1316.26,,,,1110.71,2171.83,fee schedule,
Kafo sng/dbl mechanical act,L2005,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4821.47,,,,4068.56,4821.47,fee schedule,
Kaf sng/dbl swg/stn mcpr cus,L2006,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37854.14,,,,33205.38,37854.14,fee schedule,
Kafo sng solid stirrup w/o j,L2010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1026.67,,,,866.34,1694.01,fee schedule,
Kafo dbl solid stirrup band/,L2020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1296.65,,,,1094.16,2139.47,fee schedule,
Kafo dbl solid stirrup w/o j,L2030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1274.5,,,,1075.48,2102.93,fee schedule,
Kafo pla sin up w/wo k/a cus,L2034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2390.27,,,,2017.02,3943.95,fee schedule,
Kafo plastic pediatric size,L2035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,203.85,,,,172.01,336.35,fee schedule,
Kafo plas doub free knee mol,L2036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2181.4,,,,1840.76,3599.31,fee schedule,
Kafo plas sing free knee mol,L2037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1951.23,,,,1646.53,3219.53,fee schedule,
Kafo w/o joint multi-axis an,L2038,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1572.97,,,,1327.34,2595.4,fee schedule,
Hkafo torsion bil rot straps,L2040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,238.04,,,,200.86,392.77,fee schedule,
Hkafo torsion cable hip pelv,L2050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,573.38,,,,483.84,946.08,fee schedule,
Hkafo torsion ball bearing j,L2060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,717.18,,,,605.19,1183.35,fee schedule,
Hkafo torsion unilat rot str,L2070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,182.63,,,,154.1,301.34,fee schedule,
Hkafo unilat torsion cable,L2080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,439.1,,,,370.53,724.52,fee schedule,
Hkafo unilat torsion ball br,L2090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,585.05,,,,493.68,965.33,fee schedule,
Afo tib fx cast plaster mold,L2106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,927.43,,,,782.61,1530.26,fee schedule,
Afo tib fx cast molded to pt,L2108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1352.69,,,,1141.46,2231.94,fee schedule,
Afo tibial fracture soft,L2112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,593.61,,,,500.91,979.46,fee schedule,
Afo tib fx semi-rigid,L2114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,743.52,,,,627.41,1226.81,fee schedule,
Afo tibial fracture rigid,L2116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,906.87,,,,765.26,1496.34,fee schedule,
Kafo fem fx cast thermoplas,L2126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1502.41,,,,1267.8,2478.98,fee schedule,
Kafo fem fx cast molded to p,L2128,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1886.53,,,,1591.93,3112.77,fee schedule,
Kafo femoral fx cast soft,L2132,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1145.09,,,,966.27,1889.4,fee schedule,
Kafo fem fx cast semi-rigid,L2134,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1355.93,,,,1144.19,2237.28,fee schedule,
Kafo femoral fx cast rigid,L2136,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1483.86,,,,1252.15,2448.37,fee schedule,
Plas shoe insert w ank joint,L2180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,155.99,,,,131.63,257.38,fee schedule,
Drop lock knee,L2182,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,134.45,,,,113.46,221.84,fee schedule,
Limited motion knee joint,L2184,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,136.29,,,,115,224.88,fee schedule,
Adj motion knee jnt lerman t,L2186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,181.25,,,,152.94,299.06,fee schedule,
Quadrilateral brim,L2188,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,329.49,,,,278.04,543.66,fee schedule,
Waist belt,L2190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100.36,,,,84.69,165.59,fee schedule,
Pelvic band & belt thigh fla,L2192,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,392.28,,,,331.02,647.26,fee schedule,
Limited ankle motion ea jnt,L2200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,59.12,,,,49.89,97.55,fee schedule,
Dorsiflexion assist each joi,L2210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,73.95,,,,62.41,122.02,fee schedule,
Dorsi & plantar flex ass/res,L2220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.2,,,,80.34,157.08,fee schedule,
Split flat caliper stirr & p,L2230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,112.55,,,,94.98,185.71,fee schedule,
Rocker bottom contact afo,L2232,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,114.3,,,,96.45,188.6,fee schedule,
Round caliper and plate atta,L2240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,112.03,,,,94.54,184.85,fee schedule,
Foot plate molded stirrup at,L2250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,393.02,,,,331.65,648.48,fee schedule,
Reinforced solid stirrup,L2260,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,220.54,,,,186.1,363.89,fee schedule,
Long tongue stirrup,L2265,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,158.17,,,,133.47,260.98,fee schedule,
Varus/valgus strap padded/li,L2270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.53,,,,61.2,119.67,fee schedule,
Plastic mod low ext pad/line,L2275,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,153.37,,,,129.43,253.06,fee schedule,
Molded inner boot,L2280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,664.23,,,,560.51,1095.98,fee schedule,
Abduction bar jointed adjust,L2300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,296.22,,,,249.96,488.76,fee schedule,
Abduction bar-straight,L2310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,135.35,,,,114.21,223.33,fee schedule,
Non-molded lacer,L2320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,226.98,,,,191.53,374.52,fee schedule,
Lacer molded to patient mode,L2330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,432,,,,364.54,712.8,fee schedule,
Anterior swing band,L2335,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,330.75,,,,279.11,545.74,fee schedule,
Pre-tibial shell molded to p,L2340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,491.71,,,,414.93,811.32,fee schedule,
Prosthetic type socket molde,L2350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,980.32,,,,827.24,1617.53,fee schedule,
Extended steel shank,L2360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,60.67,,,,51.2,100.11,fee schedule,
Patten bottom,L2370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,376.56,,,,317.76,621.32,fee schedule,
Torsion ank & half solid sti,L2375,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,144.78,,,,122.17,238.89,fee schedule,
Torsion straight knee joint,L2380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,151.85,,,,128.13,250.55,fee schedule,
Straight knee joint heavy du,L2385,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,172.89,,,,145.9,285.27,fee schedule,
Add le poly knee custom kafo,L2387,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,224.61,,,,189.54,370.61,fee schedule,
Offset knee joint each,L2390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,120.43,,,,101.63,198.71,fee schedule,
Offset knee joint heavy duty,L2395,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,172.14,,,,145.26,284.03,fee schedule,
Suspension sleeve lower ext,L2397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,143.61,,,,121.19,236.96,fee schedule,
Knee joint drop lock ea jnt,L2405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,102.58,,,,86.57,169.26,fee schedule,
Knee joint cam lock each joi,L2415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,142.94,,,,120.62,235.85,fee schedule,
Knee disc/dial lock/adj flex,L2425,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,168.67,,,,142.33,278.31,fee schedule,
Knee jnt ratchet lock ea jnt,L2430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,168.67,,,,142.33,278.31,fee schedule,
Knee lift loop drop lock rin,L2492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,138.01,,,,116.45,227.72,fee schedule,
Thi/glut/ischia wgt bearing,L2500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,368.2,,,,310.7,607.53,fee schedule,
Th/wght bear quad-lat brim m,L2510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,948.97,,,,800.77,1565.8,fee schedule,
Th/wght bear quad-lat brim c,L2520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,632.45,,,,533.68,1043.54,fee schedule,
Th/wght bear nar m-l brim mo,L2525,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1341.11,,,,1131.69,2212.83,fee schedule,
Th/wght bear nar m-l brim cu,L2526,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,753.57,,,,635.89,1243.39,fee schedule,
Thigh/wght bear lacer non-mo,L2530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,282.18,,,,238.12,465.6,fee schedule,
Thigh/wght bear lacer molded,L2540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,533.95,,,,450.57,881.02,fee schedule,
Thigh/wght bear high roll cu,L2550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,400.35,,,,337.83,660.58,fee schedule,
Hip clevis type 2 posit jnt,L2570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,524.03,,,,442.2,864.65,fee schedule,
Pelvic control pelvic sling,L2580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,510.61,,,,430.87,842.51,fee schedule,
Hip clevis/thrust bearing fr,L2600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,250.96,,,,211.76,414.08,fee schedule,
Hip clevis/thrust bearing lo,L2610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,277.31,,,,234,457.56,fee schedule,
Pelvic control hip heavy dut,L2620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,294.16,,,,248.23,485.36,fee schedule,
Hip joint adjustable flexion,L2622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,374.41,,,,315.94,617.78,fee schedule,
Hip adj flex ext abduct cont,L2624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,459.1,,,,387.41,757.52,fee schedule,
Plastic mold recipro hip & c,L2627,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2514.73,,,,2122.03,4149.3,fee schedule,
Metal frame recipro hip & ca,L2628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1843.24,,,,1555.4,3041.35,fee schedule,
Pelvic control band & belt u,L2630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,272.43,,,,229.89,449.51,fee schedule,
Pelvic control band & belt b,L2640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,369.72,,,,311.99,610.04,fee schedule,
Pelv & thor control gluteal,L2650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,162.82,,,,137.39,268.65,fee schedule,
Thoracic control thoracic ba,L2660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,210.82,,,,177.9,347.85,fee schedule,
Thorac cont paraspinal uprig,L2670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,187.67,,,,158.36,309.66,fee schedule,
Thorac cont lat support upri,L2680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,172.16,,,,145.28,284.06,fee schedule,
Plating chrome/nickel pr bar,L2750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.95,,,,77.6,151.72,fee schedule,
Carbon graphite lamination,L2755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,153.74,,,,129.73,253.67,fee schedule,
Extension per extension per,L2760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,66.85,,,,56.41,110.3,fee schedule,
Ortho sidebar disconnect,L2768,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,153.29,,,,129.36,252.93,fee schedule,
Non-corrosive finish,L2780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.46,,,,62.83,122.86,fee schedule,
Drop lock retainer each,L2785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.87,,,,29.42,57.54,fee schedule,
Knee control full kneecap,L2795,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,96.5,,,,81.43,159.23,fee schedule,
Knee cap medial or lateral p,L2800,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,118.49,,,,99.99,195.51,fee schedule,
Knee control condylar pad,L2810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,96.1,,,,81.09,158.57,fee schedule,
Soft interface below knee se,L2820,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.54,,,,80.62,157.64,fee schedule,
Soft interface above knee se,L2830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,103.36,,,,87.22,170.54,fee schedule,
Tibial length sock fx or equ,L2840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.76,,,,42.82,83.75,fee schedule,
Femoral lgth sock fx or equa,L2850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.17,,,,60.06,117.43,fee schedule,
Ft insert ucb berkeley shell,L3000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,369.62,,,,311.9,609.87,fee schedule,
Foot insert remov molded spe,L3001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,155.63,,,,131.33,256.79,fee schedule,
Foot insert plastazote or eq,L3002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,190.03,,,,160.36,313.55,fee schedule,
Foot insert silicone gel eac,L3003,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,204.99,,,,172.98,338.23,fee schedule,
Foot longitudinal arch suppo,L3010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,204.99,,,,172.98,338.23,fee schedule,
Foot longitud/metatarsal sup,L3020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,233.45,,,,196.99,385.19,fee schedule,
Foot arch support remov prem,L3030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,89.78,,,,75.76,148.14,fee schedule,
Foot lamin/prepreg composite,L3031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,144.1,,,,121.6,237.77,fee schedule,
Ft arch suprt premold longit,L3040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.38,,,,46.74,91.38,fee schedule,
Foot arch supp premold metat,L3050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.38,,,,46.74,91.38,fee schedule,
Foot arch supp longitud/meta,L3060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.79,,,,73.23,143.2,fee schedule,
Arch suprt att to sho longit,L3070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.41,,,,31.57,61.73,fee schedule,
Arch supp att to shoe metata,L3080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.41,,,,31.57,61.73,fee schedule,
Arch supp att to shoe long/m,L3090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.89,,,,40.42,79.02,fee schedule,
Hallus-valgus nt dyn pre ots,L3100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.9,,,,42.95,83.99,fee schedule,
Abduction rotation bar shoe,L3140,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,104.75,,,,88.39,172.84,fee schedule,
Abduct rotation bar w/o shoe,L3150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.79,,,,80.83,158.05,fee schedule,
Foot plas heel stabi pre ots,L3170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,59.85,,,,50.51,98.75,fee schedule,
Womans shoe oxford brace,L3224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,79.5,,,,67.09,131.18,fee schedule,
Mans shoe oxford brace,L3225,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.84,,,,73.28,143.29,fee schedule,
Sho lift taper to metatarsal,L3300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.37,,,,51.78,101.26,fee schedule,
Shoe lift elev heel/sole neo,L3310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.79,,,,80.83,158.05,fee schedule,
Lifts elevation metal extens,L3330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,665.89,,,,561.91,1098.72,fee schedule,
Shoe lifts tapered to one-ha,L3332,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.79,,,,73.23,143.2,fee schedule,
Shoe lifts elevation heel /i,L3334,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,44.87,,,,37.86,74.04,fee schedule,
Shoe wedge sach,L3340,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100.28,,,,84.63,165.46,fee schedule,
Shoe heel wedge,L3350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.91,,,,22.71,44.4,fee schedule,
Shoe sole wedge outside sole,L3360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,41.89,,,,35.35,69.12,fee schedule,
Shoe sole wedge between sole,L3370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.36,,,,49.25,96.29,fee schedule,
Shoe clubfoot wedge,L3380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.36,,,,49.25,93.85,fee schedule,
Shoe outflare wedge,L3390,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.36,,,,49.25,96.29,fee schedule,
Shoe metatarsal bar wedge ro,L3400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.89,,,,40.42,79.02,fee schedule,
Shoe metatarsal bar between,L3410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,109.23,,,,92.17,180.23,fee schedule,
Full sole/heel wedge btween,L3420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,64.35,,,,54.3,106.18,fee schedule,
Sho heel count plast reinfor,L3430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,188.55,,,,159.11,311.11,fee schedule,
Heel leather reinforced,L3440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,89.78,,,,75.76,148.14,fee schedule,
Shoe heel sach cushion type,L3450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,124.17,,,,104.78,204.88,fee schedule,
Shoe heel new leather standa,L3455,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.89,,,,40.42,79.02,fee schedule,
Shoe heel new rubber standar,L3460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.42,,,,34.11,66.69,fee schedule,
Shoe heel thomas with wedge,L3465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.88,,,,58.12,113.65,fee schedule,
Shoe heel thomas extend to b,L3470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,73.31,,,,61.86,120.96,fee schedule,
Shoe heel pad & depress for,L3480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,73.31,,,,61.86,120.96,fee schedule,
Ortho shoe add leather insol,L3500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.4,,,,29.03,56.76,fee schedule,
Orthopedic shoe add rub insl,L3510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.4,,,,29.03,56.76,fee schedule,
O shoe add felt w leath insl,L3520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.41,,,,31.57,61.73,fee schedule,
Ortho shoe add half sole,L3530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.41,,,,31.57,61.73,fee schedule,
Ortho shoe add full sole,L3540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,59.85,,,,50.51,98.75,fee schedule,
O shoe add standard toe tap,L3550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.52,,,,8.87,17.36,fee schedule,
O shoe add horseshoe toe tap,L3560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.91,,,,22.71,44.4,fee schedule,
O shoe add instep extension,L3570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,100.28,,,,84.63,165.46,fee schedule,
O shoe add instep velcro clo,L3580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,76.31,,,,64.4,125.91,fee schedule,
O shoe convert to sof counte,L3590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62.86,,,,53.04,103.72,fee schedule,
Ortho shoe add march bar,L3595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.35,,,,41.65,81.43,fee schedule,
Trans shoe calip plate exist,L3600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,89.78,,,,75.76,148.14,fee schedule,
Trans shoe caliper plate new,L3610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,118.22,,,,99.76,195.06,fee schedule,
Trans shoe solid stirrup exi,L3620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,89.78,,,,75.76,148.14,fee schedule,
Trans shoe solid stirrup new,L3630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,118.22,,,,99.76,195.06,fee schedule,
Shoe dennis browne splint bo,L3640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,50.9,,,,42.95,83.99,fee schedule,
So 8 abd restraint pre ots,L3650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.17,,,,65.11,127.33,fee schedule,
So 8 ab rstr can/web pre ots,L3660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,110.65,,,,93.37,182.57,fee schedule,
So acro/clav can web pre ots,L3670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,121.74,,,,102.73,200.87,fee schedule,
So cap design w/o jnts cf,L3671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,964.87,,,,814.2,1592.04,fee schedule,
So airplane w/wo joint cf,L3674,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1265.76,,,,1068.1,2088.5,fee schedule,
So vest canvas/web pre ots,L3675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,187.95,,,,158.6,310.12,fee schedule,
Eo w/o joints cf,L3702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,309.22,,,,260.93,510.21,fee schedule,
Eo elas w/metal jnts pre ots,L3710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,152.9,,,,129.03,252.29,fee schedule,
Forearm/arm cuffs free motio,L3720,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,731.68,,,,617.41,1207.27,fee schedule,
Forearm/arm cuffs ext/flex a,L3730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,970.49,,,,818.94,1601.31,fee schedule,
Cuffs adj lock w/ active con,L3740,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1150.6,,,,970.92,1898.49,fee schedule,
Eo adj jt prefab custom fit,L3760,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,535.54,,,,451.91,883.64,fee schedule,
Eo adj lock joint prefab ot,L3761,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,535.54,,,,451.91,883.64,fee schedule,
Eo rigid w/o joints pre ots,L3762,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,115.13,,,,97.15,189.96,fee schedule,
Ewho rigid w/o jnts cf,L3763,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,801.35,,,,676.21,1322.23,fee schedule,
Ewho w/joint(s) cf,L3764,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,838.63,,,,707.67,1383.74,fee schedule,
Ewhfo rigid w/o jnts cf,L3765,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1373.08,,,,1158.66,2265.58,fee schedule,
Ewhfo w/joint(s) cf,L3766,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1454,,,,1226.95,2399.1,fee schedule,
Whfo w/joint(s) custom fab,L3806,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,486.4,,,,410.45,802.56,fee schedule,
Whfo w/o joints pre cst,L3807,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,267.76,,,,225.94,441.8,fee schedule,
Whfo rigid w/o joints,L3808,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,381.46,,,,321.88,629.41,fee schedule,
Whfo w/o joints pre ots,L3809,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,267.76,,,,225.94,441.8,fee schedule,
Hinge extension/flex wrist/f,L3900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1734.69,,,,1463.81,2862.24,fee schedule,
Hinge ext/flex wrist finger,L3901,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2273.41,,,,1918.39,3751.13,fee schedule,
Whfo electric custom fitted,L3904,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3614.46,,,,3050.04,3614.46,fee schedule,
Who w/nontorsion jnt(s) cf,L3905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1061.92,,,,896.1,1752.17,fee schedule,
Who w/o joints cf,L3906,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,542.66,,,,457.93,895.39,fee schedule,
Who cock-up nonmolde pre ots,L3908,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,78.51,,,,66.25,129.54,fee schedule,
Hfo flexion glove pre ots,L3912,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,112.82,,,,95.2,186.15,fee schedule,
Hfo w/o joints cf,L3913,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,290,,,,244.72,478.5,fee schedule,
Who nontorsion jnts pre cst,L3915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,569.22,,,,480.34,939.21,fee schedule,
Who nontorsion jnts pre ots,L3916,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,569.22,,,,480.34,939.21,fee schedule,
Metacarp fx orthosis pre cst,L3917,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,113.08,,,,95.42,186.58,fee schedule,
Metacarp fx orthosis pre ots,L3918,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,113.08,,,,95.42,186.58,fee schedule,
Ho w/o joints cf,L3919,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,290,,,,244.72,478.5,fee schedule,
Hfo w/joint(s) cf,L3921,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,343.98,,,,290.26,567.57,fee schedule,
Hfo without joints pre cst,L3923,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,103.44,,,,87.28,170.68,fee schedule,
Hfo without joints pre ots,L3924,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,103.44,,,,87.28,170.68,fee schedule,
Fo pip dip jnt/sprng pre ots,L3925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.34,,,,59.36,116.06,fee schedule,
Fo pip dip no jt spr pre ots,L3927,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,37.48,,,,31.64,61.84,fee schedule,
Hfo nontorsion jnts pre cst,L3929,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,97.81,,,,82.53,161.39,fee schedule,
Hfo nontorsion jnts pre ots,L3930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,97.81,,,,82.53,161.39,fee schedule,
Whfo nontorsion joint prefab,L3931,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,223.27,,,,188.4,368.4,fee schedule,
Fo w/o joints cf,L3933,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,228.48,,,,192.8,376.99,fee schedule,
Fo nontorsion joint cf,L3935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,236.55,,,,199.62,390.31,fee schedule,
Sewho airplan desig abdu pos,L3960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,854.06,,,,720.7,1409.2,fee schedule,
Sewho cap design w/o jnts cf,L3961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1799.14,,,,1518.2,2968.58,fee schedule,
Sewho erbs palsey design abd,L3962,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,772.44,,,,651.82,1274.53,fee schedule,
Sewho airplane w/o jnts cf,L3967,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2124.15,,,,1792.45,3504.85,fee schedule,
Sewho cap design w/jnt(s) cf,L3971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2016.32,,,,1701.46,3326.93,fee schedule,
Sewho airplane w/jnt(s) cf,L3973,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2124.15,,,,1792.45,3504.85,fee schedule,
Sewhfo cap design w/o jnt cf,L3975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1799.14,,,,1518.2,2968.58,fee schedule,
Sewhfo airplane w/o jnts cf,L3976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1799.14,,,,1518.2,2968.58,fee schedule,
Sewhfo cap desgn w/jnt(s) cf,L3977,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2016.32,,,,1701.46,3326.93,fee schedule,
Sewhfo airplane w/jnt(s) cf,L3978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2124.15,,,,1792.45,3504.85,fee schedule,
Up ext fx orthos humeral nos,L3980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,414.27,,,,349.57,683.55,fee schedule,
Ue fx orth shoul cap forearm,L3981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1077.86,,,,909.54,1778.47,fee schedule,
Upper ext fx orthosis rad/ul,L3982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,420.64,,,,354.96,694.06,fee schedule,
Upper ext fx orthosis wrist,L3984,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,370.55,,,,312.69,611.41,fee schedule,
Sock fracture or equal each,L3995,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,43.96,,,,37.11,72.53,fee schedule,
Repl girdle milwaukee orth,L4000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1554.81,,,,1312.01,2565.44,fee schedule,
Replace trilateral socket br,L4010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,945.04,,,,797.46,1559.32,fee schedule,
Replace quadlat socket brim,L4020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1135.24,,,,957.97,1873.15,fee schedule,
Replace socket brim cust fit,L4030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,721.42,,,,608.76,1190.34,fee schedule,
Replace molded thigh lacer,L4040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,488.55,,,,412.26,806.11,fee schedule,
Replace non-molded thigh lac,L4045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,360.89,,,,304.54,595.47,fee schedule,
Replace molded calf lacer,L4050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,483.85,,,,408.31,798.35,fee schedule,
Replace non-molded calf lace,L4055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,294.11,,,,248.19,485.28,fee schedule,
Replace high roll cuff,L4060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,382.31,,,,322.62,630.81,fee schedule,
Replace prox & dist upright,L4070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,309.62,,,,261.27,510.87,fee schedule,
Repl met band kafo-afo prox,L4080,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,116.89,,,,98.63,192.87,fee schedule,
Repl met band kafo-afo calf/,L4090,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,99.45,,,,83.91,164.09,fee schedule,
Repl leath cuff kafo prox th,L4100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,119.49,,,,100.83,197.16,fee schedule,
Repl leath cuff kafo-afo cal,L4110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,93.3,,,,78.73,153.95,fee schedule,
Replace pretibial shell,L4130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,563.96,,,,475.9,930.53,fee schedule,
Ankle control ortho pre ots,L4350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,113.84,,,,96.08,187.84,fee schedule,
Pneumat walking boot pre cst,L4360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,304.63,,,,257.06,502.64,fee schedule,
Pneuma/vac walk boot pre ots,L4361,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,304.63,,,,257.06,502.64,fee schedule,
Pneum full leg splnt pre ots,L4370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,276.93,,,,233.69,456.93,fee schedule,
Non-pneum walk boot pre cst,L4386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.56,,,,157.42,307.82,fee schedule,
Non-pneum walk boot pre ots,L4387,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.56,,,,157.42,307.82,fee schedule,
Replace afo soft interface,L4392,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.68,,,,23.36,45.67,fee schedule,
Replace foot drop spint,L4394,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.2,,,,17.05,33.33,fee schedule,
Static or dynami afo pre cst,L4396,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,197.45,,,,166.62,325.79,fee schedule,
Static or dynami afo pre ots,L4397,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,197.45,,,,166.62,325.79,fee schedule,
Foot drop splint pre ots,L4398,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.88,,,,76.7,149.95,fee schedule,
Afo walk boot type cus fab,L4631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1734.52,,,,1463.67,2861.96,fee schedule,
Sho insert w arch toe filler,L5000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,675.65,,,,570.14,1114.82,fee schedule,
Mold socket ank hgt w/ toe f,L5010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1887.85,,,,1593.05,3114.95,fee schedule,
Tibial tubercle hgt w/ toe f,L5020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2957.65,,,,2495.79,4880.12,fee schedule,
Ank symes mold sckt sach ft,L5050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3230.31,,,,2725.88,5330.01,fee schedule,
Symes met fr leath socket ar,L5060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3982.04,,,,3360.22,6570.37,fee schedule,
Molded socket shin sach foot,L5100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3216.49,,,,2714.21,5307.21,fee schedule,
Plast socket jts/thgh lacer,L5105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4539.17,,,,3830.35,7489.63,fee schedule,
Mold sckt ext knee shin sach,L5150,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5046.47,,,,4258.43,8326.68,fee schedule,
Mold socket bent knee shin s,L5160,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5540.79,,,,4675.55,9142.3,fee schedule,
Kne sing axis fric shin sach,L5200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4285.4,,,,3616.19,7070.91,fee schedule,
No knee/ankle joints w/ ft b,L5210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3402.6,,,,2871.26,5614.29,fee schedule,
No knee joint with artic ali,L5220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3748.19,,,,3162.89,6184.51,fee schedule,
Fem focal defic constant fri,L5230,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5621.71,,,,4743.85,9275.82,fee schedule,
Hip canad sing axi cons fric,L5250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6591.61,,,,5562.29,10876.16,fee schedule,
Tilt table locking hip sing,L5270,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7344.34,,,,6197.47,12118.16,fee schedule,
Hemipelvect canad sing axis,L5280,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7138.98,,,,6024.17,11779.32,fee schedule,
Bk mold socket sach ft endo,L5301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3158.52,,,,2665.29,5211.56,fee schedule,
Knee disart sach ft endo,L5312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4976.47,,,,4199.36,8211.18,fee schedule,
Ak open end sach,L5321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4211.79,,,,3554.08,6949.45,fee schedule,
Hip disart canadian sach ft,L5331,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6168.73,,,,5205.45,10178.4,fee schedule,
Hemipelvectomy canadian sach,L5341,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6557.28,,,,5533.31,10819.51,fee schedule,
Postop dress & 1 cast chg bk,L5400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1880.91,,,,1587.19,3103.5,fee schedule,
Postop dsg bk ea add cast ch,L5410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,519.64,,,,438.49,857.41,fee schedule,
Postop dsg & 1 cast chg ak/d,L5420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2375.51,,,,2004.55,3919.59,fee schedule,
Postop dsg ak ea add cast ch,L5430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,644.82,,,,544.12,1063.95,fee schedule,
Postop app non-wgt bear dsg,L5450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,557.55,,,,470.49,919.96,fee schedule,
Postop app non-wgt bear dsg,L5460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,731.29,,,,617.09,1206.63,fee schedule,
Init bk ptb plaster direct,L5500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1738.51,,,,1467.03,2868.54,fee schedule,
Init ak ischal plstr direct,L5505,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2445.6,,,,2063.71,4035.24,fee schedule,
Prep bk ptb plaster molded,L5510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2076.07,,,,1751.87,3425.52,fee schedule,
Perp bk ptb thermopls direct,L5520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1860.95,,,,1570.35,3070.57,fee schedule,
Prep bk ptb thermopls molded,L5530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2446.34,,,,2064.32,4036.46,fee schedule,
Prep bk ptb open end socket,L5535,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2280.51,,,,1924.39,3762.84,fee schedule,
Prep bk ptb laminated socket,L5540,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2415.38,,,,2038.21,3985.38,fee schedule,
Prep ak ischial plast molded,L5560,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2752.2,,,,2322.42,4541.13,fee schedule,
Prep ak ischial direct form,L5570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2671.11,,,,2253.99,4407.33,fee schedule,
Prep ak ischial thermo mold,L5580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3315.24,,,,2797.53,5470.15,fee schedule,
Prep ak ischial open end,L5585,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3882.4,,,,3276.14,6405.96,fee schedule,
Prep ak ischial laminated,L5590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3456.46,,,,2916.71,5703.16,fee schedule,
Hip disartic sach thermopls,L5595,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5401.56,,,,4558.07,8912.57,fee schedule,
Hip disart sach laminat mold,L5600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6147.77,,,,5187.75,10143.82,fee schedule,
Above knee hydracadence,L5610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2965.04,,,,2502.02,4892.32,fee schedule,
Ak 4 bar link w/fric swing,L5611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1888.48,,,,1593.57,3115.99,fee schedule,
Ak 4 bar ling w/hydraul swig,L5613,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2872.49,,,,2423.93,4739.61,fee schedule,
4-bar link above knee w/swng,L5614,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1989.39,,,,1678.73,3282.49,fee schedule,
Ak 4 bar link hydl swg/stanc,L5615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6632.94,,,,6632.94,6632.94,fee schedule,
Ak univ multiplex sys frict,L5616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1732.02,,,,1461.56,2857.83,fee schedule,
Ak/bk self-aligning unit ea,L5617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,659.62,,,,556.61,1088.37,fee schedule,
Test socket symes,L5618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,393.91,,,,332.4,649.95,fee schedule,
Test socket below knee,L5620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,349.49,,,,294.91,576.66,fee schedule,
Test socket knee disarticula,L5622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,470.85,,,,397.32,776.9,fee schedule,
Test socket above knee,L5624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,470.67,,,,397.17,776.61,fee schedule,
Test socket hip disarticulat,L5626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,745.13,,,,628.77,1229.46,fee schedule,
Test socket hemipelvectomy,L5628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,754.55,,,,636.72,1245.01,fee schedule,
Below knee acrylic socket,L5629,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,372.49,,,,314.33,614.61,fee schedule,
Syme typ expandabl wall sckt,L5630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,647.22,,,,546.15,1067.91,fee schedule,
Ak/knee disartic acrylic soc,L5631,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,515,,,,434.58,849.75,fee schedule,
Symes type ptb brim design s,L5632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,317.42,,,,267.86,523.74,fee schedule,
Symes type poster opening so,L5634,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,396.96,,,,334.97,654.98,fee schedule,
Symes type medial opening so,L5636,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,303.42,,,,256.04,500.64,fee schedule,
Below knee total contact,L5637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,451.48,,,,380.98,744.94,fee schedule,
Below knee leather socket,L5638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,760.56,,,,641.8,1254.92,fee schedule,
Below knee wood socket,L5639,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1314.14,,,,1108.93,2168.33,fee schedule,
Knee disarticulat leather so,L5640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,863.79,,,,728.91,1425.25,fee schedule,
Above knee leather socket,L5642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,800.7,,,,675.67,1321.16,fee schedule,
Hip flex inner socket ext fr,L5643,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2361.68,,,,1992.88,3896.77,fee schedule,
Above knee wood socket,L5644,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.3,,,,584.19,1142.3,fee schedule,
Bk flex inner socket ext fra,L5645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1148.48,,,,969.14,1894.99,fee schedule,
Below knee cushion socket,L5646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,727.82,,,,614.16,1200.9,fee schedule,
Below knee suction socket,L5647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,932.37,,,,786.77,1538.41,fee schedule,
Above knee cushion socket,L5648,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,859.98,,,,725.69,1418.97,fee schedule,
Isch containmt/narrow m-l so,L5649,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2889.61,,,,2438.37,4767.86,fee schedule,
Tot contact ak/knee disart s,L5650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,572.21,,,,482.85,944.15,fee schedule,
Ak flex inner socket ext fra,L5651,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1676.49,,,,1414.71,2766.21,fee schedule,
Suction susp ak/knee disart,L5652,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,511.02,,,,431.22,843.18,fee schedule,
Knee disart expand wall sock,L5653,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,797.34,,,,672.82,1315.61,fee schedule,
Socket insert symes,L5654,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,462.21,,,,390.03,762.65,fee schedule,
Socket insert below knee,L5655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,333.72,,,,281.61,550.64,fee schedule,
Socket insert knee articulat,L5656,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,506.99,,,,427.82,836.53,fee schedule,
Socket insert above knee,L5658,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,535.14,,,,451.58,882.98,fee schedule,
Multi-durometer symes,L5661,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,767.81,,,,647.9,1266.89,fee schedule,
Multi-durometer below knee,L5665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,682.61,,,,576.02,1126.31,fee schedule,
Below knee cuff suspension,L5666,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.38,,,,76.27,149.13,fee schedule,
Bk molded distal cushion,L5668,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,134.63,,,,113.61,222.14,fee schedule,
Bk molded supracondylar susp,L5670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,318.05,,,,268.38,524.78,fee schedule,
Bk/ak locking mechanism,L5671,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,583.03,,,,491.98,962,fee schedule,
Bk removable medial brim sus,L5672,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,420.88,,,,355.15,694.45,fee schedule,
Socket insert w lock mech,L5673,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,926.6,,,,781.9,1528.89,fee schedule,
Bk knee joints single axis p,L5676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,424.74,,,,358.41,700.82,fee schedule,
Bk knee joints polycentric p,L5677,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,650.49,,,,548.92,1073.31,fee schedule,
Bk joint covers pair,L5678,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.54,,,,39.27,76.79,fee schedule,
Socket insert w/o lock mech,L5679,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,772.15,,,,651.58,1274.05,fee schedule,
Bk thigh lacer non-molded,L5680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,356.76,,,,301.05,588.65,fee schedule,
Intl custm cong/latyp insert,L5681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1550.76,,,,1308.6,2558.75,fee schedule,
Bk thigh lacer glut/ischia m,L5682,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,733.02,,,,618.56,1209.48,fee schedule,
Initial custom socket insert,L5683,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1550.76,,,,1308.6,2558.75,fee schedule,
Bk fork strap,L5684,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,56.42,,,,47.6,93.09,fee schedule,
Below knee sus/seal sleeve,L5685,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,151.03,,,,127.44,249.2,fee schedule,
Bk back check,L5686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,67.85,,,,57.25,111.95,fee schedule,
Bk waist belt webbing,L5688,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.07,,,,60.81,118.92,fee schedule,
Bk waist belt padded and lin,L5690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,147.11,,,,124.13,242.73,fee schedule,
Ak pelvic control belt light,L5692,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,155.75,,,,131.43,256.99,fee schedule,
Ak pelvic control belt pad/l,L5694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,212.64,,,,179.43,350.86,fee schedule,
Ak sleeve susp neoprene/equa,L5695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,191.15,,,,161.3,315.4,fee schedule,
Ak/knee disartic pelvic join,L5696,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,230.9,,,,194.85,380.99,fee schedule,
Ak/knee disartic pelvic band,L5697,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,109.65,,,,92.53,180.92,fee schedule,
Ak/knee disartic silesian ba,L5698,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,140.66,,,,118.7,232.09,fee schedule,
Shoulder harness,L5699,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,240.41,,,,202.87,396.68,fee schedule,
Replace socket below knee,L5700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3616.14,,,,3051.45,5966.63,fee schedule,
Replace socket above knee,L5701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4486.15,,,,3785.61,7402.15,fee schedule,
Replace socket hip,L5702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5654.11,,,,4771.18,9329.28,fee schedule,
Symes ankle w/o (sach) foot,L5703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2974.23,,,,2509.78,4907.48,fee schedule,
Custom shape cover bk,L5704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,737.31,,,,622.17,1216.56,fee schedule,
Custom shape cover ak,L5705,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1351.78,,,,1140.68,2230.44,fee schedule,
Custom shape cvr knee disart,L5706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1318.48,,,,1112.59,2175.49,fee schedule,
Custom shape cvr hip disart,L5707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1771.42,,,,1494.8,2922.84,fee schedule,
Kne-shin exo sng axi mnl loc,L5710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,421.56,,,,355.73,695.57,fee schedule,
Knee-shin exo mnl lock ultra,L5711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,707.5,,,,597.03,1167.38,fee schedule,
Knee-shin exo frict swg & st,L5712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,505.06,,,,426.19,833.35,fee schedule,
Knee-shin exo variable frict,L5714,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,513.9,,,,433.65,847.94,fee schedule,
Knee-shin exo mech stance ph,L5716,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1016.16,,,,857.48,1676.66,fee schedule,
Knee-shin exo frct swg & sta,L5718,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1086.59,,,,916.91,1792.87,fee schedule,
Knee-shin pneum swg frct exo,L5722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1321.38,,,,1115.03,2180.28,fee schedule,
Knee-shin exo fluid swing ph,L5724,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2036.68,,,,1718.63,3360.52,fee schedule,
Knee-shin ext jnts fld swg e,L5726,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2424.75,,,,2046.11,4000.84,fee schedule,
Knee-shin fluid swg & stance,L5728,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2841.54,,,,2397.81,4688.54,fee schedule,
Knee-shin pneum/hydra pneum,L5780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1564.48,,,,1320.18,2581.39,fee schedule,
Lower limb pros vacuum pump,L5781,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4717.08,,,,3980.48,7783.18,fee schedule,
Hd low limb pros vacuum pump,L5782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4972.87,,,,4196.31,8205.24,fee schedule,
Add low ext mec limb vol sys,L5783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3015.92,,,,3015.92,3015.92,fee schedule,
Exoskeletal bk ultralt mater,L5785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,608.98,,,,513.88,1004.82,fee schedule,
Exoskeletal ak ultra-light m,L5790,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,878.9,,,,741.66,1450.19,fee schedule,
Exoskel hip ultra-light mate,L5795,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1258.48,,,,1061.96,2076.49,fee schedule,
Endoskel knee-shin mnl lock,L5810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,670.51,,,,565.81,1106.34,fee schedule,
Endo knee-shin mnl lck ultra,L5811,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,925.31,,,,780.81,1526.76,fee schedule,
Endo knee-shin frct swg & st,L5812,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,696.34,,,,587.59,1148.96,fee schedule,
Endo knee-shin hydral swg ph,L5814,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4378.37,,,,3694.66,7224.31,fee schedule,
Endo knee-shin polyc mch sta,L5816,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,996.82,,,,841.16,1644.75,fee schedule,
Endo knee-shin frct swg & st,L5818,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1125.61,,,,949.83,1857.26,fee schedule,
Endo knee-shin pneum swg frc,L5822,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2064.9,,,,1742.45,3407.09,fee schedule,
Endo knee-shin fluid swing p,L5824,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1951.93,,,,1647.13,3220.68,fee schedule,
Miniature knee joint,L5826,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3681.66,,,,3106.74,6074.74,fee schedule,
Endo knee-shin fluid swg/sta,L5828,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3473.96,,,,2931.48,5732.03,fee schedule,
Endo knee-shin pneum/swg pha,L5830,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2342.38,,,,1976.59,3864.93,fee schedule,
Multi-axial knee/shin system,L5840,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4597.46,,,,3879.53,7585.81,fee schedule,
Addition endoskletl knee-shi,L5841,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2694.52,,,,2694.52,2694.52,fee schedule,
Knee-shin sys stance flexion,L5845,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2113.06,,,,1783.08,3486.55,fee schedule,
Knee-shin sys hydraul stance,L5848,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1267.73,,,,1069.76,2091.75,fee schedule,
Endo ak/hip knee extens assi,L5850,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,149.94,,,,126.53,247.4,fee schedule,
Mech hip extension assist,L5855,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,361.99,,,,305.46,597.28,fee schedule,
Elec knee-shin swing/stance,L5856,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28300.96,,,,23881.56,46696.58,fee schedule,
Elec knee-shin swing only,L5857,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10042.24,,,,8474.07,16569.7,fee schedule,
Stance phase only,L5858,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21910.47,,,,18488.99,36152.28,fee schedule,
Knee-shin pro flex/ext cont,L5859,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17105.29,,,,14434.17,28223.73,fee schedule,
Endo below knee alignable sy,L5910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,424.51,,,,358.22,700.44,fee schedule,
Endo ak/hip alignable system,L5920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,621.92,,,,524.8,1026.17,fee schedule,
Above knee manual lock,L5925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,393.84,,,,332.34,649.84,fee schedule,
Endoskel posit rotat unit,L5926,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,758.03,,,,758.03,758.03,fee schedule,
High activity knee frame,L5930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3968.15,,,,3348.49,6547.45,fee schedule,
Endo bk ultra-light material,L5940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,587.94,,,,496.13,970.1,fee schedule,
Endo ak ultra-light material,L5950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,911.91,,,,769.51,1504.65,fee schedule,
Endo hip ultra-light materia,L5960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1363.54,,,,1150.61,2249.84,fee schedule,
Endo poly hip pneu/hyd/rot,L5961,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5627.3,,,,4748.56,9285.05,fee schedule,
Below knee flex cover system,L5962,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,688.95,,,,581.37,1136.77,fee schedule,
Above knee flex cover system,L5964,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1321.55,,,,1115.18,2180.56,fee schedule,
Hip flexible cover system,L5966,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1702.39,,,,1436.55,2808.94,fee schedule,
Multiaxial ankle w dorsiflex,L5968,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4284.06,,,,3615.07,7068.7,fee schedule,
Foot external keel sach foot,L5970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,256.08,,,,216.09,422.53,fee schedule,
Sach foot replacement,L5971,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,256.08,,,,216.09,422.53,fee schedule,
Flexible keel foot,L5972,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,466.48,,,,393.64,769.69,fee schedule,
Ank-foot sys dors-plant flex,L5973,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20813.72,,,,17563.51,34342.64,fee schedule,
Foot single axis ankle/foot,L5974,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,273.14,,,,230.49,450.68,fee schedule,
Combo ankle/foot prosthesis,L5975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,546.55,,,,461.2,901.81,fee schedule,
Energy storing foot,L5976,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,692.82,,,,584.63,1143.15,fee schedule,
Ft prosth multiaxial ankl/ft,L5978,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,367.11,,,,309.78,605.73,fee schedule,
Multi-axial ankle/ft prosth,L5979,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2939.37,,,,2480.36,4849.96,fee schedule,
Flex foot system,L5980,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4478.39,,,,3779.05,7202.09,fee schedule,
Flex-walk sys low ext prosth,L5981,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4022.68,,,,3394.51,6637.42,fee schedule,
Exoskeletal axial rotation u,L5982,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,755.69,,,,637.68,1246.89,fee schedule,
Endoskeletal axial rotation,L5984,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,758.03,,,,639.66,1250.75,fee schedule,
Lwr ext dynamic prosth pylon,L5985,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,332.92,,,,280.92,549.32,fee schedule,
Multi-axial rotation unit,L5986,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,914.4,,,,771.61,1508.76,fee schedule,
Shank ft w vert load pylon,L5987,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8480.87,,,,7156.53,13993.44,fee schedule,
Vertical shock reducing pylo,L5988,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2355.12,,,,1987.35,3885.95,fee schedule,
User adjustable heel height,L5990,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2138.74,,,,1804.76,2138.74,fee schedule,
Low pros ext osseo connector,L5991,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,11254.44,,,,11254.44,18569.83,fee schedule,
Part hand thumb rem,L6000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2076.5,,,,1752.24,3426.23,fee schedule,
Part hand little/ring,L6010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2310.81,,,,1949.95,3812.84,fee schedule,
Part hand no fingers,L6020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2154.45,,,,1818.02,3554.84,fee schedule,
Part hand myo exclu term dev,L6026,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5128.15,,,,4327.35,8461.45,fee schedule,
Wrst mld sck flx hng tri pad,L6050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2930.49,,,,2472.87,4835.31,fee schedule,
Wrst mold sock w/exp interfa,L6055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3738.01,,,,3154.28,6167.72,fee schedule,
Elb mold sock flex hinge pad,L6100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2965.56,,,,2502.47,4893.17,fee schedule,
Elbow mold sock suspension t,L6110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3137.36,,,,2647.44,5176.64,fee schedule,
Elbow mold doub splt soc ste,L6120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3548.37,,,,2994.27,5854.81,fee schedule,
Elbow stump activated lock h,L6130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3743.6,,,,3159.02,6176.94,fee schedule,
Elbow mold outsid lock hinge,L6200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3856.35,,,,3254.15,6362.98,fee schedule,
Elbow molded w/ expand inter,L6205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5319.76,,,,4489.04,8777.6,fee schedule,
Elbow inter loc elbow forarm,L6250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3793.97,,,,3201.52,6260.05,fee schedule,
Shlder disart int lock elbow,L6300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5232.94,,,,4415.78,8634.35,fee schedule,
Shoulder passive restor comp,L6310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4742.53,,,,4001.94,7825.17,fee schedule,
Shoulder passive restor cap,L6320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2471.65,,,,2085.69,4078.22,fee schedule,
Thoracic intern lock elbow,L6350,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5733.68,,,,4838.33,9460.57,fee schedule,
Thoracic passive restor comp,L6360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4977.85,,,,4200.52,8213.45,fee schedule,
Thoracic passive restor cap,L6370,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2886.82,,,,2436.01,4763.25,fee schedule,
Postop dsg cast chg wrst/elb,L6380,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1669.65,,,,1408.92,2754.92,fee schedule,
Postop dsg cast chg elb dis/,L6382,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1987.64,,,,1677.26,3279.61,fee schedule,
Postop dsg cast chg shlder/t,L6384,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2514.48,,,,2121.82,4148.89,fee schedule,
Postop ea cast chg & realign,L6386,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,551.19,,,,465.11,909.46,fee schedule,
Postop applicat rigid dsg on,L6388,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,606.99,,,,512.21,1001.53,fee schedule,
Below elbow prosth tiss shap,L6400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3207.98,,,,2707.04,5293.17,fee schedule,
Elb disart prosth tiss shap,L6450,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4192.67,,,,3537.96,6917.91,fee schedule,
Above elbow prosth tiss shap,L6500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4117.12,,,,3474.2,6793.25,fee schedule,
Shldr disar prosth tiss shap,L6550,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5332.52,,,,4499.81,8798.66,fee schedule,
Scap thorac prosth tiss shap,L6570,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5953.06,,,,5023.44,9822.55,fee schedule,
Wrist/elbow bowden cable mol,L6580,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2380.17,,,,2008.49,3927.28,fee schedule,
Wrist/elbow bowden cbl dir f,L6582,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1999.02,,,,1686.86,3298.38,fee schedule,
Elbow fair lead cable molded,L6584,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2960.01,,,,2497.78,4884.02,fee schedule,
Elbow fair lead cable dir fo,L6586,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2637.55,,,,2225.68,4351.96,fee schedule,
Shdr fair lead cable molded,L6588,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4200.64,,,,3544.68,6931.06,fee schedule,
Shdr fair lead cable direct,L6590,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3661.01,,,,3089.33,6040.67,fee schedule,
Polycentric hinge pair,L6600,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,267.4,,,,225.64,441.21,fee schedule,
Single pivot hinge pair,L6605,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,275.23,,,,232.25,454.13,fee schedule,
Flexible metal hinge pair,L6610,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,260.19,,,,219.56,429.31,fee schedule,
Additional switch ext power,L6611,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,485.38,,,,409.58,800.88,fee schedule,
Disconnect locking wrist uni,L6615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.57,,,,213.13,416.74,fee schedule,
Disconnect insert locking wr,L6616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,76.03,,,,64.16,125.45,fee schedule,
Flexion/extension wrist unit,L6620,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,441.53,,,,372.59,728.52,fee schedule,
Flex/ext wrist w/wo friction,L6621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2696.55,,,,2275.47,4449.31,fee schedule,
Spring-ass rot wrst w/ latch,L6623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,841.11,,,,709.77,1387.83,fee schedule,
Flex/ext/rotation wrist unit,L6624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4439.9,,,,3746.58,7325.84,fee schedule,
Rotation wrst w/ cable lock,L6625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,623.39,,,,526.04,1028.59,fee schedule,
Quick disconn hook adapter o,L6628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,671.02,,,,566.23,1107.18,fee schedule,
Lamination collar w/ couplin,L6629,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,228.64,,,,192.94,377.26,fee schedule,
Stainless steel any wrist,L6630,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,336.82,,,,284.22,555.75,fee schedule,
Latex suspension sleeve each,L6632,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,76.15,,,,64.26,125.65,fee schedule,
Lift assist for elbow,L6635,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,243.43,,,,205.42,401.66,fee schedule,
Nudge control elbow lock,L6637,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,476.6,,,,402.17,786.39,fee schedule,
Elec lock on manual pw elbow,L6638,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2948.17,,,,2487.79,4864.48,fee schedule,
Shoulder abduction joint pai,L6640,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,396.92,,,,334.94,654.92,fee schedule,
Excursion amplifier pulley t,L6641,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,231.13,,,,195.03,381.36,fee schedule,
Excursion amplifier lever ty,L6642,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,339.83,,,,286.76,560.72,fee schedule,
Shoulder flexion-abduction j,L6645,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,429.26,,,,362.22,708.28,fee schedule,
Multipo locking shoulder jnt,L6646,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3718.31,,,,3137.67,6135.21,fee schedule,
Shoulder lock actuator,L6647,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,612.16,,,,516.57,1010.06,fee schedule,
Ext pwrd shlder lock/unlock,L6648,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3834.91,,,,3236.06,6327.6,fee schedule,
Shoulder universal joint,L6650,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,465.58,,,,392.87,768.21,fee schedule,
Standard control cable extra,L6655,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.32,,,,76.21,149.03,fee schedule,
Heavy duty control cable,L6660,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,120.86,,,,101.98,199.42,fee schedule,
Teflon or equal cable lining,L6665,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,53.98,,,,45.55,89.07,fee schedule,
Hook to hand cable adapter,L6670,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,56.21,,,,47.43,92.75,fee schedule,
Harness chest/shlder saddle,L6672,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,257.96,,,,217.68,425.63,fee schedule,
Harness figure of 8 sing con,L6675,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,140.76,,,,118.78,232.25,fee schedule,
Harness figure of 8 dual con,L6676,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,147.27,,,,124.27,243,fee schedule,
Ue triple control harness,L6677,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,349.71,,,,295.09,577.02,fee schedule,
Test sock wrist disart/bel e,L6680,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,362.58,,,,305.96,598.26,fee schedule,
Test sock elbw disart/above,L6682,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,400.88,,,,338.29,661.45,fee schedule,
Test socket shldr disart/tho,L6684,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,544.75,,,,459.68,898.84,fee schedule,
Suction socket,L6686,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,808.34,,,,682.11,1333.76,fee schedule,
Frame typ socket bel elbow/w,L6687,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,676.09,,,,570.51,1115.55,fee schedule,
Frame typ sock above elb/dis,L6688,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,748.25,,,,631.41,1234.66,fee schedule,
Frame typ socket shoulder di,L6689,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,891.78,,,,752.52,1471.44,fee schedule,
Frame typ sock interscap-tho,L6690,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1049.93,,,,885.98,1732.38,fee schedule,
Removable insert each,L6691,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,414.44,,,,349.72,683.83,fee schedule,
Silicone gel insert or equal,L6692,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,753.99,,,,636.24,1244.08,fee schedule,
Lockingelbow forearm cntrbal,L6693,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3346.97,,,,2824.31,5522.5,fee schedule,
Elbow socket ins use w/lock,L6694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,926.6,,,,781.9,1528.89,fee schedule,
Elbow socket ins use w/o lck,L6695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,772.15,,,,651.58,1274.05,fee schedule,
Cus elbo skt in for con/atyp,L6696,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1550.76,,,,1308.6,2558.75,fee schedule,
Cus elbo skt in not con/atyp,L6697,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1550.76,,,,1308.6,2558.75,fee schedule,
Below/above elbow lock mech,L6698,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,583.03,,,,491.98,962,fee schedule,
Term dev passive hand mitt,L6703,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,412.35,,,,347.96,680.38,fee schedule,
Term dev sport/rec/work att,L6704,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,795.95,,,,671.66,1313.32,fee schedule,
Term dev mech hook vol open,L6706,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,493.94,,,,416.81,815,fee schedule,
Term dev mech hook vol close,L6707,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1747.32,,,,1474.45,2883.08,fee schedule,
Term dev mech hand vol open,L6708,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1155.04,,,,974.67,1905.82,fee schedule,
Term dev mech hand vol close,L6709,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1639.3,,,,1383.31,2704.85,fee schedule,
Ped term dev hook vol open,L6711,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,792.6,,,,668.82,1307.79,fee schedule,
Ped term dev hook vol clos,L6712,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1459.37,,,,1231.48,2407.96,fee schedule,
Ped term dev hand vol open,L6713,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1841.82,,,,1554.2,3039,fee schedule,
Ped term dev hand vol clos,L6714,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1560.01,,,,1316.4,2574.02,fee schedule,
Term device multi art digit,L6715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3722.04,,,,3140.81,6141.37,fee schedule,
Hook/hand hvy dty vol open,L6721,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2772.81,,,,2339.81,4575.14,fee schedule,
Hook/hand hvy dty vol clos,L6722,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2390.32,,,,2017.06,3944.03,fee schedule,
Term dev modifier wrist unit,L6805,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,452.15,,,,381.55,746.05,fee schedule,
Term dev precision pinch dev,L6810,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,240.37,,,,202.83,396.61,fee schedule,
Elec hand ind art digits,L6880,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,28167.32,,,,23768.79,46476.08,fee schedule,
Term dev auto grasp feature,L6881,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4819.74,,,,4067.1,7952.57,fee schedule,
Microprocessor control uplmb,L6882,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3656,,,,3085.08,6032.4,fee schedule,
Replc sockt below e/w disa,L6883,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2341.9,,,,1976.18,3766.21,fee schedule,
Replc sockt above elbow disa,L6884,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3204.25,,,,2703.88,5287.01,fee schedule,
Replc sockt shldr dis/interc,L6885,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4977.85,,,,4200.52,8213.45,fee schedule,
Prefab glove for term device,L6890,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,235.46,,,,198.69,388.51,fee schedule,
Custom glove for term device,L6895,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,787.31,,,,664.36,1299.06,fee schedule,
Hand restorat thumb/1 finger,L6900,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2286.29,,,,1929.27,3772.38,fee schedule,
Hand restoration multiple fi,L6905,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2262.78,,,,1909.44,3733.59,fee schedule,
Hand restoration no fingers,L6910,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2224.47,,,,1877.1,3670.38,fee schedule,
Hand restoration replacmnt g,L6915,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,955.77,,,,806.51,1577.02,fee schedule,
Wrist disarticul switch ctrl,L6920,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9875.73,,,,8333.57,16294.95,fee schedule,
Wrist disart myoelectronic c,L6925,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10550.58,,,,8903.02,17408.46,fee schedule,
Below elbow switch control,L6930,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9511.72,,,,8026.38,15694.34,fee schedule,
Below elbow myoelectronic ct,L6935,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10501,,,,8861.19,17326.65,fee schedule,
Elbow disarticulation switch,L6940,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12282.74,,,,10364.7,20266.52,fee schedule,
Elbow disart myoelectronic c,L6945,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13702.99,,,,11563.17,22609.93,fee schedule,
Above elbow switch control,L6950,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12259.96,,,,10345.48,20228.93,fee schedule,
Above elbow myoelectronic ct,L6955,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14217.7,,,,11997.51,23459.21,fee schedule,
Shldr disartic switch contro,L6960,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14956.47,,,,12620.91,24678.18,fee schedule,
Shldr disartic myoelectronic,L6965,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17718.26,,,,14951.43,29235.13,fee schedule,
Interscapular-thor switch ct,L6970,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18965.44,,,,16003.84,31292.98,fee schedule,
Interscap-thor myoelectronic,L6975,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20904.38,,,,17640.01,34492.23,fee schedule,
Adult electric hand,L7007,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4306.02,,,,3633.6,7104.93,fee schedule,
Pediatric electric hand,L7008,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6677.34,,,,5634.63,11017.61,fee schedule,
Adult electric hook,L7009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4405.57,,,,3717.61,7269.19,fee schedule,
Prehensile actuator,L7040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3585.85,,,,3025.89,5916.65,fee schedule,
Pediatric electric hook,L7045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1894.52,,,,1598.67,3125.96,fee schedule,
Electronic elbow hosmer swit,L7170,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7091.45,,,,5984.06,11700.89,fee schedule,
Electronic elbow sequential,L7180,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,45879.28,,,,38714.9,75700.81,fee schedule,
Electronic elbo simultaneous,L7181,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47237.07,,,,39860.65,77941.17,fee schedule,
Electron elbow adolescent sw,L7185,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7455.42,,,,6291.19,12301.44,fee schedule,
Electron elbow child switch,L7186,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12533.61,,,,10576.39,20680.46,fee schedule,
Elbow adolescent myoelectron,L7190,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9892.63,,,,8347.82,16322.84,fee schedule,
Elbow child myoelectronic ct,L7191,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13183.37,,,,11124.69,21752.56,fee schedule,
Electronic wrist rotator any,L7259,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4831.5,,,,4077.02,7971.98,fee schedule,
Six volt bat otto bock/eq ea,L7360,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,311.88,,,,263.18,514.6,fee schedule,
Battery chrgr six volt otto,L7362,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,340.71,,,,287.51,562.17,fee schedule,
Twelve volt battery utah/equ,L7364,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,602.87,,,,508.72,994.74,fee schedule,
Battery chrgr 12 volt utah/e,L7366,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,829.1,,,,699.63,1368.02,fee schedule,
Replacemnt lithium ionbatter,L7367,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,459,,,,387.32,757.35,fee schedule,
Lithium ion battery charger,L7368,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,594.99,,,,502.08,981.73,fee schedule,
Add ue prost be/wd ultlite,L7400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,361.32,,,,304.89,596.18,fee schedule,
Add ue prost a/e ultlite mat,L7401,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,404.46,,,,341.3,667.36,fee schedule,
Add ue prost s/d ultlite mat,L7402,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,436.84,,,,368.62,720.79,fee schedule,
Add ue prost b/e acrylic,L7403,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,434.17,,,,366.37,716.38,fee schedule,
Add ue prost a/e acrylic,L7404,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,655.3,,,,552.96,1081.25,fee schedule,
Add ue prost s/d acrylic,L7405,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,856.96,,,,723.13,1413.98,fee schedule,
Pros soc insert gasket/seal,L7700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,176.38,,,,148.84,291.03,fee schedule,
Mastectomy bra,L8000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.91,,,,42.12,82.35,fee schedule,
Breast prosthesis bra & form,L8001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,147.91,,,,124.81,244.05,fee schedule,
Brst prsth bra & bilat form,L8002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,194.5,,,,164.13,320.93,fee schedule,
Ext breastprosthesis garment,L8015,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.66,,,,59.63,116.59,fee schedule,
Mastectomy form,L8020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,266.54,,,,224.93,439.79,fee schedule,
Breast prosthes w/o adhesive,L8030,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,412.06,,,,347.72,679.9,fee schedule,
Breast prosthesis w adhesive,L8031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,412.06,,,,347.72,679.9,fee schedule,
Reusable nipple prosthesis,L8032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,46.17,,,,38.96,76.18,fee schedule,
Custom breast prosthesis,L8035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4319.09,,,,3644.64,7126.5,fee schedule,
Nasal prosthesis,L8040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2922.74,,,,2466.32,4822.52,fee schedule,
Midfacial prosthesis,L8041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3522.52,,,,2972.45,5812.16,fee schedule,
Orbital prosthesis,L8042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3957.88,,,,3339.82,6530.5,fee schedule,
Upper facial prosthesis,L8043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4432.84,,,,3740.62,7314.19,fee schedule,
Hemi-facial prosthesis,L8044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4907.78,,,,4141.39,8097.84,fee schedule,
Auricular prosthesis,L8045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3843.12,,,,3242.99,6341.15,fee schedule,
Partial facial prosthesis,L8046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3166.34,,,,2671.89,5224.46,fee schedule,
Nasal septal prosthesis,L8047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1622.74,,,,1369.34,2677.52,fee schedule,
Truss single w/ standard pad,L8300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,98.87,,,,83.43,163.14,fee schedule,
Truss double w/ standard pad,L8310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,175.16,,,,147.81,289.01,fee schedule,
Truss addition to std pad wa,L8320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.67,,,,61.33,119.91,fee schedule,
Truss add to std pad scrotal,L8330,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,57.86,,,,48.83,95.47,fee schedule,
Sheath below knee,L8400,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,18.45,,,,15.57,30.44,fee schedule,
Sheath above knee,L8410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.28,,,,20.49,40.06,fee schedule,
Sheath upper limb,L8415,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25.13,,,,21.2,41.46,fee schedule,
Pros sheath/sock w gel cushn,L8417,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,88.67,,,,74.82,146.31,fee schedule,
Prosthetic sock multi ply bk,L8420,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.59,,,,20.75,40.57,fee schedule,
Prosthetic sock multi ply ak,L8430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.85,,,,23.5,45.95,fee schedule,
Pros sock multi ply upper lm,L8435,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.46,,,,22.33,43.66,fee schedule,
Shrinker below knee,L8440,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.95,,,,46.37,90.67,fee schedule,
Shrinker above knee,L8460,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,78.12,,,,65.92,128.9,fee schedule,
Shrinker upper limb,L8465,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.2,,,,60.93,119.13,fee schedule,
Pros sock single ply bk,L8470,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.82,,,,6.6,12.9,fee schedule,
Pros sock single ply ak,L8480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.79,,,,9.1,17.8,fee schedule,
Pros sock single ply upper l,L8485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.52,,,,12.26,23.96,fee schedule,
Artificial larynx,L8500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,775.81,,,,654.66,1247.65,fee schedule,
Tracheostomy speaking valve,L8501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,141.59,,,,119.48,233.62,fee schedule,
Trach-esoph voice pros pt in,L8507,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,49.36,,,,41.66,79.38,fee schedule,
Trach-esoph voice pros md in,L8509,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,128.75,,,,108.65,212.44,fee schedule,
Voice amplifier,L8510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,297.92,,,,251.4,491.57,fee schedule,
Indwelling trach insert,L8511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,85.73,,,,72.34,141.45,fee schedule,
Gel cap for trach voice pros,L8512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2.57,,,,2.17,4.24,fee schedule,
Trach pros cleaning device,L8513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6.13,,,,5.16,10.11,fee schedule,
Repl trach puncture dilator,L8514,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,111.18,,,,93.82,183.45,fee schedule,
Gel cap app device for trach,L8515,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.43,,,,62.79,122.81,fee schedule,
Coch implant headset replace,L8615,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,531.7,,,,448.67,877.31,fee schedule,
Coch implant microphone repl,L8616,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,123.83,,,,104.49,204.32,fee schedule,
Coch implant trans coil repl,L8617,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,108.16,,,,91.27,178.46,fee schedule,
Coch implant tran cable repl,L8618,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.92,,,,26.1,51.02,fee schedule,
Coch imp ext proc/contr rplc,L8619,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9909.3,,,,8361.89,16350.35,fee schedule,
Repl zinc air battery,L8621,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.73,,,,0.61,1.2,fee schedule,
Repl alkaline battery,L8622,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.38,,,,0.32,0.63,fee schedule,
Lith ion batt cidnon-earlvl,L8623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,76.26,,,,64.35,125.83,fee schedule,
Lith ion batt cid ear level,L8624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,190.12,,,,160.44,313.7,fee schedule,
Charger coch impl/aoi battry,L8625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,222.67,,,,187.9,367.41,fee schedule,
Cid ext speech process repl,L8627,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8410.8,,,,7097.39,13877.82,fee schedule,
Cid ext controller repl,L8628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1498.48,,,,1264.49,2472.49,fee schedule,
Cid transmit coil and cable,L8629,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,211.09,,,,178.13,348.3,fee schedule,
Pt prgrm for implt neurostim,L8681,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1344.57,,,,1134.61,2218.54,fee schedule,
Radiofq trsmtr for implt neu,L8683,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,6353.03,,,,5360.96,10482.5,fee schedule,
Radiof trsmtr implt scrl neu,L8684,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,996.87,,,,841.21,1644.84,fee schedule,
External recharg sys intern,L8689,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2033.57,,,,1716.02,3355.39,fee schedule,
Aoi snd proc repl excl actua,L8691,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2030.27,,,,1713.22,3349.95,fee schedule,
Aud osseo dev abutment,L8693,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1787.62,,,,1508.47,2949.57,fee schedule,
Aoi transducer/actuator repl,L8694,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1113.35,,,,939.49,1837.03,fee schedule,
External recharg sys extern,L8695,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.66,,,,16.59,32.44,fee schedule,
Ext antenna phren nerve stim,L8696,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,255.5,,,,215.6,421.58,fee schedule,
Ewh s/d uprt micro sensor,L8701,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33480.9,,,,33480.9,33480.9,fee schedule,
Ewhf s/d uprt micro sensor,L8702,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65871.74,,,,65871.74,65871.74,fee schedule,
Pne flu hepb cov home admin,M0201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,39.18,,,,18.02,139.66,fee schedule,
Tixagev and cilgav inj,M0220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,160.03,,,,150.5,160.03,fee schedule,
Tixagev and cilgav inj hm,M0221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,266.37,,,,122.49,949.4,fee schedule,
Bebtelovimab injection,M0222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,372.7,,,,171.39,1328.4,fee schedule,
Bebtelovimab injection home,M0223,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,585.37,,,,269.19,2086.4,fee schedule,
Pemivibart infusion,M0224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.04,,,,455.85,479.04,fee schedule,
Casiri and imdev repeat,M0240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.04,,,,220.29,1707.4,fee schedule,
Casiri and imdev repeat hm,M0241,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,798.04,,,,366.99,2844.4,fee schedule,
Casirivi and imdevi inj,M0243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.04,,,,220.29,1707.4,fee schedule,
Casirivi and imdevi inj hm,M0244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,798.04,,,,366.99,2844.4,fee schedule,
Bamlan and etesev infusion,M0245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.04,,,,220.29,1707.4,fee schedule,
Bamlan and etesev infus home,M0246,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,798.04,,,,366.99,2844.4,fee schedule,
Sotrovimab infusion,M0247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.04,,,,220.29,1707.4,fee schedule,
Sotrovimab inf home admin,M0248,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,798.04,,,,366.99,2844.4,fee schedule,
Adm tocilizu covid-19 1st,M0249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.04,,,,220.29,1707.4,fee schedule,
Adm tocilizu covid-19 2nd,M0250,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,479.04,,,,220.29,1707.4,fee schedule,
Cephalin floculation test,P2028,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.95,,,,4.95,5.5,fee schedule,
Congo red blood test,P2029,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.95,,,,4.95,5.5,fee schedule,
Blood thymol turbidity,P2033,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.95,,,,4.95,5.5,fee schedule,
Blood mucoprotein,P2038,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.95,,,,4.95,5.5,fee schedule,
Screen pap by tech w md supv,P3000,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,14.99,29.3,fee schedule,
Whole blood for transfusion,P9010,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,232.96,,,,103.33,232.96,fee schedule,
Blood split unit,P9011,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,170.99,,,,135.01,170.99,fee schedule,
Cryoprecipitate each unit,P9012,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,68.67,,,,34.7,74.39,fee schedule,
Rbc leukocytes reduced,P9016,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.41,,,,140.35,231.58,fee schedule,
Plasma 1 donor frz w/in 8 hr,P9017,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.72,,,,76.61,184.55,fee schedule,
Platelets each unit,P9019,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,74.6,,,,48.55,115.63,fee schedule,
Plaelet rich plasma unit,P9020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,629.5,,,,57.54,629.5,fee schedule,
Red blood cells unit,P9021,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,156.58,,,,101.31,167.16,fee schedule,
Washed red blood cells unit,P9022,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,455.51,,,,188.75,455.51,fee schedule,
Frozen plasma pooled sd,P9023,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,69.35,,,,60.46,240.5,fee schedule,
Plasma cryo redu path each,P9025,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,355.19,,,,65.23,355.19,fee schedule,
Cryo fib comp path redu each,P9026,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.99,,,,79.29,90.99,fee schedule,
Rbc o2 co2 reduced,P9027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,289.6,,,,252.48,289.6,fee schedule,
Platelets leukocytes reduced,P9031,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,150.12,,,,130.88,231.58,fee schedule,
Platelets irradiated,P9032,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,152.97,,,,87.97,184.12,fee schedule,
Platelets leukoreduced irrad,P9033,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,264.54,,,,140.35,268.36,fee schedule,
Platelets pheresis,P9034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,369.19,,,,321.86,793.24,fee schedule,
Platelet pheres leukoreduced,P9035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,541.78,,,,472.33,793.24,fee schedule,
Platelet pheresis irradiated,P9036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,642.27,,,,521.66,860.74,fee schedule,
Plate pheres leukoredu irrad,P9037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,771.36,,,,480.75,793.24,fee schedule,
Rbc irradiated,P9038,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,248.59,,,,127.86,248.59,fee schedule,
Rbc deglycerolized,P9039,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,356.86,,,,215.83,413.23,fee schedule,
Rbc leukoreduced irradiated,P9040,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,289.6,,,,215.83,356.12,fee schedule,
Albumin (human)5% 50ml,P9041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10.62,,,,10.49,17.31,fee schedule,
Plasma protein fract5%50ml,P9043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.12,,,,7.94,28.86,fee schedule,
Cryoprecipitatereducedplasma,P9044,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,79.32,,,,42.76,95.03,fee schedule,
Albumin (human) 5% 250 ml,P9045,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,53.08,,,,52.45,86.54,fee schedule,
Albumin (human) 25% 20 ml,P9046,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.23,,,,20.98,34.62,fee schedule,
Albumin (human) 25% 50ml,P9047,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,53.08,,,,52.45,86.54,fee schedule,
Plasmaprotein fract5%250ml,P9048,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,117.04,,,,47.86,158.36,fee schedule,
Blood l/r cmv-neg,P9051,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,191.84,,,,167.25,196.43,fee schedule,
Platelets hla-m l/r unit,P9052,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,826.64,,,,720.67,904.81,fee schedule,
Plt pher l/r cmv-neg irr,P9053,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,594.39,,,,518.19,594.39,fee schedule,
Blood l/r froz/degly/wash,P9054,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,246.85,,,,215.21,319.55,fee schedule,
Plt aph/pher l/r cmv-neg,P9055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,287.69,,,,250.81,476.66,fee schedule,
Blood l/r irradiated,P9056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,105.52,,,,91.99,241.48,fee schedule,
Rbc frz/deg/wsh l/r irrad,P9057,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,565.15,,,,240.45,565.15,fee schedule,
Rbc l/r cmv-neg irrad,P9058,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,277.42,,,,241.86,277.42,fee schedule,
Plasma frz between 8-24hour,P9059,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,83.24,,,,72.57,83.24,fee schedule,
Fr frz plasma donor retested,P9060,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,66.63,,,,54.74,67.27,fee schedule,
Pathogen reduced plasma pool,P9070,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.83,,,,31.24,73.01,fee schedule,
Pathogen reduced plasma sing,P9071,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,265.63,,,,83.91,265.63,fee schedule,
Platelets pheresis path redu,P9073,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,632.34,,,,551.28,669.3,fee schedule,
Blood component/product noc,P9099,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.83,,,,31.24,54.74,fee schedule,
Pathogen test for platelets,P9100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.97,,,,28.11,217.85,fee schedule,
Catheterize for urine spec,P9612,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.83,,,,3,14.57,fee schedule,
Cardiokymography,Q0035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,40.63,,,,16.61,128.71,case rate,
Obtaining screen pap smear,Q0091,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.17,,,,12.21,94.6,fee schedule,
Wet mounts/ w preparations,Q0111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17.76,,,,14.99,29.3,fee schedule,
Potassium hydroxide preps,Q0112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.83,,,,5.83,9.62,fee schedule,
Pinworm examinations,Q0113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4.27,,,,4.27,7.05,fee schedule,
Fern test,Q0114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,9.74,,,,9.74,16.07,fee schedule,
Post-coital mucous exam,Q0115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,25,,,,25,41.25,fee schedule,
Ferumoxytol non-esrd,Q0138,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.34,,,,0.34,1,fee schedule,
Ferumoxytol esrd use,Q0139,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.34,,,,0.34,1,fee schedule,
Tixagev and cilgav 300mg,Q0220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Tixagev and cilgav 600mg,Q0221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Bebtelovimab 175 mg,Q0222,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,2394,,,,2100,3465,fee schedule,
Inj- pemivibart- 4500 mg,Q0224,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Casirivi and imdevi 600 mg,Q0240,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Casirivimab and imdevimab,Q0243,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Casirivi and imdevi 1200 mg,Q0244,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Bamlanivimab and etesevima,Q0245,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,27,35.7,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Sotrovimab,Q0247,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,0.01,2394,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Tocilizumab for covid-19,Q0249,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,3.43,6.57,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Pwr module pt cable lvad rpl,Q0477,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,914.67,,,,771.83,1509.21,fee schedule,
Power adapter combo vad,Q0478,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,216.64,,,,182.8,357.46,fee schedule,
Power module combo vad rep,Q0479,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14151.44,,,,11941.6,23349.88,fee schedule,
Driver pneumatic vad rep,Q0480,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,99999.95,,,,89598.32,164999.92,fee schedule,
Microprcsr cu elec vad rep,Q0481,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,17130.77,,,,14455.68,28265.77,fee schedule,
Microprcsr cu combo vad rep,Q0482,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5365.67,,,,4527.78,8853.36,fee schedule,
Monitor elec vad rep,Q0483,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22104.13,,,,18652.42,36471.81,fee schedule,
Monitor elec or comb vad rep,Q0484,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4292.55,,,,3622.23,7082.71,fee schedule,
Monitor cable elec vad rep,Q0485,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,414.46,,,,349.74,683.86,fee schedule,
Mon cable elec/pneum vad rep,Q0486,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,344.94,,,,291.07,569.15,fee schedule,
Leads any type vad rep only,Q0487,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,402.41,,,,339.56,663.98,fee schedule,
Pwr pck base combo vad rep,Q0489,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19163.09,,,,16170.63,31619.1,fee schedule,
Emr pwr source elec vad rep,Q0490,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,828.91,,,,699.46,1367.7,fee schedule,
Emr pwr source combo vad rep,Q0491,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1303.13,,,,1099.63,2150.16,fee schedule,
Emr pwr cbl elec vad rep,Q0492,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,105,,,,88.6,173.25,fee schedule,
Emr pwr cbl combo vad rep,Q0493,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,298.93,,,,252.24,493.23,fee schedule,
Emr hd pmp elec/combo rep,Q0494,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,252.94,,,,213.44,417.35,fee schedule,
Charger elec/combo vad rep,Q0495,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,4924.43,,,,4155.44,8125.31,fee schedule,
Battery elec/combo vad rep,Q0496,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1767.47,,,,1491.47,2916.33,fee schedule,
Bat clps elec/comb vad rep,Q0497,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,551.89,,,,465.71,910.62,fee schedule,
Holster elec/combo vad rep,Q0498,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,605.55,,,,510.98,999.16,fee schedule,
Belt/vest elec/combo vad rep,Q0499,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,196.76,,,,166.03,324.65,fee schedule,
Filters elec/combo vad rep,Q0500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.98,,,,30.36,59.37,fee schedule,
Shwr cov elec/combo vad rep,Q0501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,602.06,,,,508.03,993.4,fee schedule,
Mobility cart pneum vad rep,Q0502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,766.55,,,,646.84,1264.81,fee schedule,
Battery pneum vad replacemnt,Q0503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1533.01,,,,1293.62,2529.47,fee schedule,
Pwr adpt pneum vad rep veh,Q0504,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,808.97,,,,682.64,1334.8,fee schedule,
Lith-ion batt elec/pneum vad,Q0506,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1006.92,,,,849.68,1661.42,fee schedule,
Bladder calculi irrig sol,Q2004,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,146.92,,,,1,146.92,fee schedule,
Fosphenytoin inj pe,Q2009,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,3.2,,,,1.41,7.65,fee schedule,
Radiesse injection,Q2026,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,298.73,,,,167.36,473.9,fee schedule,
Inj sculptra 0.5mg,Q2028,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1.4,,,,0.5,3.87,fee schedule,
Agriflu vaccine,Q2034,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,29.96,29.96,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Afluria vacc 3 yrs & > im,Q2035,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,18.23,30.08,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Flulaval vacc 3 yrs & > im,Q2036,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,8.58,8.58,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Fluvirin vacc 3 yrs & > im,Q2037,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,17.69,17.69,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Fluzone vacc 3 yrs & > im,Q2038,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,12.04,12.04,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Influenza virus vaccine nos,Q2039,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,12.04,37.6,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
Axicabtagene ciloleucel car+,Q2041,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,489455.96,,,,212694.48,1648490.92,fee schedule,
Tisagenlecleucel car-pos t,Q2042,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,529192.86,,,,232849.25,1804700.7,fee schedule,
Sipuleucel-t auto cd54+,Q2043,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55015.23,,,,44024.6,88153.97,fee schedule,
Imported lipodox inj,Q2049,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,391.42,,,,391.42,838.89,fee schedule,
Doxorubicin inj 10mg,Q2050,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,133.08,,,,85.48,349.3,fee schedule,
Brexucabtagene car pos t,Q2053,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,460530.4,,,,213211.94,1652501.56,fee schedule,
Lisocabtagene mara car pos t,Q2054,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,516726.08,,,,212674.9,1648339.22,fee schedule,
Idecabtagene vicleucel car,Q2055,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,526587.59,,,,217443.63,1685299.3,fee schedule,
Ciltacabtagene car-pos t,Q2056,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,527123.43,,,,241028.1,1868091,fee schedule,
Inj beta interferon im 1 mcg,Q3027,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,56.23,,,,31.64,56.23,fee schedule,
Injection zarxio,Q5101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.36,,,,0.24,0.61,fee schedule,
Injection inflectra,Q5103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,13.62,,,,13.62,51.32,fee schedule,
Injection renflexis,Q5104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,27.18,,,,27.18,54.65,fee schedule,
Inj retacrit esrd on dialysi,Q5105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.76,,,,0.76,1.25,fee schedule,
Inj retacrit non-esrd use,Q5106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,7.62,,,,7.62,12.66,fee schedule,
Inj mvasi 10 mg,Q5107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,26.59,,,,25.14,41.48,fee schedule,
Injection fulphila,Q5108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,135.53,,,,122.54,332.55,fee schedule,
Nivestym,Q5110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.27,,,,0.27,0.69,fee schedule,
Injection udenyca 0.5 mg,Q5111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,143.38,,,,122.1,359.21,fee schedule,
Inj ontruzant 10 mg,Q5112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,34.17,,,,34.17,63.05,fee schedule,
Inj herzuma 10 mg,Q5113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,60.44,,,,36.4,65.27,fee schedule,
Inj ogivri 10 mg,Q5114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.16,,,,42.6,71.94,fee schedule,
Inj truxima 10 mg,Q5115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,33.59,,,,33.59,58.11,fee schedule,
Inj. trazimera 10 mg,Q5116,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.17,,,,16.06,33.2,fee schedule,
Inj. kanjinti 10 mg,Q5117,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,24.33,,,,13.2,33.37,fee schedule,
Inj. zirabev 10 mg,Q5118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.59,,,,21.11,34.83,fee schedule,
Inj ruxience 10 mg,Q5119,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.44,,,,20.06,33.1,fee schedule,
Inj pegfilgrastim-bmez 0.5mg,Q5120,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,346.76,,,,29.49,346.76,fee schedule,
Inj. avsola 10 mg,Q5121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,21.29,,,,21.29,41.38,fee schedule,
Inj nyvepria,Q5122,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,96.55,,,,62.37,146.65,fee schedule,
Inj. riabni 10 mg,Q5123,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,38.65,,,,38.65,67.07,fee schedule,
Inj. byooviz 0.1 mg,Q5124,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,170.8,,,,170.8,303.65,fee schedule,
Inj releuko 1 mcg,Q5125,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,0.47,,,,0.47,0.86,fee schedule,
Inj alymsys 10 mg,Q5126,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,56.86,,,,56.86,98.11,fee schedule,
Inj stimufend 0.5 mg,Q5127,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,305.66,,,,305.66,542.26,fee schedule,
Inj cimerli 0.1 mg,Q5128,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,201.01,,,,201.01,432.42,fee schedule,
Inj vegzelma 10 mg,Q5129,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,56.82,,,,56.82,111.77,fee schedule,
Inj fylnetra 0.5 mg,Q5130,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,186.19,,,,186.19,333.25,fee schedule,
Inj idacio 20 mg,Q5131,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,292.57,,,,292.57,292.57,fee schedule,
Inj- tofidence- 1 mg,Q5133,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.72,,,,5.72,5.72,fee schedule,
Inj- tyenne- 1 mg,Q5135,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,5.04,,,,5.04,5.04,fee schedule,
Visualization adjunct,Q9968,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,8.53,,,,0.56,29.38,fee schedule,
Non-heu tc-99m add-on/dose,Q9969,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,10,,,,4.89,37.9,fee schedule,
Buprenorph xr 100 mg or less,Q9991,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1943.06,,,,1674.8,3113.73,fee schedule,
Buprenorphine xr over 100 mg,Q9992,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1943.06,,,,1674.8,3113.73,fee schedule,
2019-ncov diagnostic p,U0001,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,35.92,,,,35.92,59.27,fee schedule,
Covid-19 lab test non-cdc,U0002,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.31,,,,51.31,84.66,fee schedule,
Vision svcs frames purchases,V2020,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,88.17,,,,74.4,130,fee schedule,
Lens spher single plano 4.00,V2100,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,54.49,,,,45.99,54.49,fee schedule,
Single visn sphere 4.12-7.00,V2101,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.36,,,,44.18,52.36,fee schedule,
Singl visn sphere 7.12-20.00,V2102,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.53,,,,76.4,90.53,fee schedule,
Spherocylindr 4.00d/12-2.00d,V2103,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,45.87,,,,38.7,45.87,fee schedule,
Spherocylindr 4.00d/2.12-4d,V2104,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,47.29,,,,39.9,47.29,fee schedule,
Spherocylinder 4.00d/4.25-6d,V2105,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,56.25,,,,47.45,56.25,fee schedule,
Spherocylinder 4.00d/>6.00d,V2106,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62.3,,,,52.57,62.3,fee schedule,
Spherocylinder 4.25d/12-2d,V2107,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.48,,,,46.82,55.48,fee schedule,
Spherocylinder 4.25d/2.12-4d,V2108,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.63,,,,46.95,55.63,fee schedule,
Spherocylinder 4.25d/4.25-6d,V2109,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.48,,,,65.38,77.48,fee schedule,
Spherocylinder 4.25d/over 6d,V2110,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,62.58,,,,52.8,62.58,fee schedule,
Spherocylindr 7.25d/.25-2.25,V2111,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,75.84,,,,63.99,75.84,fee schedule,
Spherocylindr 7.25d/2.25-4d,V2112,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,85.67,,,,72.29,85.67,fee schedule,
Spherocylindr 7.25d/4.25-6d,V2113,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.64,,,,73.1,86.64,fee schedule,
Spherocylinder over 12.00d,V2114,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,102.65,,,,86.62,102.65,fee schedule,
Lens lenticular bifocal,V2115,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,103.46,,,,87.3,103.46,fee schedule,
Lens aniseikonic single,V2118,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,112.58,,,,95,112.58,fee schedule,
Lenticular lens single,V2121,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,101.52,,,,85.67,101.52,fee schedule,
Lens spher bifoc plano 4.00d,V2200,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,61.37,,,,51.78,61.37,fee schedule,
Lens sphere bifocal 4.12-7.0,V2201,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65.75,,,,55.48,65.75,fee schedule,
Lens sphere bifocal 7.12-20.,V2202,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,81.51,,,,68.77,81.51,fee schedule,
Lens sphcyl bifocal 4.00d/.1,V2203,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,63.2,,,,53.33,63.2,fee schedule,
Lens sphcy bifocal 4.00d/2.1,V2204,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,65.03,,,,54.88,65.03,fee schedule,
Lens sphcy bifocal 4.00d/4.2,V2205,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,72.1,,,,60.84,72.1,fee schedule,
Lens sphcy bifocal 4.00d/ove,V2206,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,84.63,,,,71.43,84.63,fee schedule,
Lens sphcy bifocal 4.25-7d/.,V2207,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.53,,,,60.37,71.53,fee schedule,
Lens sphcy bifocal 4.25-7/2.,V2208,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,70.29,,,,59.31,70.29,fee schedule,
Lens sphcy bifocal 4.25-7/4.,V2209,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,82.52,,,,69.63,82.52,fee schedule,
Lens sphcy bifocal 4.25-7/ov,V2210,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,88.92,,,,75.03,88.92,fee schedule,
Lens sphcy bifo 7.25-12/.25-,V2211,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.56,,,,73.04,86.56,fee schedule,
Lens sphcyl bifo 7.25-12/2.2,V2212,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,90.61,,,,76.46,90.61,fee schedule,
Lens sphcyl bifo 7.25-12/4.2,V2213,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,95.27,,,,80.4,95.27,fee schedule,
Lens sphcyl bifocal over 12.,V2214,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,99.57,,,,84.02,99.57,fee schedule,
Lens lenticular bifocal,V2215,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,124.32,,,,104.91,124.32,fee schedule,
Lens aniseikonic bifocal,V2218,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,126.69,,,,106.91,126.69,fee schedule,
Lens bifocal seg width over,V2219,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,58.44,,,,49.32,58.44,fee schedule,
Lens bifocal add over 3.25d,V2220,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,51.91,,,,43.8,51.91,fee schedule,
Lenticular lens bifocal,V2221,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,103.53,,,,87.37,103.53,fee schedule,
Lens sphere trifocal 4.00d,V2300,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,83.89,,,,70.79,83.89,fee schedule,
Lens sphere trifocal 4.12-7.,V2301,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,102.89,,,,86.81,102.89,fee schedule,
Lens sphere trifocal 7.12-20,V2302,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,96.12,,,,81.11,96.12,fee schedule,
Lens sphcy trifocal 4.0/.12-,V2303,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,80.75,,,,68.14,80.75,fee schedule,
Lens sphcy trifocal 4.0/2.25,V2304,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,81.69,,,,68.94,81.69,fee schedule,
Lens sphcy trifocal 4.0/4.25,V2305,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,91.26,,,,77.01,91.26,fee schedule,
Lens sphcyl trifocal 4.00/>6,V2306,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,93.97,,,,79.29,93.97,fee schedule,
Lens sphcy trifocal 4.25-7/.,V2307,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,89.47,,,,75.5,89.47,fee schedule,
Lens sphc trifocal 4.25-7/2.,V2308,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,97.59,,,,82.35,97.59,fee schedule,
Lens sphc trifocal 4.25-7/4.,V2309,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,102.13,,,,86.18,102.13,fee schedule,
Lens sphc trifocal 4.25-7/>6,V2310,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,106.67,,,,90.02,106.67,fee schedule,
Lens sphc trifo 7.25-12/.25-,V2311,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,123.17,,,,103.93,123.17,fee schedule,
Lens sphc trifo 7.25-12/2.25,V2312,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,112.9,,,,95.27,112.9,fee schedule,
Lens sphc trifo 7.25-12/4.25,V2313,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,123.24,,,,104,123.24,fee schedule,
Lens sphcyl trifocal over 12,V2314,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,125.98,,,,106.31,125.98,fee schedule,
Lens lenticular trifocal,V2315,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,139.85,,,,118.02,139.85,fee schedule,
Lens aniseikonic trifocal,V2318,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,171.93,,,,145.09,171.93,fee schedule,
Lens trifocal seg width > 28,V2319,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,77.62,,,,65.49,77.62,fee schedule,
Lens trifocal add over 3.25d,V2320,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,81.87,,,,69.09,81.87,fee schedule,
Lenticular lens trifocal,V2321,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,137.85,,,,116.33,137.85,fee schedule,
Lens variab asphericity sing,V2410,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,120.52,,,,101.7,120.52,fee schedule,
Lens variable asphericity bi,V2430,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,127.57,,,,107.65,127.57,fee schedule,
Contact lens pmma spherical,V2500,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,107.84,,,,35.65,107.84,fee schedule,
Cntct lens pmma-toric/prism,V2501,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,153.04,,,,50.6,153.04,fee schedule,
Contact lens pmma bifocal,V2502,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.36,,,,68.55,207.36,fee schedule,
Cntct lens pmma color vision,V2503,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,200.28,,,,66.21,200.28,fee schedule,
Cntct gas permeable sphericl,V2510,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,143.8,,,,47.55,143.8,fee schedule,
Cntct toric prism ballast,V2511,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,213.14,,,,70.46,213.14,fee schedule,
Cntct lens gas permbl bifocl,V2512,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,245.34,,,,81.11,245.34,fee schedule,
Contact lens extended wear,V2513,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,247.16,,,,81.72,247.16,fee schedule,
Contact lens hydrophilic,V2520,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,143.29,,,,47.38,143.29,fee schedule,
Cntct lens hydrophilic toric,V2521,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,283.76,,,,93.81,283.76,fee schedule,
Cntct lens hydrophil bifocl,V2522,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,207.66,,,,68.65,207.66,fee schedule,
Cntct lens hydrophil extend,V2523,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,218.03,,,,72.08,218.03,fee schedule,
Cntct lens hydrophil photoch,V2524,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,164.19,,,,144.03,164.19,fee schedule,
Contact lens gas impermeable,V2530,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,348.56,,,,115.24,348.56,fee schedule,
Contact lens gas permeable,V2531,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,638.32,,,,211.03,638.32,fee schedule,
Plastic eye prosth custom,V2623,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1105.26,,,,885.82,1461.6,fee schedule,
Polishing artifical eye,V2624,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,71.36,,,,52,95.78,fee schedule,
Enlargemnt of eye prosthesis,V2625,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,565.11,,,,427.63,747.32,fee schedule,
Reduction of eye prosthesis,V2626,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,233.85,,,,187.42,309.24,fee schedule,
Scleral cover shell,V2627,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,1676.48,,,,1343.64,2217.01,fee schedule,
Fabrication & fitting,V2628,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,356.61,,,,285.81,471.59,fee schedule,
Balance lens,V2700,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,52.56,,,,44.35,52.56,fee schedule,
Glass/plastic slab off prism,V2710,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,86.16,,,,72.71,86.16,fee schedule,
Prism lens/es,V2715,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,16.89,,,,14.25,16.89,fee schedule,
Fresnell prism press-on lens,V2718,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,36.48,,,,30.78,36.48,fee schedule,
Special base curve,V2730,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,30.54,,,,25.78,30.54,fee schedule,
Tint photochromatic lens/es,V2744,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,20.9,,,,17.63,20.9,fee schedule,
Tint any color/solid/grad,V2745,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,12.03,,,,10.16,12.03,fee schedule,
Anti-reflective coating,V2750,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,23.46,,,,19.8,23.46,fee schedule,
Uv lens/es,V2755,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,19.64,,,,16.58,19.64,fee schedule,
Occluder lens/es,V2770,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,22.88,,,,19.3,22.88,fee schedule,
Oversize lens/es,V2780,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,14.69,,,,12.4,14.69,fee schedule,
Lens 1.54-1.65 p/1.60-1.79g,V2782,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,75.89,,,,64.04,75.89,fee schedule,
Lens >= 1.66 p/>=1.80 g,V2783,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,85.59,,,,72.22,85.59,fee schedule,
Lens polycarb or equal,V2784,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,55.65,,,,46.97,55.65,fee schedule,
Corneal tissue processing,V2785,CPT,,,,,,,facility,outpatient,,,,,Advocare/Security Health,Medicare,,,35.7,,999999999,975,1608.75,percent of total billed charges,There is not sufficient historic claims history to derive the estimated allowed amount
SPINAL NEEDLE 22G X 5 (WHITACRE),100.0126,CDM,,,272,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
OXIMETRY;MULT DETERMINE,610,CDM,94761,CPT,460,RC,,,facility,both,,,238,168.5,Aetna First Health,Commercial,,202.3,85,,,105.48,202.3,percent of total billed charges,
IMMUNIZATION ADMIN - INFLUENZA,3241,CDM,90471,CPT,771,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
"ADMIN HEP B,ADULT 19+",3242,CDM,90471,CPT,771,RC,,,facility,both,,,61,43.19,Aetna First Health,Commercial,,51.85,85,,,27.04,51.85,percent of total billed charges,
IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID),3542,CDM,90471,CPT,771,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
SURG PATHOLOGY-LEVEL 2-TC,3932,CDM,88302,CPT,310,RC,,,facility,both,,,179,126.73,Aetna First Health,Commercial,TC,152.15,85,,,79.33,152.15,percent of total billed charges,
"LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION, TECH",3933,CDM,88304,CPT,310,RC,,,facility,both,,,194,137.35,Aetna First Health,Commercial,TC,164.9,85,,,85.98,164.9,percent of total billed charges,
"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION , TECH",3934,CDM,88305,CPT,310,RC,,,facility,both,,,360,254.88,Aetna First Health,Commercial,TC,306,85,,,159.55,306,percent of total billed charges,
SURG PATHOLOGY-LEVEL I-TC,3938,CDM,88300,CPT,310,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,TC,88.4,85,,,46.09,88.4,percent of total billed charges,
"LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION, TECH",3939,CDM,88307,CPT,310,RC,,,facility,both,,,555,392.94,Aetna First Health,Commercial,TC,471.75,85,,,245.98,471.75,percent of total billed charges,
"SPECIAL STAINS,GROUP I",3978,CDM,88312,CPT,310,RC,,,facility,both,,,294,208.15,Aetna First Health,Commercial,TC,249.9,85,,,130.3,249.9,percent of total billed charges,
PATH SPECIAL STAINS II,3979,CDM,88313,CPT,310,RC,,,facility,both,,,192,135.94,Aetna First Health,Commercial,TC,163.2,85,,,85.09,163.2,percent of total billed charges,
"LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION , TECH",3985,CDM,88309,CPT,310,RC,,,facility,both,,,709,501.97,Aetna First Health,Commercial,TC,602.65,85,,,314.23,602.65,percent of total billed charges,
SURG PATH-CONSLT W/ FROZ,3986,CDM,88331,CPT,310,RC,,,facility,both,,,234,165.67,Aetna First Health,Commercial,TC,198.9,85,,,103.71,198.9,percent of total billed charges,
IMMUNOCYTOCHEMISTRY,3993,CDM,88342,CPT,310,RC,,,facility,both,,,265,187.62,Aetna First Health,Commercial,TC,225.25,85,,,117.45,225.25,percent of total billed charges,
"EOSINOPHILS,URINE",5189,CDM,89190,CPT,300,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,,62.05,85,,,32.35,62.05,percent of total billed charges,
PT MIXING TEST-PT 1,5222,CDM,85611,CPT,300,RC,,,facility,both,,,42,29.74,Aetna First Health,Commercial,,35.7,85,,,18.61,35.7,percent of total billed charges,
PTT MIXING TEST-PT 1,5223,CDM,85732,CPT,300,RC,,,facility,both,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
LAB ANTIGEN TYPING,5247,CDM,86905,CPT,300,RC,,,facility,both,,,248,175.58,Aetna First Health,Commercial,,210.8,85,,,109.91,210.8,percent of total billed charges,
ASSAY CRYOFIBRINOGEN,5513,CDM,82585,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
LAB PSA SCREENING,6019,CDM,84153,CPT,300,RC,,,facility,both,,,142,100.54,Aetna First Health,Commercial,,120.7,85,,,62.93,120.7,percent of total billed charges,
BLOOD VISCOSITY EXAMINATION,7085,CDM,85810,CPT,300,RC,,,facility,both,,,109,77.17,Aetna First Health,Commercial,,92.65,85,,,48.31,92.65,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS; SERUM,7136,CDM,86334,CPT,300,RC,,,facility,both,,,213,150.8,Aetna First Health,Commercial,,181.05,85,,,94.4,181.05,percent of total billed charges,
ASSAY FOR PROCAINAMIDE,7191,CDM,80190,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
CYTOLOGY BODY FLUID,7235,CDM,88104,CPT,310,RC,,,facility,both,,,153,108.32,Aetna First Health,Commercial,TC,130.05,85,,,67.81,130.05,percent of total billed charges,
CYTOPATH/CONCENTRATION TECH,7260,CDM,88108,CPT,310,RC,,,facility,both,,,200,141.6,Aetna First Health,Commercial,TC,170,85,,,88.64,170,percent of total billed charges,
SEMEN COMPLETE,7270,CDM,89320,CPT,300,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,,96.9,85,,,50.52,96.9,percent of total billed charges,
EVALUATION OF FNA SMEAR,7280,CDM,88172,CPT,310,RC,,,facility,both,,,234,165.67,Aetna First Health,Commercial,TC,198.9,85,,,103.71,198.9,percent of total billed charges,
FIBRINOGEN,7426,CDM,85384,CPT,300,RC,,,facility,both,,,124,87.79,Aetna First Health,Commercial,,105.4,85,,,54.96,105.4,percent of total billed charges,
BLOOD METHEMOGLOBIN ASSAY,7456,CDM,83050,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
"LAB ANTIBODY ID,RBC",7605,CDM,86870,CPT,300,RC,,,facility,both,,,281,198.95,Aetna First Health,Commercial,,238.85,85,,,124.54,238.85,percent of total billed charges,
"LAB AB TITER,RBC",7610,CDM,86886,CPT,300,RC,,,facility,both,,,160,113.28,Aetna First Health,Commercial,,136,85,,,70.91,136,percent of total billed charges,
ASSAY CRYOGLOBULIN,7644,CDM,82595,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,,72.25,85,,,37.67,72.25,percent of total billed charges,
LAB ANTIBODY SCREEN,7665,CDM,86850,CPT,300,RC,,,facility,both,,,132,93.46,Aetna First Health,Commercial,,112.2,85,,,58.5,112.2,percent of total billed charges,
MICROSOMAL ANTIBODY,7893,CDM,86376,CPT,300,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
PHOSPHORUS,7906,CDM,84100,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
LAB ORG ID ANAEROBIC-EACH,7942,CDM,87076,CPT,300,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,,88.4,85,,,46.09,88.4,percent of total billed charges,
BILIRUBIN DIRECT,8502,CDM,82248,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,,77.35,85,,,40.33,77.35,percent of total billed charges,
LAB IMM SPIN X-MATCH,8837,CDM,86920,CPT,300,RC,,,facility,both,,,168,118.94,Aetna First Health,Commercial,,142.8,85,,,74.46,142.8,percent of total billed charges,
PAP SCREEN THIN LAYER PREP,9100,CDM,88142,CPT,311,RC,,,facility,both,,,147,104.08,Aetna First Health,Commercial,,124.95,85,,,65.15,124.95,percent of total billed charges,
MNT ASSESS & INTERV EA 15 MIN,9218,CDM,97802,CPT,942,RC,,,facility,both,,,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
MNT REASSESS & INT EA 15 MIN,9219,CDM,97803,CPT,942,RC,,,facility,both,,,51,36.11,Aetna First Health,Commercial,,43.35,85,,,22.6,43.35,percent of total billed charges,
REMOVAL OF SUTURES OR STAPLES (LIST SEPERATELY IN ADDITION TO E/M),15853,CDM,15853,CPT,761,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,,106.25,85,,,55.4,106.25,percent of total billed charges,
REMOVAL OF SUTURES AND STAPLES (LIST SEPERATELY IN ADDITION TO E/M),15854,CDM,15854,CPT,761,RC,,,facility,both,,,150,106.2,Aetna First Health,Commercial,,127.5,85,,,66.48,127.5,percent of total billed charges,
VENIPUNCTURE,36415,CDM,36415,CPT,300,RC,,,facility,both,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
CAPILLARY BLOOD COLLECTION,36416,CDM,36416,CPT,300,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
BLOOD TRANSFUSION SERVICE,36430,CDM,36430,CPT,391,RC,,,facility,both,,,1082,766.06,Aetna First Health,Commercial,,919.7,85,,,479.54,919.7,percent of total billed charges,
"THROMBOLYTIC THERAPY, STROKE",37195,CDM,37195,CPT,761,RC,,,facility,both,,,390,276.12,Aetna First Health,Commercial,,331.5,85,,,172.85,331.5,percent of total billed charges,
REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT,69209,CDM,69209,CPT,510,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,,90.1,85,,,46.98,90.1,percent of total billed charges,
US EXAM PELVIC LIMITED,76857.0301,CDM,76857,CPT,402,RC,,,facility,both,,,196,138.77,Aetna First Health,Commercial,TC,166.6,85,,,86.87,166.6,percent of total billed charges,
INTENSITY MODULATED RAD TX DLVR SIMPLE,77385,CDM,77385,CPT,333,RC,,,facility,both,,,382,270.46,Aetna First Health,Commercial,,324.7,85,,,169.3,324.7,percent of total billed charges,
INTENSITY MODULATED RAD TX DLVR COMPLEX,77386,CDM,77386,CPT,333,RC,,,facility,both,,,402,284.62,Aetna First Health,Commercial,,341.7,85,,,178.17,341.7,percent of total billed charges,
GUIDE FOR LOC OF TARGET VOL RADIAJ TX DLVR,77387,CDM,77387,CPT,333,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,,72.25,85,,,37.67,72.25,percent of total billed charges,
RADIOLOGY PORT FILM(S),77417,CDM,77417,CPT,333,RC,,,facility,both,,,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
BASIC METABOLIC PANEL CA ION,80047,CDM,80047,CPT,300,RC,,,facility,both,,,178,126.02,Aetna First Health,Commercial,,151.3,85,,,78.89,151.3,percent of total billed charges,
LAB BASIC METABOLIC PANEL,80048,CDM,80048,CPT,300,RC,,,facility,both,,,235,166.38,Aetna First Health,Commercial,,199.75,85,,,104.15,199.75,percent of total billed charges,
GENERAL HEALTH PANEL,80050,CDM,80050,CPT,300,RC,,,facility,both,,,368,260.54,Aetna First Health,Commercial,,312.8,85,,,163.1,312.8,percent of total billed charges,
ELECTROLYTE PANEL,80051,CDM,80051,CPT,300,RC,,,facility,both,,,173,122.48,Aetna First Health,Commercial,,147.05,85,,,76.67,147.05,percent of total billed charges,
COMPREHENSIVE METABOLIC PANEL,80053,CDM,80053,CPT,300,RC,,,facility,both,,,330,233.64,Aetna First Health,Commercial,,280.5,85,,,146.26,280.5,percent of total billed charges,
LIPID PROFILE,80061,CDM,80061,CPT,300,RC,,,facility,both,,,147,104.08,Aetna First Health,Commercial,,124.95,85,,,65.15,124.95,percent of total billed charges,
RENAL FUNCTION PANEL,80069,CDM,80069,CPT,300,RC,,,facility,both,,,298,210.98,Aetna First Health,Commercial,,253.3,85,,,132.07,253.3,percent of total billed charges,
ACUTE HEPATITIS PANEL,80074,CDM,80074,CPT,300,RC,,,facility,both,,,383,271.16,Aetna First Health,Commercial,,325.55,85,,,169.75,325.55,percent of total billed charges,
HEPATIC FUNCTION PANEL,80076,CDM,80076,CPT,300,RC,,,facility,both,,,204,144.43,Aetna First Health,Commercial,,173.4,85,,,90.41,173.4,percent of total billed charges,
ACETAMINOPHEN,80143,CDM,80143,CPT,300,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
ASSAY CARBAMAZEPINE TOTAL,80156,CDM,80156,CPT,300,RC,,,facility,both,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
ASSAY OF DIGOXIN,80162,CDM,80162,CPT,300,RC,,,facility,both,,,151,106.91,Aetna First Health,Commercial,,128.35,85,,,66.92,128.35,percent of total billed charges,
ASSAY DIPROPYLACETIC ACID,80164,CDM,80164,CPT,300,RC,,,facility,both,,,152,107.62,Aetna First Health,Commercial,,129.2,85,,,67.37,129.2,percent of total billed charges,
GENTAMICIN,80170,CDM,80170,CPT,300,RC,,,facility,both,,,207,146.56,Aetna First Health,Commercial,,175.95,85,,,91.74,175.95,percent of total billed charges,
LEVETIRACETAM,80177,CDM,80177,CPT,300,RC,,,facility,both,,,151,106.91,Aetna First Health,Commercial,,128.35,85,,,66.92,128.35,percent of total billed charges,
ASSAY OF LITHIUM,80178,CDM,80178,CPT,300,RC,,,facility,both,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
SALICYLATE,80179,CDM,80179,CPT,300,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
ASSAY OF PHENOBARBITAL,80184,CDM,80184,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
ASSAY OF PHENYTOIN TOTAL,80185,CDM,80185,CPT,300,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,,126.65,85,,,66.04,126.65,percent of total billed charges,
ASSAY FOR THEOPHYLLINE,80198,CDM,80198,CPT,300,RC,,,facility,both,,,171,121.07,Aetna First Health,Commercial,,145.35,85,,,75.79,145.35,percent of total billed charges,
ASSAY FOR TOBRAMYCIN,80200,CDM,80200,CPT,300,RC,,,facility,both,,,137,97,Aetna First Health,Commercial,,116.45,85,,,60.72,116.45,percent of total billed charges,
ASSAY FOR VANCOMYCIN,80202,CDM,80202,CPT,300,RC,,,facility,both,,,222,157.18,Aetna First Health,Commercial,,188.7,85,,,98.39,188.7,percent of total billed charges,
METHOTREXATE,80204,CDM,80204,CPT,300,RC,,,facility,both,,,45,31.86,Aetna First Health,Commercial,,38.25,85,,,19.94,38.25,percent of total billed charges,
"QUANTITATIVE ASSAY, DRUG",80299,CDM,80299,CPT,300,RC,,,facility,both,,,103,72.92,Aetna First Health,Commercial,,87.55,85,,,45.65,87.55,percent of total billed charges,
"URINALYSIS, AUTO, W/SCOPE",81001,CDM,81001,CPT,300,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,,83.3,85,,,43.43,83.3,percent of total billed charges,
URINALYSIS NONAUTO W/O SCOPE,81002,CDM,81002,CPT,300,RC,,,facility,both,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
"URINALYSIS, AUTO W/O SCOPE",81003,CDM,81003,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,,60.35,85,,,31.47,60.35,percent of total billed charges,
MICROSCOPIC EXAM OF URINE,81015,CDM,81015,CPT,300,RC,,,facility,both,,,13,9.2,Aetna First Health,Commercial,,11.05,85,,,5.76,11.05,percent of total billed charges,
"INFECT, BACT VAGINOSIS, QUANT",81513,CDM,81513,CPT,300,RC,,,facility,both,,,176,124.61,Aetna First Health,Commercial,,149.6,85,,,78,149.6,percent of total billed charges,
"INFECT, BACT VAGINOSIS AND VAGINITIS, QUANT",81514,CDM,81514,CPT,300,RC,,,facility,both,,,291,206.03,Aetna First Health,Commercial,,247.35,85,,,128.97,247.35,percent of total billed charges,
ACETONE ASSAY,82010,CDM,82010,CPT,300,RC,,,facility,both,,,171,121.07,Aetna First Health,Commercial,,145.35,85,,,75.79,145.35,percent of total billed charges,
"ALBUMIN, BLOOD",82040,CDM,82040,CPT,300,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,90,73.95,85,,,38.56,73.95,percent of total billed charges,
"ALBUMIN; OTHER SOURCE, QUANTITATIVE, EACH SPECIMEN",82042,CDM,82042,CPT,300,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
MICROALBUMIN QUANTITATIVE,82043,CDM,82043,CPT,300,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,,90.1,85,,,46.98,90.1,percent of total billed charges,
ASSAY BREATH ETHANOL,82075,CDM,82075,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
"ETHANOL, P",82077,CDM,82077,CPT,300,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,,28.05,85,,,14.63,28.05,percent of total billed charges,
ALPHA-1-ANTITRYPSIN TOTAL,82103,CDM,82103,CPT,300,RC,,,facility,both,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
ALPHA-FETOPROTEIN SERUM,82105,CDM,82105,CPT,300,RC,,,facility,both,,,27,19.12,Aetna First Health,Commercial,,22.95,85,,,11.97,22.95,percent of total billed charges,
AMMONIA,82140,CDM,82140,CPT,300,RC,,,facility,both,,,168,118.94,Aetna First Health,Commercial,,142.8,85,,,74.46,142.8,percent of total billed charges,
ASSAY OF AMYLASE,82150,CDM,82150,CPT,300,RC,,,facility,both,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
BILIRUBIN TOTAL,82247,CDM,82247,CPT,300,RC,,,facility,both,,,156,110.45,Aetna First Health,Commercial,,132.6,85,,,69.14,132.6,percent of total billed charges,
BILIRUBIN DIRECT,82248,CDM,82248,CPT,300,RC,,,facility,both,,,94,66.55,Aetna First Health,Commercial,,79.9,85,,,41.66,79.9,percent of total billed charges,
"BLOOD, OCCULT, OTHER SOURCES",82271,CDM,82271,CPT,300,RC,,,facility,both,,,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
BLOOD OCCULT PEROXIDASE,82272,CDM,82272,CPT,300,RC,,,facility,both,,,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
DX OCCULT BLOOD IMMUNOASSAY,82274,CDM,82274,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,,96.05,85,,,50.08,96.05,percent of total billed charges,
"VITAMIN D, 25 HYDROXY",82306,CDM,82306,CPT,300,RC,,,facility,both,,,260,184.08,Aetna First Health,Commercial,,221,85,,,115.23,221,percent of total billed charges,
CALCIUM TOTAL,82310,CDM,82310,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,,77.35,85,,,40.33,77.35,percent of total billed charges,
"ASSAY CALCIUM, IONIZED",82330,CDM,82330,CPT,300,RC,,,facility,both,,,134,94.87,Aetna First Health,Commercial,,113.9,85,,,59.39,113.9,percent of total billed charges,
ASSAY OF CALCIUM IN URINE,82340,CDM,82340,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
ASSAY BLOOD CARBON DIOXIDE,82374,CDM,82374,CPT,300,RC,,,facility,both,,,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
ASSAY BLOOD CARBON MONOXIDE,82375,CDM,82375,CPT,300,RC,,,facility,both,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
CARCINOEMBRYONIC ANTIGEN,82378,CDM,82378,CPT,300,RC,,,facility,both,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
ASSAY BLOOD CHLORIDE,82435,CDM,82435,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
ASSAY URINE CHLORIDE,82436,CDM,82436,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
ASSAY BLD/SERUM CHOLESTEROL,82465,CDM,82465,CPT,300,RC,,,facility,both,,,46,32.57,Aetna First Health,Commercial,,39.1,85,,,20.39,39.1,percent of total billed charges,
TOTAL CORTISOL,82533,CDM,82533,CPT,300,RC,,,facility,both,,,155,109.74,Aetna First Health,Commercial,,131.75,85,,,68.7,131.75,percent of total billed charges,
ASSAY OF CK (CPK),82550,CDM,82550,CPT,300,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,,96.9,85,,,50.52,96.9,percent of total billed charges,
CREATININE; BLOOD,82565,CDM,82565,CPT,300,RC,,,facility,both,,,94,66.55,Aetna First Health,Commercial,,79.9,85,,,41.66,79.9,percent of total billed charges,
CREATININE; OTHER SOURCE - REF,82570,CDM,82570,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,90,77.35,85,,,40.33,77.35,percent of total billed charges,
CREATININE; CLEARANCE,82575,CDM,82575,CPT,300,RC,,,facility,both,,,173,122.48,Aetna First Health,Commercial,,147.05,85,,,76.67,147.05,percent of total billed charges,
VITAMIN B-12,82607,CDM,82607,CPT,300,RC,,,facility,both,,,210,148.68,Aetna First Health,Commercial,,178.5,85,,,93.07,178.5,percent of total billed charges,
VIT D 1 25-DIHYDROXY,82652,CDM,82652,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,,45.9,85,,,23.93,45.9,percent of total billed charges,
ENDOCRINE E2,82670,CDM,82670,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,90,96.05,85,,,50.08,96.05,percent of total billed charges,
ASSAY OF FERRITIN,82728,CDM,82728,CPT,300,RC,,,facility,both,,,220,155.76,Aetna First Health,Commercial,,187,85,,,97.5,187,percent of total billed charges,
ASSAY OF FETAL FIBRONECTIN,82731,CDM,82731,CPT,300,RC,,,facility,both,,,602,426.22,Aetna First Health,Commercial,,511.7,85,,,266.81,511.7,percent of total billed charges,
"FOLIC ACID (FOLATE), SERUM",82746,CDM,82746,CPT,300,RC,,,facility,both,,,167,118.24,Aetna First Health,Commercial,,141.95,85,,,74.01,141.95,percent of total billed charges,
ASSAY IGA/IGD/IGG/IGM EACH,82784,CDM,82784,CPT,300,RC,,,facility,both,,,102,72.22,Aetna First Health,Commercial,,86.7,85,,,45.21,86.7,percent of total billed charges,
PH VENOUS BLOOD,82800,CDM,82800,CPT,300,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,,97.75,85,,,50.97,97.75,percent of total billed charges,
"BLOOD GASES: PH, PO2 & PCO2",82803,CDM,82803,CPT,300,RC,,,facility,both,,,245,173.46,Aetna First Health,Commercial,,208.25,85,,,108.58,208.25,percent of total billed charges,
"BLOOD GASES, O2 SATURATION ONLY",82810,CDM,82810,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,,60.35,85,,,31.47,60.35,percent of total billed charges,
"GLUCOSE, BODY FLUID OTHER THAN BLOOD",82945,CDM,82945,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,,72.25,85,,,37.67,72.25,percent of total billed charges,
"ASSAY, GLUCOSE, BLOOD QUANT",82947,CDM,82947,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
GLUCOSE TEST,82950,CDM,82950,CPT,300,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
GLUCOSE TOLERANCE TEST (GTT),82951,CDM,82951,CPT,300,RC,,,facility,both,,,220,155.76,Aetna First Health,Commercial,,187,85,,,97.5,187,percent of total billed charges,
GTT-ADDED SAMPLES,82952,CDM,82952,CPT,300,RC,,,facility,both,,,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
GLUCOSE BLOOD TEST,82962,CDM,82962,CPT,300,RC,,,facility,both,,,51,36.11,Aetna First Health,Commercial,,43.35,85,,,22.6,43.35,percent of total billed charges,
ASSAY OF GGT,82977,CDM,82977,CPT,300,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
FOLLICLE STIMULATING HORMONE,83001,CDM,83001,CPT,300,RC,,,facility,both,,,142,100.54,Aetna First Health,Commercial,,120.7,85,,,62.93,120.7,percent of total billed charges,
GONADOTROPIN (LH),83002,CDM,83002,CPT,300,RC,,,facility,both,,,168,118.94,Aetna First Health,Commercial,,142.8,85,,,74.46,142.8,percent of total billed charges,
HAPTOGLOBIN; QUANTITATIVE,83010,CDM,83010,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
GLYCOSYLATED HEMOGLOBIN TEST,83036,CDM,83036,CPT,300,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,,85,85,,,44.32,85,percent of total billed charges,
BLOOD METHEMOGLOBIN ASSAY,83050,CDM,83050,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,,72.25,85,,,37.67,72.25,percent of total billed charges,
HOMOCYSTEINE,83090,CDM,83090,CPT,300,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
"LAB IMMUNOASSAY, NON ANTIBODY",83516,CDM,83516,CPT,300,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
"IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT AB OR AG; QAUANTITATIVE, NOT OTHERWISE",83520,CDM,83520,CPT,300,RC,,,facility,both,,,170,120.36,Aetna First Health,Commercial,,144.5,85,,,75.34,144.5,percent of total billed charges,
ASSAY OF INSULIN TOTAL,83525,CDM,83525,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
ASSAY OF IRON,83540,CDM,83540,CPT,300,RC,,,facility,both,,,110,77.88,Aetna First Health,Commercial,,93.5,85,,,48.75,93.5,percent of total billed charges,
ASSAY OF LACTIC ACID,83605,CDM,83605,CPT,300,RC,,,facility,both,,,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
LACTATE (LD) (LDH) ENZYME,83615,CDM,83615,CPT,300,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,,75.65,85,,,39.44,75.65,percent of total billed charges,
"LACTOFERRIN, FECAL; QUAL",83630,CDM,83630,CPT,300,RC,,,facility,both,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
LEAD,83655,CDM,83655,CPT,300,RC,,,facility,both,,,99,70.09,Aetna First Health,Commercial,,84.15,85,,,43.88,84.15,percent of total billed charges,
ASSAY OF LIPASE,83690,CDM,83690,CPT,300,RC,,,facility,both,,,138,97.7,Aetna First Health,Commercial,,117.3,85,,,61.16,117.3,percent of total billed charges,
ASSAY OF LIPOPROTEIN,83718,CDM,83718,CPT,300,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
ASSAY OF BLOOD LIPOPROTEIN,83721,CDM,83721,CPT,300,RC,,,facility,both,,,96,67.97,Aetna First Health,Commercial,,81.6,85,,,42.55,81.6,percent of total billed charges,
MAGNESIUM,83735,CDM,83735,CPT,300,RC,,,facility,both,,,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
ASSAY OF NATRIURETIC PEPTIDE,83880,CDM,83880,CPT,300,RC,,,facility,both,,,277,196.12,Aetna First Health,Commercial,,235.45,85,,,122.77,235.45,percent of total billed charges,
OSMOLALITY; BLOOD,83930,CDM,83930,CPT,300,RC,,,facility,both,,,118,83.54,Aetna First Health,Commercial,,100.3,85,,,52.3,100.3,percent of total billed charges,
OSMOLALITY; URINE,83935,CDM,83935,CPT,300,RC,,,facility,both,,,118,83.54,Aetna First Health,Commercial,,100.3,85,,,52.3,100.3,percent of total billed charges,
LAB PTH IMMUNOCH PART 1,83970,CDM,83970,CPT,300,RC,,,facility,both,,,141,99.83,Aetna First Health,Commercial,,119.85,85,,,62.49,119.85,percent of total billed charges,
ASSAY PH BODY FLUIDS NOS,83986,CDM,83986,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,,52.7,85,,,27.48,52.7,percent of total billed charges,
ASSAY ALKALINE PHOSPHATASE,84075,CDM,84075,CPT,300,RC,,,facility,both,,,92,65.14,Aetna First Health,Commercial,,78.2,85,,,40.77,78.2,percent of total billed charges,
ASSAY OF PHOSPHORUS,84100,CDM,84100,CPT,300,RC,,,facility,both,,,88,62.3,Aetna First Health,Commercial,,74.8,85,,,39,74.8,percent of total billed charges,
"PHOSPHORUS, URINE",84105,CDM,84105,CPT,300,RC,,,facility,both,,,46,32.57,Aetna First Health,Commercial,,39.1,85,,,20.39,39.1,percent of total billed charges,
PLACENTAL ALPHA MICRO IG C/V,84112,CDM,84112,CPT,300,RC,,,facility,both,,,228,161.42,Aetna First Health,Commercial,,193.8,85,,,101.05,193.8,percent of total billed charges,
"POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD",84132,CDM,84132,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
POTASSIUM; URINE,84133,CDM,84133,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,,72.25,85,,,37.67,72.25,percent of total billed charges,
PREALBUMIN,84134,CDM,84134,CPT,300,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
PROGESTERONE,84144,CDM,84144,CPT,300,RC,,,facility,both,,,145,102.66,Aetna First Health,Commercial,,123.25,85,,,64.26,123.25,percent of total billed charges,
PROCALCITONIN,84145,CDM,84145,CPT,300,RC,,,facility,both,,,130,92.04,Aetna First Health,Commercial,,110.5,85,,,57.62,110.5,percent of total billed charges,
PROLACTIN,84146,CDM,84146,CPT,300,RC,,,facility,both,,,153,108.32,Aetna First Health,Commercial,,130.05,85,,,67.81,130.05,percent of total billed charges,
ASSAY OF PSA TOTAL,84153,CDM,84153,CPT,300,RC,,,facility,both,,,162,114.7,Aetna First Health,Commercial,,137.7,85,,,71.8,137.7,percent of total billed charges,
"PROTEIN, TOTAL; SERUM, PLASMA OR WHOLE BLOOD",84155,CDM,84155,CPT,300,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
"PROTEIN, TOTAL; URINE",84156,CDM,84156,CPT,300,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,,97.75,85,,,50.97,97.75,percent of total billed charges,
"PROTEIN, TOTAL; OTHER SOURCE",84157,CDM,84157,CPT,300,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,,79.05,85,,,41.22,79.05,percent of total billed charges,
PROTEIN E-PHORESIS SERUM,84165,CDM,84165,CPT,300,RC,,,facility,both,,,126,89.21,Aetna First Health,Commercial,,107.1,85,,,55.84,107.1,percent of total billed charges,
PROTEIN ELP,84166,CDM,84166,CPT,300,RC,,,facility,both,,,145,102.66,Aetna First Health,Commercial,,123.25,85,,,64.26,123.25,percent of total billed charges,
"SODIUM; SERUM, PLASMA OR WHOLE BLOOD",84295,CDM,84295,CPT,300,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,,75.65,85,,,39.44,75.65,percent of total billed charges,
SODIUM; URINE,84300,CDM,84300,CPT,300,RC,,,facility,both,,,79,55.93,Aetna First Health,Commercial,,67.15,85,,,35.01,67.15,percent of total billed charges,
"SPECTROPHOTOMETRY, NOS",84311,CDM,84311,CPT,300,RC,,,facility,both,,,143,101.24,Aetna First Health,Commercial,,121.55,85,,,63.38,121.55,percent of total billed charges,
ASSAY OF TOTAL TESTOSTERONE,84403,CDM,84403,CPT,300,RC,,,facility,both,,,127,89.92,Aetna First Health,Commercial,,107.95,85,,,56.29,107.95,percent of total billed charges,
"THYROXIN, FREE (FREE T4)",84439,CDM,84439,CPT,300,RC,,,facility,both,,,109,77.17,Aetna First Health,Commercial,,92.65,85,,,48.31,92.65,percent of total billed charges,
ASSAY THYROID STIM HORMONE,84443,CDM,84443,CPT,300,RC,,,facility,both,,,165,116.82,Aetna First Health,Commercial,,140.25,85,,,73.13,140.25,percent of total billed charges,
TRANSFERASE; ASPARTATE AMINO (AST) (SGOT),84450,CDM,84450,CPT,300,RC,,,facility,both,,,79,55.93,Aetna First Health,Commercial,,67.15,85,,,35.01,67.15,percent of total billed charges,
TRANSFERASE; ALANINE AMINO (ALT) (SGPT),84460,CDM,84460,CPT,300,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,,66.3,85,,,34.57,66.3,percent of total billed charges,
ASSAY OF TRANSFERRIN,84466,CDM,84466,CPT,300,RC,,,facility,both,,,152,107.62,Aetna First Health,Commercial,,129.2,85,,,67.37,129.2,percent of total billed charges,
ASSAY OF TRIGLYCERIDES,84478,CDM,84478,CPT,300,RC,,,facility,both,,,55,38.94,Aetna First Health,Commercial,,46.75,85,,,24.38,46.75,percent of total billed charges,
"TRIIODOTHYRONINE T3, FREE (FREE T3)",84481,CDM,84481,CPT,300,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,,62.05,85,,,32.35,62.05,percent of total billed charges,
"TROPONIN, QUANTITATIVE",84484,CDM,84484,CPT,300,RC,,,facility,both,,,193,136.64,Aetna First Health,Commercial,,164.05,85,,,85.54,164.05,percent of total billed charges,
ASSAY OF UREA NITROGEN,84520,CDM,84520,CPT,300,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,,66.3,85,,,34.57,66.3,percent of total billed charges,
ASSAY URINE UREA-N,84540,CDM,84540,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,,60.35,85,,,31.47,60.35,percent of total billed charges,
URIC ACID; BLOOD,84550,CDM,84550,CPT,300,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
URIC ACID; OTHER SOURCE,84560,CDM,84560,CPT,300,RC,,,facility,both,,,52,36.82,Aetna First Health,Commercial,,44.2,85,,,23.05,44.2,percent of total billed charges,
"GONADOTROPINC, CHORIONIC (HCG), QUANT",84702,CDM,84702,CPT,300,RC,,,facility,both,,,208,147.26,Aetna First Health,Commercial,,176.8,85,,,92.19,176.8,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG), QUALITATIVE",84703,CDM,84703,CPT,300,RC,,,facility,both,,,146,103.37,Aetna First Health,Commercial,,124.1,85,,,64.71,124.1,percent of total billed charges,
LAB WBC AND DIFFERENTIAL,85004,CDM,85004,CPT,300,RC,,,facility,both,,,58,41.06,Aetna First Health,Commercial,,49.3,85,,,25.71,49.3,percent of total billed charges,
BL SMEAR W/DIFF WBC COUNT,85007,CDM,85007,CPT,300,RC,,,facility,both,,,143,101.24,Aetna First Health,Commercial,,121.55,85,,,63.38,121.55,percent of total billed charges,
HEMATOCRIT,85014,CDM,85014,CPT,300,RC,,,facility,both,,,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
HEMOGLOBIN,85018,CDM,85018,CPT,300,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
COMPLETE CBC W/AUTO DIFF WBC,85025,CDM,85025,CPT,300,RC,,,facility,both,,,170,120.36,Aetna First Health,Commercial,,144.5,85,,,75.34,144.5,percent of total billed charges,
COMPLETE CBC AUTOMATED,85027,CDM,85027,CPT,300,RC,,,facility,both,,,157,111.16,Aetna First Health,Commercial,,133.45,85,,,69.58,133.45,percent of total billed charges,
"RETICULOCYTE COUNT,FLOW CYTO",85045,CDM,85045,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS,85046,CDM,85046,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
AUTOMATED LEUKOCYTE COUNT,85048,CDM,85048,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
LAB PLATELET COUNT,85049,CDM,85049,CPT,300,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,,69.7,85,,,36.34,69.7,percent of total billed charges,
RETICULATED PLATELET ASSAY,85055,CDM,85055,CPT,300,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
BLOOD CLOT FACTOR II TEST,85210,CDM,85210,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,90,77.35,85,,,40.33,77.35,percent of total billed charges,
BLOOD CLOT FACTOR V TEST,85220,CDM,85220,CPT,300,RC,,,facility,both,,,197,139.48,Aetna First Health,Commercial,,167.45,85,,,87.31,167.45,percent of total billed charges,
BLOOD CLOT FACTOR IX TEST,85250,CDM,85250,CPT,300,RC,,,facility,both,,,199,140.89,Aetna First Health,Commercial,,169.15,85,,,88.2,169.15,percent of total billed charges,
ANTITHROMBIN III,85300,CDM,85300,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
"COAGULATION TIME, ACTIVATED",85347,CDM,85347,CPT,300,RC,,,facility,both,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
FIBRIN DEGRADATION QUANT,85379,CDM,85379,CPT,300,RC,,,facility,both,,,167,118.24,Aetna First Health,Commercial,,141.95,85,,,74.01,141.95,percent of total billed charges,
FIBRINOGEN,85384,CDM,85384,CPT,300,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
LAB FMH SCREENING,85461,CDM,85461,CPT,300,RC,,,facility,both,,,136,96.29,Aetna First Health,Commercial,,115.6,85,,,60.28,115.6,percent of total billed charges,
HEPARIN XA,85520,CDM,85520,CPT,300,RC,,,facility,both,,,168,118.94,Aetna First Health,Commercial,,142.8,85,,,74.46,142.8,percent of total billed charges,
"PLATELET, AGGREGATION (IN VITRO), EACH AGENT",85576,CDM,85576,CPT,300,RC,,,facility,both,,,163,115.4,Aetna First Health,Commercial,,138.55,85,,,72.24,138.55,percent of total billed charges,
PROTHROMBIN TIME (PT/INR),85610,CDM,85610,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
"RBC SED RATE, AUTO",85652,CDM,85652,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,,50.15,85,,,26.15,50.15,percent of total billed charges,
RBC SICKLE CELL TEST,85660,CDM,85660,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
THROMBIN TIME PLASMA,85670,CDM,85670,CPT,300,RC,,,facility,both,,,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL,85730,CDM,85730,CPT,300,RC,,,facility,both,,,103,72.92,Aetna First Health,Commercial,,87.55,85,,,45.65,87.55,percent of total billed charges,
PLATELET AB,86022,CDM,86022,CPT,300,RC,,,facility,both,,,148,104.78,Aetna First Health,Commercial,,125.8,85,,,65.59,125.8,percent of total billed charges,
ANTINUCLEAR ANTIBODIES,86038,CDM,86038,CPT,300,RC,,,facility,both,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
C-REACTIVE PROTEIN,86140,CDM,86140,CPT,300,RC,,,facility,both,,,118,83.54,Aetna First Health,Commercial,,100.3,85,,,52.3,100.3,percent of total billed charges,
HIGH SENS CRP,86141,CDM,86141,CPT,300,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,,90.1,85,,,46.98,90.1,percent of total billed charges,
"COMPLEMENT; ANTIGEN, EACH COMPONENT",86160,CDM,86160,CPT,300,RC,,,facility,both,,,110,77.88,Aetna First Health,Commercial,,93.5,85,,,48.75,93.5,percent of total billed charges,
IMMUNOASSAY CA 15-3 (27.29),86300,CDM,86300,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
CA 19-9,86301,CDM,86301,CPT,300,RC,,,facility,both,,,151,106.91,Aetna First Health,Commercial,,128.35,85,,,66.92,128.35,percent of total billed charges,
"TUMOR ANTIGEN, CA-125",86304,CDM,86304,CPT,300,RC,,,facility,both,,,151,106.91,Aetna First Health,Commercial,,128.35,85,,,66.92,128.35,percent of total billed charges,
HETEROPHILE ANTIBODIES,86308,CDM,86308,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,,96.05,85,,,50.08,96.05,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS; SERUM,86334,CDM,86334,CPT,300,RC,,,facility,both,,,219,155.05,Aetna First Health,Commercial,,186.15,85,,,97.06,186.15,percent of total billed charges,
IMMUNOFIX ELP,86335,CDM,86335,CPT,300,RC,,,facility,both,,,164,116.11,Aetna First Health,Commercial,,139.4,85,,,72.68,139.4,percent of total billed charges,
"B CELLS, TOTAL COUNT",86355,CDM,86355,CPT,300,RC,,,facility,both,,,147,104.08,Aetna First Health,Commercial,,124.95,85,,,65.15,124.95,percent of total billed charges,
"NATURAL KILLER CELLS, TOTAL COUNT",86357,CDM,86357,CPT,300,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,,126.65,85,,,66.04,126.65,percent of total billed charges,
"T CELLS, TOTAL COUNT",86359,CDM,86359,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,,109.65,85,,,57.17,109.65,percent of total billed charges,
T CELL ABSOLUTE COUNT/RATIO,86360,CDM,86360,CPT,300,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,,88.4,85,,,46.09,88.4,percent of total billed charges,
TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS,86364,CDM,86364,CPT,300,RC,,,facility,both,,,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
MICROSOMAL ANTIBODY,86376,CDM,86376,CPT,300,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
RHEUMATOID FACTOR QUANT,86431,CDM,86431,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP,86481,CDM,86481,CPT,300,RC,,,facility,both,,,108,76.46,Aetna First Health,Commercial,,91.8,85,,,47.87,91.8,percent of total billed charges,
SYPHILIS TEST NON-TREP QUAL,86592,CDM,86592,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
LYME DISEASE ANTIBODY,86617,CDM,86617,CPT,300,RC,,,facility,both,,,38,26.9,Aetna First Health,Commercial,,32.3,85,,,16.84,32.3,percent of total billed charges,
LYME DISEASE ANTIBODY,86618,CDM,86618,CPT,300,RC,,,facility,both,,,170,120.36,Aetna First Health,Commercial,,144.5,85,,,75.34,144.5,percent of total billed charges,
EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN (EBNA),86664,CDM,86664,CPT,300,RC,,,facility,both,,,24,16.99,Aetna First Health,Commercial,,20.4,85,,,10.64,20.4,percent of total billed charges,
EPSTEEN-BARR ANTIBODY VIRAL CAPSID(VAC),86665,CDM,86665,CPT,300,RC,,,facility,both,,,27,19.12,Aetna First Health,Commercial,,22.95,85,,,11.97,22.95,percent of total billed charges,
EHRLICHIA ANTIBODY,86666,CDM,86666,CPT,300,RC,,,facility,both,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
LAB HSV IGM TITER PT 1,86695,CDM,86695,CPT,300,RC,,,facility,both,,,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
HERPES SIMPLEX TYPE 2,86696,CDM,86696,CPT,300,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
"HEPATITIS B CORE ANTIBODY, TOTAL",86704,CDM,86704,CPT,300,RC,,,facility,both,,,136,96.29,Aetna First Health,Commercial,,115.6,85,,,60.28,115.6,percent of total billed charges,
HEPATITIS B CORE IGM ANTIBODY,86705,CDM,86705,CPT,300,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
HEPATITIS B SURFACE ANTIBODY,86706,CDM,86706,CPT,300,RC,,,facility,both,,,167,118.24,Aetna First Health,Commercial,,141.95,85,,,74.01,141.95,percent of total billed charges,
HEPATITIS A IGM ANTIBODY,86709,CDM,86709,CPT,300,RC,,,facility,both,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
MUMPS,86735,CDM,86735,CPT,300,RC,,,facility,both,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
RUBELLA ANTIBODY,86762,CDM,86762,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,,109.65,85,,,57.17,109.65,percent of total billed charges,
RUBEOLA ANTIBODY,86765,CDM,86765,CPT,300,RC,,,facility,both,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
SARS-COV-2 COVID-19 ANTIBODY,86769,CDM,86769,CPT,300,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
TREPONEMA PALLIDUM,86780,CDM,86780,CPT,300,RC,,,facility,both,,,97,68.68,Aetna First Health,Commercial,,82.45,85,,,42.99,82.45,percent of total billed charges,
VARICELLA-ZOSTER ANTIBODY,86787,CDM,86787,CPT,300,RC,,,facility,both,,,109,77.17,Aetna First Health,Commercial,,92.65,85,,,48.31,92.65,percent of total billed charges,
HEPATITIS C ANTIBODY,86803,CDM,86803,CPT,300,RC,,,facility,both,,,153,108.32,Aetna First Health,Commercial,,130.05,85,,,67.81,130.05,percent of total billed charges,
RBC ANTIBODY SCREEN,86850,CDM,86850,CPT,300,RC,,,facility,both,,,132,93.46,Aetna First Health,Commercial,,112.2,85,,,58.5,112.2,percent of total billed charges,
RBC ANTIBODY ELUTION,86860,CDM,86860,CPT,300,RC,,,facility,both,,,208,147.26,Aetna First Health,Commercial,,176.8,85,,,92.19,176.8,percent of total billed charges,
LAB DIRECT COOMBS,86880,CDM,86880,CPT,300,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,,85,85,,,44.32,85,percent of total billed charges,
AUTOLOGOUS BLOOD PROCESS,86890,CDM,86890,CPT,300,RC,,,facility,both,,,403,285.32,Aetna First Health,Commercial,,342.55,85,,,178.61,342.55,percent of total billed charges,
BLOOD TYPING ABO,86900,CDM,86900,CPT,300,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
BLOOD TYPING RH (D),86901,CDM,86901,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
BLOOD TYPE ANTIGEN DONOR EA,86902,CDM,86902,CPT,300,RC,,,facility,both,,,248,175.58,Aetna First Health,Commercial,,210.8,85,,,109.91,210.8,percent of total billed charges,
LAB ANTIGEN TYPING,86905,CDM,86905,CPT,300,RC,,,facility,both,,,248,175.58,Aetna First Health,Commercial,,210.8,85,,,109.91,210.8,percent of total billed charges,
"BLOOD TYPING, RH PHENOTYPE",86906,CDM,86906,CPT,300,RC,,,facility,both,,,109,77.17,Aetna First Health,Commercial,,92.65,85,,,48.31,92.65,percent of total billed charges,
"COMPATIBILITY TEST,ANTIGLOB TECH",86922,CDM,86922,CPT,300,RC,,,facility,both,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
"COMPATABILITY TEST, ELECTRONIC, EACH UNIT",86923,CDM,86923,CPT,300,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,,126.65,85,,,66.04,126.65,percent of total billed charges,
"FFP THAWING FEE, EACH UNIT",86927,CDM,86927,CPT,390,RC,,,facility,both,,,46,32.57,Aetna First Health,Commercial,,39.1,85,,,20.39,39.1,percent of total billed charges,
"SPLITTING FEE, EACH UNIT",86985,CDM,86985,CPT,300,RC,,,facility,both,,,53,37.52,Aetna First Health,Commercial,,45.05,85,,,23.49,45.05,percent of total billed charges,
BLOOD CULTURE FOR BACTERIA,87040,CDM,87040,CPT,300,RC,,,facility,both,,,260,184.08,Aetna First Health,Commercial,,221,85,,,115.23,221,percent of total billed charges,
LAB CULTURE BACTERIA,87070,CDM,87070,CPT,300,RC,,,facility,both,,,171,121.07,Aetna First Health,Commercial,,145.35,85,,,75.79,145.35,percent of total billed charges,
"CULTURE SPEC, BACTERIA,QUANT,AEROBIC",87071,CDM,87071,CPT,300,RC,,,facility,both,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
WOUND CULTURE ANAEROBIC,87075,CDM,87075,CPT,300,RC,,,facility,both,,,185,130.98,Aetna First Health,Commercial,,157.25,85,,,81.99,157.25,percent of total billed charges,
LAB ORG ID ANAEROBIC-EACH,87076,CDM,87076,CPT,300,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,,88.4,85,,,46.09,88.4,percent of total billed charges,
ORG ID AEROBIC-EACH,87077,CDM,87077,CPT,300,RC,,,facility,both,,,101,71.51,Aetna First Health,Commercial,,85.85,85,,,44.76,85.85,percent of total billed charges,
CULTURE SCREEN ONLY,87081,CDM,87081,CPT,300,RC,,,facility,both,,,166,117.53,Aetna First Health,Commercial,,141.1,85,,,73.57,141.1,percent of total billed charges,
URINE CULTURE/COLONY COUNT,87086,CDM,87086,CPT,300,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
FUNGUS CULTURE,87101,CDM,87101,CPT,300,RC,,,facility,both,,,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
FUNGUS ISOLATION CULTURE,87102,CDM,87102,CPT,300,RC,,,facility,both,,,137,97,Aetna First Health,Commercial,,116.45,85,,,60.72,116.45,percent of total billed charges,
"FUNGUS IDENTIFICATION, MOLD",87107,CDM,87107,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,,45.9,85,,,23.93,45.9,percent of total billed charges,
CULTURE TYPE IMMUNOLOGIC,87147,CDM,87147,CPT,300,RC,,,facility,both,,,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
"MACROSCOPIC EXAM, ARTHROPOD",87168,CDM,87168,CPT,300,RC,,,facility,both,,,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
"MACROSCOPIC EXAM, PARASITE",87169,CDM,87169,CPT,300,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,,62.05,85,,,32.35,62.05,percent of total billed charges,
PINWORM EXAM,87172,CDM,87172,CPT,300,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,,56.95,85,,,29.69,56.95,percent of total billed charges,
"ANTIBIOTIC SENS,ENZYME DETECTION,EACH",87185,CDM,87185,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,,50.15,85,,,26.15,50.15,percent of total billed charges,
MICROBE SUSCEPTIBLE MIC,87186,CDM,87186,CPT,300,RC,,,facility,both,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
SMEAR GRAM STAIN,87205,CDM,87205,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
SMEAR FLUORESCENT/ACID STAI,87206,CDM,87206,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
SMEAR SPECIAL STAIN,87207,CDM,87207,CPT,300,RC,,,facility,both,,,141,99.83,Aetna First Health,Commercial,,119.85,85,,,62.49,119.85,percent of total billed charges,
SMEAR WET MOUNT SALINE/INK,87210,CDM,87210,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
TISSUE EXAM FOR FUNGI,87220,CDM,87220,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
"CLOSTRIDIUM AG, EIA",87324,CDM,87324,CPT,300,RC,,,facility,both,,,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
CRYPTOCOCCUS NEOFORMANS,87327,CDM,87327,CPT,300,RC,,,facility,both,,,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
LAB H PYLORI STOOL AG,87338,CDM,87338,CPT,300,RC,,,facility,both,,,177,125.32,Aetna First Health,Commercial,,150.45,85,,,78.45,150.45,percent of total billed charges,
HEPATITIS B SURFACE ANTIGEN,87340,CDM,87340,CPT,300,RC,,,facility,both,,,154,109.03,Aetna First Health,Commercial,,130.9,85,,,68.25,130.9,percent of total billed charges,
HIV-1 ANTIGENS W/HIV 1/2 ANTIB,87389,CDM,87389,CPT,300,RC,,,facility,both,,,94,66.55,Aetna First Health,Commercial,,79.9,85,,,41.66,79.9,percent of total billed charges,
AG DETECT NOS EIA MULT,87449,CDM,87449,CPT,300,RC,,,facility,both,,,176,124.61,Aetna First Health,Commercial,,149.6,85,,,78,149.6,percent of total billed charges,
CANDIDA DNA DIR PROBE,87480,CDM,87480,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ,87481,CDM,87481,CPT,300,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25,87483,CDM,87483,CPT,300,RC,,,facility,both,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS DNA, AMP PROBE",87491,CDM,87491,CPT,300,RC,,,facility,both,,,167,118.24,Aetna First Health,Commercial,,141.95,85,,,74.01,141.95,percent of total billed charges,
C DIFF AMPLIFIED PROBE,87493,CDM,87493,CPT,300,RC,,,facility,both,,,222,157.18,Aetna First Health,Commercial,,188.7,85,,,98.39,188.7,percent of total billed charges,
FLU DNA AMP PROBE 1ST 2 TYPES,87502,CDM,87502,CPT,300,RC,,,facility,both,,,384,271.87,Aetna First Health,Commercial,,326.4,85,,,170.19,326.4,percent of total billed charges,
INFECTION AGENT DETECT DNA/RNA PROBE TQ 12-25,87507,CDM,87507,CPT,300,RC,,,facility,both,,,987,698.8,Aetna First Health,Commercial,,838.95,85,,,437.44,838.95,percent of total billed charges,
GARDNER VAG DNA DIR PROBE,87510,CDM,87510,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
"HEPATITIS B VIRUS DNA DET & QUANT, PCR",87517,CDM,87517,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,,52.7,85,,,27.48,52.7,percent of total billed charges,
HEPATITIS C RNA QUANT,87522,CDM,87522,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
HSV DNA AMP PROBE,87529,CDM,87529,CPT,300,RC,,,facility,both,,,233,164.96,Aetna First Health,Commercial,,198.05,85,,,103.27,198.05,percent of total billed charges,
HIV-1 DNA QUANT,87536,CDM,87536,CPT,300,RC,,,facility,both,,,102,72.22,Aetna First Health,Commercial,,86.7,85,,,45.21,86.7,percent of total billed charges,
"NEISSERIA GONORRHOEAE DNA, AMP PROBE",87591,CDM,87591,CPT,300,RC,,,facility,both,,,165,116.82,Aetna First Health,Commercial,,140.25,85,,,73.13,140.25,percent of total billed charges,
HPV HIGH-RISK TYPES,87624,CDM,87624,CPT,300,RC,,,facility,both,,,197,139.48,Aetna First Health,Commercial,,167.45,85,,,87.31,167.45,percent of total billed charges,
RESP VIRUS 3-5 TARGETS,87631,CDM,87631,CPT,300,RC,,,facility,both,,,321,227.27,Aetna First Health,Commercial,,272.85,85,,,142.27,272.85,percent of total billed charges,
RESP VIRUS 6-11 TARGETS,87632,CDM,87632,CPT,300,RC,,,facility,both,,,388,274.7,Aetna First Health,Commercial,,329.8,85,,,171.96,329.8,percent of total billed charges,
"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA);RESPIRATORY SYNCYTIAL VIRUS,AMPLIFIED PROBE",87634,CDM,87634,CPT,300,RC,,,facility,both,,,141,99.83,Aetna First Health,Commercial,,119.85,85,,,62.49,119.85,percent of total billed charges,
IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ,87635,CDM,87635,CPT,300,RC,,,facility,both,,,181,128.15,Aetna First Health,Commercial,,153.85,85,,,80.22,153.85,percent of total billed charges,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA)B,87636,CDM,87636,CPT,300,RC,,,facility,both,,,215,152.22,Aetna First Health,Commercial,,182.75,85,,,95.29,182.75,percent of total billed charges,
MRSA BY AMPLIF NA,87641,CDM,87641,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,87651,CDM,87651,CPT,300,RC,,,facility,both,,,102,72.22,Aetna First Health,Commercial,,86.7,85,,,45.21,86.7,percent of total billed charges,
STREPTOCOCCUS GROUP B,87653,CDM,87653,CPT,300,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
TRICHOMONAS VAGIN DIR PROBE,87660,CDM,87660,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH,87661,CDM,87661,CPT,300,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
DETECT AGENT NOS DNA AMP,87798,CDM,87798,CPT,300,RC,,,facility,both,,,254,179.83,Aetna First Health,Commercial,,215.9,85,,,112.57,215.9,percent of total billed charges,
"DETECT AGENT, MULT ORGS, DNA, DIR",87800,CDM,87800,CPT,300,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,,97.75,85,,,50.97,97.75,percent of total billed charges,
AMPLIFIED PROBE(S) TECHNIQUE,87801,CDM,87801,CPT,300,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
INFLUENZA ASSAY W/OPTIC,87804,CDM,87804,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,,50.15,85,,,26.15,50.15,percent of total billed charges,
STREP A ASSAY W/OPTIC,87880,CDM,87880,CPT,300,RC,,,facility,both,,,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
PAP DIAGNOSTIC THIN LAYER PREP,88142,CDM,88142,CPT,310,RC,,,facility,both,,,147,104.08,Aetna First Health,Commercial,,124.95,85,,,65.15,124.95,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, NUCLEAR MARKER, TECH. COMP.; 1ST",88184,CDM,88184,CPT,310,RC,,,facility,both,,,286,202.49,Aetna First Health,Commercial,,243.1,85,,,126.76,243.1,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, NUCLEAR MARKER, TECH. COMP.; ADD'L",88185,CDM,88185,CPT,310,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,,187.85,85,,,97.95,187.85,percent of total billed charges,
BILIRUBIN TOTAL TRANSCUT,88720,CDM,88720,CPT,300,RC,,,facility,both,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
BODY FLUID CELL COUNT,89050,CDM,89050,CPT,300,RC,,,facility,both,,,101,71.51,Aetna First Health,Commercial,,85.85,85,,,44.76,85.85,percent of total billed charges,
BODY FLUID CELL COUNT W DIFF,89051,CDM,89051,CPT,300,RC,,,facility,both,,,134,94.87,Aetna First Health,Commercial,,113.9,85,,,59.39,113.9,percent of total billed charges,
"EXAM,SYNOVIAL FLUID CRYSTALS",89060,CDM,89060,CPT,300,RC,,,facility,both,,,92,65.14,Aetna First Health,Commercial,,78.2,85,,,40.77,78.2,percent of total billed charges,
"SPERM ISOLATION, SIMPLE",89260,CDM,89260,CPT,300,RC,,,facility,both,,,152,107.62,Aetna First Health,Commercial,,129.2,85,,,67.37,129.2,percent of total billed charges,
SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT,89320,CDM,89320,CPT,300,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,,96.9,85,,,50.52,96.9,percent of total billed charges,
LAB SEMEN POV NONDC VAS.,89321,CDM,89321,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,,72.25,85,,,37.67,72.25,percent of total billed charges,
hepatitis B immune globulin 110 UNIT/0.5ML solution prefilled syringe 0.5 mL Syringe,90371,CDM,90371,CPT,636,RC,13533063603,NDC,facility,both,1,ML,199.01,140.9,Aetna First Health,Commercial,,169.16,85,,,88.2,169.16,percent of total billed charges,
hepatitis B immune globulin 312 UNIT/ML Solution 1 mL Vial,90371,CDM,90371,CPT,636,RC,59730420201,NDC,facility,both,1,ML,364.55,258.1,Aetna First Health,Commercial,,309.87,85,,,161.57,309.87,percent of total billed charges,
hepatitis B immune globulin 220 UNIT/ML Solution 1 mL Vial,90371,CDM,90371,CPT,636,RC,13533063601,NDC,facility,both,1,ML,375.28,265.7,Aetna First Health,Commercial,,318.99,85,,,166.32,318.99,percent of total billed charges,
hepatitis B immune globulin 220 UNIT/ML Solution 1 mL Vial,90371,CDM,90371,CPT,636,RC,13533063610,NDC,facility,both,1,ML,375.28,265.7,Aetna First Health,Commercial,,318.99,85,,,166.32,318.99,percent of total billed charges,
hepatitis B immune globulin 220 UNIT/ML solution prefilled syringe 1 mL Syringe,90371,CDM,90371,CPT,636,RC,13533063602,NDC,facility,both,1,ML,375.28,265.7,Aetna First Health,Commercial,,318.99,85,,,166.32,318.99,percent of total billed charges,
IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TO*,90471,CDM,90471,CPT,771,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
hepatitis A vaccine 50 UNIT/ML Suspension 1 mL Vial,90632,CDM,90632,CPT,636,RC,00006484100,NDC,facility,both,1,ML,152.42,107.91,Aetna First Health,Commercial,,129.56,85,,,67.55,129.56,percent of total billed charges,
hepatitis A vaccine 1440 EL U/ML Suspension 1 mL Vial,90632,CDM,90632,CPT,636,RC,58160082611,NDC,facility,both,1,ML,152.94,108.28,Aetna First Health,Commercial,,130,85,,,67.78,130,percent of total billed charges,
hepatitis A vaccine 1440 EL U/ML Suspension 1 mL Vial,90632,CDM,90632,CPT,636,RC,58160082601,NDC,facility,both,1,ML,165.94,117.49,Aetna First Health,Commercial,,141.05,85,,,73.54,141.05,percent of total billed charges,
hepatitis A vaccine 50 UNIT/ML Suspension 1 mL Vial,90632,CDM,90632,CPT,636,RC,00006484141,NDC,facility,both,1,ML,189.53,134.19,Aetna First Health,Commercial,,161.1,85,,,84,161.1,percent of total billed charges,
hepatitis A vaccine 50 UNIT/ML Suspension 1 mL Syringe,90632,CDM,90632,CPT,636,RC,00006409602,NDC,facility,both,1,ML,189.53,134.19,Aetna First Health,Commercial,,161.1,85,,,84,161.1,percent of total billed charges,
hepatitis A vaccine 50 UNIT/ML Suspension 1 mL Syringe,90632,CDM,90632,CPT,636,RC,00006409601,NDC,facility,both,1,ML,189.53,134.19,Aetna First Health,Commercial,,161.1,85,,,84,161.1,percent of total billed charges,
hepatitis A vaccine 50 UNIT/ML Suspension 1 mL Vial,90632,CDM,90632,CPT,636,RC,00006484101,NDC,facility,both,1,ML,189.53,134.19,Aetna First Health,Commercial,,161.1,85,,,84,161.1,percent of total billed charges,
hepatitis A vaccine 1440 EL U/ML Suspension 1 mL Syringe,90632,CDM,90632,CPT,636,RC,58160082652,NDC,facility,both,1,ML,198.88,140.81,Aetna First Health,Commercial,,169.05,85,,,88.14,169.05,percent of total billed charges,
hepatitis A vaccine 1440 EL U/ML Suspension 1 mL Syringe,90632,CDM,90632,CPT,636,RC,58160082643,NDC,facility,both,1,ML,198.88,140.81,Aetna First Health,Commercial,,169.05,85,,,88.14,169.05,percent of total billed charges,
hepatitis A vaccine 720 EL U/0.5ML Suspension 0.5 mL Vial,90633,CDM,90633,CPT,636,RC,58160082501,NDC,facility,both,1,ML,68.98,48.84,Aetna First Health,Commercial,,58.63,85,,,30.57,58.63,percent of total billed charges,
hepatitis A vaccine 720 EL U/0.5ML Suspension 0.5 mL Vial,90633,CDM,90633,CPT,636,RC,58160082511,NDC,facility,both,1,ML,76.68,54.29,Aetna First Health,Commercial,,65.18,85,,,33.98,65.18,percent of total billed charges,
hepatitis A vaccine 720 EL U/0.5ML Suspension 0.5 mL Syringe,90633,CDM,90633,CPT,636,RC,58160082552,NDC,facility,both,1,ML,91.22,64.58,Aetna First Health,Commercial,,77.54,85,,,40.43,77.54,percent of total billed charges,
hepatitis A vaccine 720 EL U/0.5ML Suspension 0.5 mL Syringe,90633,CDM,90633,CPT,636,RC,58160082543,NDC,facility,both,1,ML,91.22,64.58,Aetna First Health,Commercial,,77.54,85,,,40.43,77.54,percent of total billed charges,
hepatitis a-hepatitis b recomb vaccine 720-20 ELU-MCG/ML suspension prefilled syringe 1 mL Syringe,90636,CDM,90636,CPT,636,RC,58160081552,NDC,facility,both,1,ML,302.87,214.43,Aetna First Health,Commercial,,257.44,85,,,134.23,257.44,percent of total billed charges,
hepatitis a-hepatitis b recomb vaccine 720-20 ELU-MCG/ML suspension prefilled syringe 1 mL Syringe,90636,CDM,90636,CPT,636,RC,58160081543,NDC,facility,both,1,ML,302.87,214.43,Aetna First Health,Commercial,,257.44,85,,,134.23,257.44,percent of total billed charges,
haemophilus B polysac conj vac Recon Soln 1 Each Vial,90647,CDM,90647,CPT,636,RC,49281054503,NDC,facility,both,1,EA,31.01,21.96,Aetna First Health,Commercial,,26.36,85,,,13.74,26.36,percent of total billed charges,
haemophilus B polysac conj vac Recon Soln 1 Each Vial,90647,CDM,90647,CPT,636,RC,49281054505,NDC,facility,both,1,EA,65.97,46.71,Aetna First Health,Commercial,,56.07,85,,,29.24,56.07,percent of total billed charges,
haemophilus B polysac conj vac 7.5 MCG/0.5 ML Suspension 0.5 mL Vial,90648,CDM,90647,CPT,636,RC,00006489700,NDC,facility,both,1,ML,71.3,50.48,Aetna First Health,Commercial,,60.6,85,,,31.6,60.6,percent of total billed charges,
haemophilus B polysac conj vac 7.5 MCG/0.5 ML Suspension 0.5 mL Vial,90648,CDM,90648,CPT,636,RC,00006489701,NDC,facility,both,1,ML,71.3,50.48,Aetna First Health,Commercial,,60.6,85,,,31.6,60.6,percent of total billed charges,
quadrivalent HPV vaccine Suspension 0.5 mL Vial,90649,CDM,90649,CPT,636,RC,00006404541,NDC,facility,both,1,ML,352.81,249.79,Aetna First Health,Commercial,,299.89,85,,,156.37,299.89,percent of total billed charges,
quadrivalent HPV vaccine Suspension 0.5 mL Vial,90649,CDM,90649,CPT,636,RC,00006404501,NDC,facility,both,1,ML,352.82,249.8,Aetna First Health,Commercial,,299.9,85,,,156.37,299.9,percent of total billed charges,
HPV 9-Valent Recomb Vaccine suspension prefilled syringe 0.5 mL Syringe,90651,CDM,90651,CPT,636,RC,00006412102,NDC,facility,both,1,ML,690.08,488.58,Aetna First Health,Commercial,,586.57,85,,,305.84,586.57,percent of total billed charges,
HPV 9-Valent Recomb Vaccine Suspension 0.5 mL Vial,90651,CDM,90651,CPT,636,RC,00006411903,NDC,facility,both,1,ML,690.08,488.58,Aetna First Health,Commercial,,586.57,85,,,305.84,586.57,percent of total billed charges,
HPV 9-Valent Recomb Vaccine suspension prefilled syringe 0.5 mL Syringe,90651,CDM,90651,CPT,636,RC,00006412101,NDC,facility,both,1,ML,690.08,488.58,Aetna First Health,Commercial,,586.57,85,,,305.84,586.57,percent of total billed charges,
HPV 9-Valent Recomb Vaccine Suspension 0.5 mL Vial,90651,CDM,90651,CPT,636,RC,00006411901,NDC,facility,both,1,ML,690.08,488.58,Aetna First Health,Commercial,,586.57,85,,,305.84,586.57,percent of total billed charges,
pneumococcal 13-Val conj vacc Suspension 0.5 mL Syringe,90670,CDM,90670,CPT,636,RC,00005197101,NDC,facility,both,1,ML,543.43,384.75,Aetna First Health,Commercial,,461.92,85,,,240.85,461.92,percent of total billed charges,
influenza virus vaccine quad 0.5 ML suspension prefilled syringe 0.5 mL Syringe,90674,CDM,90674,CPT,636,RC,70461032303,NDC,facility,both,1,ML,72.24,51.15,Aetna First Health,Commercial,,61.4,85,,,32.02,61.4,percent of total billed charges,
influenza virus vaccine quad 0.5 ML suspension prefilled syringe 0.5 mL Syringe,90674,CDM,90674,CPT,636,RC,70461032304,NDC,facility,both,1,ML,72.24,51.15,Aetna First Health,Commercial,,61.4,85,,,32.02,61.4,percent of total billed charges,
pneumococcal 20-val conj vacc 0.5 ML suspension prefilled syringe 0.5 mL Syringe,90677,CDM,90677,CPT,636,RC,00005200001,NDC,facility,both,1,ML,616.32,436.35,Aetna First Health,Commercial,,523.87,85,,,273.15,523.87,percent of total billed charges,
pneumococcal 20-val conj vacc 0.5 ML suspension prefilled syringe 0.5 mL Syringe,90677,CDM,90677,CPT,636,RC,00005200010,NDC,facility,both,1,ML,627.74,444.44,Aetna First Health,Commercial,,533.58,85,,,278.21,533.58,percent of total billed charges,
pneumococcal 20-val conj vacc 0.5 ML suspension prefilled syringe 0.5 mL Syringe,90677,CDM,90677,CPT,636,RC,00005200002,NDC,facility,both,1,ML,647.42,458.37,Aetna First Health,Commercial,,550.31,85,,,286.94,550.31,percent of total billed charges,
influenza virus vaccine quad 0.5 ML suspension prefilled syringe 0.5 mL Syringe,90686,CDM,90686,CPT,636,RC,19515081441,NDC,facility,both,1,ML,47.35,33.52,Aetna First Health,Commercial,,40.25,85,,,20.99,40.25,percent of total billed charges,
influenza virus vaccine quad 0.5 ML suspension prefilled syringe 0.5 mL Syringe,90686,CDM,90686,CPT,636,RC,19515081452,NDC,facility,both,1,ML,47.35,33.52,Aetna First Health,Commercial,,40.25,85,,,20.99,40.25,percent of total billed charges,
typhoid VI polysaccharide vacc 25 MCG/0.5ML solution prefilled syringe 0.5 mL Syringe,90691,CDM,90691,CPT,636,RC,49281079051,NDC,facility,both,1,ML,319.06,225.89,Aetna First Health,Commercial,,271.2,85,,,141.41,271.2,percent of total billed charges,
influenza vaccine adj quad (65+ yrs) 0.5 ML Prefilled Syringe 0.5 mL Syringe,90694,CDM,90694,CPT,636,RC,70461012303,NDC,facility,both,1,ML,163.16,115.52,Aetna First Health,Commercial,,138.69,85,,,72.31,138.69,percent of total billed charges,
influenza vaccine adj quad (65+ yrs) 0.5 ML Prefilled Syringe 0.5 mL Syringe,90694,CDM,90694,CPT,636,RC,70461012304,NDC,facility,both,1,ML,163.16,115.52,Aetna First Health,Commercial,,138.69,85,,,72.31,138.69,percent of total billed charges,
tetanus-diphtheria toxoids 5-2 LFU Injectable 0.5 mL Syringe,90714,CDM,90714,CPT,636,RC,49281029110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tetanus-diphtheria toxoids 5-2 LFU Injectable 0.5 mL Vial,90714,CDM,90714,CPT,636,RC,49281029183,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tetanus-diphtheria toxoid td 2-2 LF/0.5ML Suspension 0.5 mL Vial,90714,CDM,90714,CPT,636,RC,17478013101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tetanus-diphtheria toxoid td 2-2 LF/0.5ML Suspension 0.5 mL Vial,90714,CDM,90714,CPT,636,RC,13533013101,NDC,facility,both,1,ML,67.16,47.55,Aetna First Health,Commercial,,57.09,85,,,29.77,57.09,percent of total billed charges,
tetanus-diphtheria toxoid td 2-2 LF/0.5ML Suspension 0.5 mL Vial,90714,CDM,90714,CPT,636,RC,13533013100,NDC,facility,both,1,ML,67.18,47.56,Aetna First Health,Commercial,,57.1,85,,,29.77,57.1,percent of total billed charges,
tetanus-diphtheria toxoids 5-2 LFU Injectable 0.5 mL Vial,90714,CDM,90714,CPT,636,RC,49281021510,NDC,facility,both,1,ML,83.48,59.1,Aetna First Health,Commercial,,70.96,85,,,37,70.96,percent of total billed charges,
tetanus-diphtheria toxoids 5-2 LFU Injectable 0.5 mL Syringe,90714,CDM,90714,CPT,636,RC,49281021515,NDC,facility,both,1,ML,89.04,63.04,Aetna First Health,Commercial,,75.68,85,,,39.46,75.68,percent of total billed charges,
tetanus-diphtheria toxoids 5-2 LFU Injectable 0.5 mL Vial,90714,CDM,90714,CPT,636,RC,49281021558,NDC,facility,both,1,ML,89.04,63.04,Aetna First Health,Commercial,,75.68,85,,,39.46,75.68,percent of total billed charges,
tetanus-diphtheria toxoids 5-2 LFU Injectable 0.5 mL Syringe,90714,CDM,90714,CPT,636,RC,49281021588,NDC,facility,both,1,ML,89.04,63.04,Aetna First Health,Commercial,,75.68,85,,,39.46,75.68,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2-15.5 LF-MCG/0.5 Suspension 0.5 mL Syringe,90715,CDM,90715,CPT,636,RC,49281040015,NDC,facility,both,1,ML,66.58,47.14,Aetna First Health,Commercial,,56.59,85,,,29.51,56.59,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2-15.5 LF-MCG/0.5 Suspension 0.5 mL Syringe,90715,CDM,90715,CPT,636,RC,49281040088,NDC,facility,both,1,ML,102.27,72.41,Aetna First Health,Commercial,,86.93,85,,,45.33,86.93,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 Suspension 0.5 mL Vial,90715,CDM,90715,CPT,636,RC,58160084201,NDC,facility,both,1,ML,106.63,75.49,Aetna First Health,Commercial,,90.64,85,,,47.26,90.64,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 suspension prefilled syringe 0.5 mL Syringe,90715,CDM,90715,CPT,636,RC,58160084252,NDC,facility,both,1,ML,113.74,80.53,Aetna First Health,Commercial,,96.68,85,,,50.41,96.68,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 suspension prefilled syringe 0.5 mL Syringe,90715,CDM,90715,CPT,636,RC,58160084243,NDC,facility,both,1,ML,113.74,80.53,Aetna First Health,Commercial,,96.68,85,,,50.41,96.68,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 Suspension 0.5 mL Vial,90715,CDM,90715,CPT,636,RC,58160084211,NDC,facility,both,1,ML,113.74,80.53,Aetna First Health,Commercial,,96.68,85,,,50.41,96.68,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2-15.5 LF-MCG/0.5 Suspension 0.5 mL Vial,90715,CDM,90715,CPT,636,RC,49281040010,NDC,facility,both,1,ML,114.79,81.27,Aetna First Health,Commercial,,97.57,85,,,50.87,97.57,percent of total billed charges,
tetanus-diphth-acell pertussis 5-2-15.5 LF-MCG/0.5 Suspension 0.5 mL Syringe,90715,CDM,90715,CPT,636,RC,49281040020,NDC,facility,both,1,ML,114.8,81.28,Aetna First Health,Commercial,,97.58,85,,,50.88,97.58,percent of total billed charges,
varicella virus vaccine (live) 1350 PFU/0.5ML Injectable 1 Each Vial,90716,CDM,90716,CPT,636,RC,00006482700,NDC,facility,both,1,EA,418.38,296.21,Aetna First Health,Commercial,,355.62,85,,,185.43,355.62,percent of total billed charges,
varicella virus vaccine (live) 1350 PFU/0.5ML Injectable 1 Each Vial,90716,CDM,90716,CPT,636,RC,00006482701,NDC,facility,both,1,EA,418.38,296.21,Aetna First Health,Commercial,,355.62,85,,,185.43,355.62,percent of total billed charges,
DTAP-hepatitis B recomb-IPV suspension prefilled syringe 0.5 mL Syringe,90723,CDM,90723,CPT,636,RC,58160081143,NDC,facility,both,1,ML,220.43,156.06,Aetna First Health,Commercial,,187.37,85,,,97.69,187.37,percent of total billed charges,
DTAP-hepatitis B recomb-IPV suspension prefilled syringe 0.5 mL Syringe,90723,CDM,90723,CPT,636,RC,58160081152,NDC,facility,both,1,ML,235.12,166.46,Aetna First Health,Commercial,,199.85,85,,,104.21,199.85,percent of total billed charges,
pneumococcal vaccine 25 MCG/0.5ML Injectable 0.5 mL Vial,90732,CDM,90732,CPT,636,RC,00006494300,NDC,facility,both,1,ML,280.99,198.94,Aetna First Health,Commercial,,238.84,85,,,124.53,238.84,percent of total billed charges,
pneumococcal vaccine 25 MCG/0.5ML Injectable 0.5 mL Vial,90732,CDM,90732,CPT,636,RC,00006494301,NDC,facility,both,1,ML,280.99,198.94,Aetna First Health,Commercial,,238.84,85,,,124.53,238.84,percent of total billed charges,
pneumococcal vaccine 25 MCG/0.5ML Injectable 0.5 mL Syringe,90732,CDM,90732,CPT,636,RC,00006483703,NDC,facility,both,1,ML,280.99,198.94,Aetna First Health,Commercial,,238.84,85,,,124.53,238.84,percent of total billed charges,
pneumococcal vaccine 25 MCG/0.5ML Injectable 0.5 mL Syringe,90732,CDM,90732,CPT,636,RC,00006483701,NDC,facility,both,1,ML,280.99,198.94,Aetna First Health,Commercial,,238.84,85,,,124.53,238.84,percent of total billed charges,
meningococcal B (Recomb) suspension prefilled syringe 0.5 mL Syringe,90733,CDM,90733,CPT,636,RC,58160097606,NDC,facility,both,1,ML,384.19,272.01,Aetna First Health,Commercial,,326.56,85,,,170.27,326.56,percent of total billed charges,
meningococcal B (Recomb) suspension prefilled syringe 0.5 mL Syringe,90733,CDM,90733,CPT,636,RC,46028011402,NDC,facility,both,1,ML,385.8,273.15,Aetna First Health,Commercial,,327.93,85,,,170.99,327.93,percent of total billed charges,
meningococcal B (Recomb) suspension prefilled syringe 0.5 mL Syringe,90733,CDM,90733,CPT,636,RC,46028011411,NDC,facility,both,1,ML,385.8,273.15,Aetna First Health,Commercial,,327.93,85,,,170.99,327.93,percent of total billed charges,
meningococcal B (Recomb) suspension prefilled syringe 0.5 mL Syringe,90733,CDM,90733,CPT,636,RC,58160097620,NDC,facility,both,1,ML,536.99,380.19,Aetna First Health,Commercial,,456.44,85,,,237.99,456.44,percent of total billed charges,
meningococcal B (Recomb) suspension prefilled syringe 0.5 mL Syringe,90733,CDM,90733,CPT,636,RC,58160097602,NDC,facility,both,1,ML,536.99,380.19,Aetna First Health,Commercial,,456.44,85,,,237.99,456.44,percent of total billed charges,
hepatitis b recomb vaccine 20 MCG/ML suspension prefilled syringe 1 mL Syringe,90740,CDM,90740,CPT,636,RC,58160082143,NDC,facility,both,1,ML,166.78,118.08,Aetna First Health,Commercial,,141.76,85,,,73.92,141.76,percent of total billed charges,
hepatitis b recomb vaccine 20 MCG/ML suspension prefilled syringe 1 mL Syringe,90740,CDM,90740,CPT,636,RC,58160082152,NDC,facility,both,1,ML,166.78,118.08,Aetna First Health,Commercial,,141.76,85,,,73.92,141.76,percent of total billed charges,
hepatitis b recomb vaccine 20 MCG/ML Suspension 1 mL Vial,90740,CDM,90740,CPT,636,RC,58160082111,NDC,facility,both,1,ML,166.78,118.08,Aetna First Health,Commercial,,141.76,85,,,73.92,141.76,percent of total billed charges,
hepatitis b recomb vaccine 20 MCG/ML Suspension 1 mL Vial,90740,CDM,90740,CPT,636,RC,58160082101,NDC,facility,both,1,ML,166.78,118.08,Aetna First Health,Commercial,,141.76,85,,,73.92,141.76,percent of total billed charges,
hepatitis b recomb vaccine 10 MCG/0.5ML suspension prefilled syringe 0.5 mL Syringe,90743,CDM,90743,CPT,636,RC,58160082052,NDC,facility,both,1,ML,68.21,48.29,Aetna First Health,Commercial,,57.98,85,,,30.23,57.98,percent of total billed charges,
hepatitis b recomb vaccine 10 MCG/0.5ML suspension prefilled syringe 0.5 mL Syringe,90743,CDM,90743,CPT,636,RC,58160082043,NDC,facility,both,1,ML,68.21,48.29,Aetna First Health,Commercial,,57.98,85,,,30.23,57.98,percent of total billed charges,
hepatitis b vaccine recombinant 5 MCG/0.5ML suspension prefilled syringe 0.5 mL Syringe,90744,CDM,90744,CPT,636,RC,00006409301,NDC,facility,both,1,ML,57.48,40.7,Aetna First Health,Commercial,,48.86,85,,,25.48,48.86,percent of total billed charges,
hepatitis b vaccine recombinant 5 MCG/0.5ML Suspension 0.5 mL Vial,90744,CDM,90744,CPT,636,RC,00006498100,NDC,facility,both,1,ML,57.48,40.7,Aetna First Health,Commercial,,48.86,85,,,25.48,48.86,percent of total billed charges,
hepatitis b vaccine recombinant 5 MCG/0.5ML Suspension 0.5 mL Syringe,90744,CDM,90744,CPT,636,RC,00006409309,NDC,facility,both,1,ML,57.48,40.7,Aetna First Health,Commercial,,48.86,85,,,25.48,48.86,percent of total billed charges,
hepatitis b vaccine recombinant 5 MCG/0.5ML Suspension 0.5 mL Syringe,90744,CDM,90744,CPT,636,RC,00006409301,NDC,facility,both,1,ML,57.48,40.7,Aetna First Health,Commercial,,48.86,85,,,25.48,48.86,percent of total billed charges,
hepatitis b vaccine recombinant 5 MCG/0.5ML Suspension 0.5 mL Vial,90744,CDM,90744,CPT,636,RC,00006498101,NDC,facility,both,1,ML,57.48,40.7,Aetna First Health,Commercial,,48.86,85,,,25.48,48.86,percent of total billed charges,
hepatitis b vaccine recombinant 10 MCG/ML Suspension 1 mL Vial,90746,CDM,90746,CPT,636,RC,,,facility,both,0.5,ML,80.19,56.77,Aetna First Health,Commercial,,68.16,85,,,35.54,68.16,percent of total billed charges,
zoster vaccine lyophilized gE antigen 50 MCG/0.5ML Recon Susp 1 Each Vial,90750,CDM,90750,CPT,636,RC,58160082803,NDC,facility,both,1,EA,336,237.89,Aetna First Health,Commercial,,285.6,85,,,148.92,285.6,percent of total billed charges,
zoster vaccine lyophilized gE antigen 50 MCG/0.5ML Recon Susp 1 Each Vial,90750,CDM,90750,CPT,636,RC,58160082311,NDC,facility,both,1,EA,474.95,336.26,Aetna First Health,Commercial,,403.71,85,,,210.5,403.71,percent of total billed charges,
zoster vaccine lyophilized gE antigen 50 MCG/0.5ML Recon Susp 1 Each Vial,90750,CDM,90750,CPT,636,RC,58160081912,NDC,facility,both,1,EA,474.96,336.27,Aetna First Health,Commercial,,403.72,85,,,210.5,403.72,percent of total billed charges,
covid-19 vaccine (Novavax) 5 MCG/0.5ML Suspension 2.5 mL Vial,91304,CDM,91304,CPT,636,RC,80631010501,NDC,facility,both,0.2,ML,312,220.9,Aetna First Health,Commercial,,265.2,85,,,138.28,265.2,percent of total billed charges,
covid-19 vaccine (Novavax) 5 MCG/0.5ML Suspension 2.5 mL Vial,91304,CDM,91304,CPT,636,RC,80631010502,NDC,facility,both,0.2,ML,312,220.9,Aetna First Health,Commercial,,265.2,85,,,138.28,265.2,percent of total billed charges,
covid-19 mRNA vac 6m-4y Pfizer 3 MCG/0.3ML Suspension 0.9 mL Vial,91318,CDM,91318,CPT,636,RC,59267431501,NDC,facility,both,0.33333,ML,138,97.7,Aetna First Health,Commercial,,117.3,85,,,61.16,117.3,percent of total billed charges,
covid-19 mRNA vac 6m-4y Pfizer 3 MCG/0.3ML Suspension 0.9 mL Vial,91318,CDM,91318,CPT,636,RC,59267431502,NDC,facility,both,0.33333,ML,138,97.7,Aetna First Health,Commercial,,117.3,85,,,61.16,117.3,percent of total billed charges,
covid-19 mRNA vac 5-11y Pfizer 10 MCG/0.3ML Suspension 0.3 mL Vial,91319,CDM,91319,CPT,636,RC,59267433101,NDC,facility,both,1,ML,184.8,130.84,Aetna First Health,Commercial,,157.08,85,,,81.9,157.08,percent of total billed charges,
covid-19 mRNA vac 5-11y Pfizer 10 MCG/0.3ML Suspension 0.3 mL Vial,91319,CDM,91319,CPT,636,RC,59267433102,NDC,facility,both,1,ML,184.8,130.84,Aetna First Health,Commercial,,157.08,85,,,81.9,157.08,percent of total billed charges,
covid-19 vaccine (Pfizer 12yr+) 30 MCG/0.3ML Suspension 0.3 mL Vial,91320,CDM,91320,CPT,636,RC,00069236210,NDC,facility,both,1,ML,276,195.41,Aetna First Health,Commercial,,234.6,85,,,122.32,234.6,percent of total billed charges,
covid-19 vaccine (Pfizer 12yr+) 30 MCG/0.3ML Suspension 0.3 mL Vial,91320,CDM,91320,CPT,636,RC,00069236201,NDC,facility,both,1,ML,276,195.41,Aetna First Health,Commercial,,234.6,85,,,122.32,234.6,percent of total billed charges,
SPEECH/HEARING THERAPY,92507,CDM,92507,CPT,440,RC,,,facility,both,,,258,182.66,Aetna First Health,Commercial,,219.3,85,,,114.35,219.3,percent of total billed charges,
LARYNGEAL FUNCTION STUDIES,92520,CDM,92520,CPT,440,RC,,,facility,both,,,179,126.73,Aetna First Health,Commercial,,152.15,85,,,79.33,152.15,percent of total billed charges,
EVALUATION OF SPEECH FLUENCY,92521,CDM,92521,CPT,444,RC,,,facility,both,,,238,168.5,Aetna First Health,Commercial,,202.3,85,,,105.48,202.3,percent of total billed charges,
EVALUATE SPEECH PRODUCTION,92522,CDM,92522,CPT,444,RC,,,facility,both,,,385,272.58,Aetna First Health,Commercial,,327.25,85,,,170.63,327.25,percent of total billed charges,
SPEECH SOUND LANG COMPREHEN,92523,CDM,92523,CPT,444,RC,,,facility,both,,,371,262.67,Aetna First Health,Commercial,,315.35,85,,,164.43,315.35,percent of total billed charges,
BEHAVRAL QUALIT ANALYS VOICE,92524,CDM,92524,CPT,444,RC,,,facility,both,,,385,272.58,Aetna First Health,Commercial,,327.25,85,,,170.63,327.25,percent of total billed charges,
ORAL FUNCTION THERAPY,92526,CDM,92526,CPT,440,RC,,,facility,both,,,231,163.55,Aetna First Health,Commercial,,196.35,85,,,102.38,196.35,percent of total billed charges,
EVOKED AUDITORY TEST QUAL,92558,CDM,92558,CPT,471,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,,69.7,85,,,36.34,69.7,percent of total billed charges,
USE OF SPEECH DEVICE SERVICE,92609,CDM,92609,CPT,440,RC,,,facility,both,,,325,230.1,Aetna First Health,Commercial,,276.25,85,,,144.04,276.25,percent of total billed charges,
EVALUATE SWALLOWING FUNCTION,92610,CDM,92610,CPT,444,RC,,,facility,both,,,265,187.62,Aetna First Health,Commercial,,225.25,85,,,117.45,225.25,percent of total billed charges,
MOTION FLUOROSCOPY/SWALLOW,92611,CDM,92611,CPT,444,RC,,,facility,both,,,512,362.5,Aetna First Health,Commercial,,435.2,85,,,226.92,435.2,percent of total billed charges,
"AUDITORY EVOKED POTEN SCREEN, AUTO ANAL",92650,CDM,92650,CPT,471,RC,,,facility,both,,,339,240.01,Aetna First Health,Commercial,,288.15,85,,,150.24,288.15,percent of total billed charges,
"ECG 12 LEAD, TRACING ONLY",93005,CDM,93005,CPT,730,RC,,,facility,both,,,265,187.62,Aetna First Health,Commercial,,225.25,85,,,117.45,225.25,percent of total billed charges,
"ECG 12 LEAD, TRACING",93005.01,CDM,93005,CPT,730,RC,,,facility,both,,,177,125.32,Aetna First Health,Commercial,,150.45,85,,,78.45,150.45,percent of total billed charges,
"CARDIAC STRESS TST,TRACING ONLY",93017,CDM,93017,CPT,482,RC,,,facility,both,,,1014,717.91,Aetna First Health,Commercial,,861.9,85,,,449.4,861.9,percent of total billed charges,
ECG MONITOR/RECORD,93225,CDM,93225,CPT,731,RC,,,facility,both,,,410,290.28,Aetna First Health,Commercial,,348.5,85,,,181.71,348.5,percent of total billed charges,
ECG MONITOR/SCAN,93226,CDM,93226,CPT,731,RC,,,facility,both,,,541,383.03,Aetna First Health,Commercial,,459.85,85,,,239.77,459.85,percent of total billed charges,
"LONG TERM HOLTER, 48 HRS UP TO 7 DAYS, RECORDING",93242,CDM,93242,CPT,731,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
"LONG TERM HOLTER, MORE THAN 7 DAYS UP TO 15 DAYS, RECORDING",93246,CDM,93246,CPT,731,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
UP TO 30 DAY EVENT-LOOP HOOK UP,93270,CDM,93270,CPT,730,RC,,,facility,both,,,376,266.21,Aetna First Health,Commercial,,319.6,85,,,166.64,319.6,percent of total billed charges,
"PM/ICD REMOTE TECH SERV, UP TO 90 DAYS",93296,CDM,93296,CPT,480,RC,,,facility,both,,,226,160.01,Aetna First Health,Commercial,,192.1,85,,,100.16,192.1,percent of total billed charges,
AMBULATORY BP RECORDING,93786,CDM,93786,CPT,480,RC,,,facility,both,,,108,76.46,Aetna First Health,Commercial,,91.8,85,,,47.87,91.8,percent of total billed charges,
AMBULATORY BP ANALYSIS,93788,CDM,93788,CPT,480,RC,,,facility,both,,,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
CARDIAC REHAB I W/ MONITOR,93798.01,CDM,93798,CPT,943,RC,,,facility,both,,,128,90.62,Aetna First Health,Commercial,,108.8,85,,,56.73,108.8,percent of total billed charges,
CARDIAC REHAB II W/ MONITOR,93798.02,CDM,93798,CPT,943,RC,,,facility,both,,,317,224.44,Aetna First Health,Commercial,,269.45,85,,,140.49,269.45,percent of total billed charges,
CARDIAC REHAB I EVAL,93798.04,CDM,93798,CPT,943,RC,,,facility,both,,,415,293.82,Aetna First Health,Commercial,,352.75,85,,,183.93,352.75,percent of total billed charges,
CARDIAC REHAB II EVAL,93798.05,CDM,93798,CPT,943,RC,,,facility,both,,,415,293.82,Aetna First Health,Commercial,,352.75,85,,,183.93,352.75,percent of total billed charges,
"PULMONARY STRESS TEST-TECH 6 MIN WALK, INCLUDES MEASURED HEART RATE,OXIMETRY,O2 TITRATION,WHEN PERF",94618.0301,CDM,94618,CPT,460,RC,,,facility,both,,,237,167.8,Aetna First Health,Commercial,TC,201.45,85,,,105.04,201.45,percent of total billed charges,
"PULMONARY REHAB, W/OUT CONTINUOUS OXIMETRY, PER SESSION",94625,CDM,94625,CPT,948,RC,,,facility,both,,,116,82.13,Aetna First Health,Commercial,,98.6,85,,,51.41,98.6,percent of total billed charges,
"PULMONARY REHAB, W/ CONTINUOUS OXIMETRY, PER SESSION",94626,CDM,94626,CPT,948,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
AIRWAY INHALATION TREATMENT,94640,CDM,94640,CPT,410,RC,,,facility,both,,,199,140.89,Aetna First Health,Commercial,,169.15,85,,,88.2,169.15,percent of total billed charges,
AEROSOL INHALATION TREATMENT,94642,CDM,94642,CPT,410,RC,,,facility,both,,,186,131.69,Aetna First Health,Commercial,,158.1,85,,,82.44,158.1,percent of total billed charges,
MECHANICAL CHEST WALL OSCILL,94669,CDM,94669,CPT,410,RC,,,facility,both,,,258,182.66,Aetna First Health,Commercial,,219.3,85,,,114.35,219.3,percent of total billed charges,
"NONINVASV OXYGEN SATUR,MULTIPLE",94761,CDM,94761,CPT,460,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,,56.95,85,,,29.69,56.95,percent of total billed charges,
"NONINVASV OXYGEN SATUT,CONTINUOUS",94762,CDM,94762,CPT,460,RC,,,facility,both,,,347,245.68,Aetna First Health,Commercial,,294.95,85,,,153.79,294.95,percent of total billed charges,
CAR SEAT/BED TEST W/I&R 60 MIN,94780,CDM,94780,CPT,410,RC,,,facility,both,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
CAR SEAT/BED TEST W/II&R EA ADD 30 MIN,94781,CDM,94781,CPT,410,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,,57.8,85,,,30.14,57.8,percent of total billed charges,
FENO,95012,CDM,95012,CPT,460,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
"IMMUNOTHERAPY, 2+ INJECTIONS",95117,CDM,95117,CPT,940,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,,56.95,85,,,29.69,56.95,percent of total billed charges,
GLUCOSE MONITORING PT PROV EQUIP,95249,CDM,95249,CPT,510,RC,,,facility,both,,,233,164.96,Aetna First Health,Commercial,,198.05,85,,,103.27,198.05,percent of total billed charges,
"GLUCOSE MONITORING, CONT",95250,CDM,95250,CPT,510,RC,,,facility,both,,,572,404.98,Aetna First Health,Commercial,,486.2,85,,,253.51,486.2,percent of total billed charges,
"EEG CONT REC W/VIDEO BY TECH, MIN 8 CHANNELS",95700,CDM,95700,CPT,740,RC,,,facility,both,,,555,392.94,Aetna First Health,Commercial,,471.75,85,,,245.98,471.75,percent of total billed charges,
"EEG BY TECH, 2-12 HR UNMONITORED",95705,CDM,95705,CPT,740,RC,,,facility,both,,,1260,892.08,Aetna First Health,Commercial,,1071,85,,,558.43,1071,percent of total billed charges,
"EEG BY TECH, 2-12 HR INTERMITTENT MONITOR",95706,CDM,95706,CPT,740,RC,,,facility,both,,,1512,1070.5,Aetna First Health,Commercial,,1285.2,85,,,670.12,1285.2,percent of total billed charges,
"EEG BY TECH, 2-12 HR CONT REAL-TIME MONITOR",95707,CDM,95707,CPT,740,RC,,,facility,both,,,1814,1284.31,Aetna First Health,Commercial,,1541.9,85,,,803.96,1541.9,percent of total billed charges,
"EEG BY TECH, EA INCR 12-26 HR UNMONITORED",95708,CDM,95708,CPT,740,RC,,,facility,both,,,2516,1781.33,Aetna First Health,Commercial,,2138.6,85,,,1115.09,2138.6,percent of total billed charges,
"EEG BY TECH, EA INCR 12-26 HR INTERMITTENT MONITOR",95709,CDM,95709,CPT,740,RC,,,facility,both,,,3019,2137.45,Aetna First Health,Commercial,,2566.15,85,,,1338.02,2566.15,percent of total billed charges,
"EEG BY TECH, EA INCR 12-26 HR CONT REAL-TIME MONITOR",95710,CDM,95710,CPT,740,RC,,,facility,both,,,3623,2565.08,Aetna First Health,Commercial,,3079.55,85,,,1605.71,3079.55,percent of total billed charges,
"VEEG BY TECH, 2-12 HR UNMONITORED",95711,CDM,95711,CPT,740,RC,,,facility,both,,,1512,1070.5,Aetna First Health,Commercial,,1285.2,85,,,670.12,1285.2,percent of total billed charges,
"VEEG BY TECH, 2-12 HR INTERMITTENT MONITOR",95712,CDM,95712,CPT,740,RC,,,facility,both,,,1814,1284.31,Aetna First Health,Commercial,,1541.9,85,,,803.96,1541.9,percent of total billed charges,
"VEEG BY TECH, 2-12 HR CONT REAL-TIME MONITOR",95713,CDM,95713,CPT,740,RC,,,facility,both,,,2177,1541.32,Aetna First Health,Commercial,,1850.45,85,,,964.85,1850.45,percent of total billed charges,
"VEEG BY TECH, EA INCR 12-26 HR UNMONITORED",95714,CDM,95714,CPT,740,RC,,,facility,both,,,3019,2137.45,Aetna First Health,Commercial,,2566.15,85,,,1338.02,2566.15,percent of total billed charges,
"VEEG BY TECH, EA INCR 12-26 HR INTERMITTENT MONITOR",95715,CDM,95715,CPT,740,RC,,,facility,both,,,3623,2565.08,Aetna First Health,Commercial,,3079.55,85,,,1605.71,3079.55,percent of total billed charges,
"VEEG BY TECH, EA INCR 12-26 HR CONT REAL-TIME MONITOR",95716,CDM,95716,CPT,740,RC,,,facility,both,,,4348,3078.38,Aetna First Health,Commercial,,3695.8,85,,,1927.03,3695.8,percent of total billed charges,
CANALITH REPOSITIONING,95992,CDM,95992,CPT,420,RC,,,facility,both,,,141,99.83,Aetna First Health,Commercial,,119.85,85,,,62.49,119.85,percent of total billed charges,
"DEVELOPMENTAL TEST W/ INTERP & REPORT; PHYSICIAN/QHP, FIRST HOUR",96112.01,CDM,96112,CPT,420,RC,,,facility,both,,,423,299.48,Aetna First Health,Commercial,,359.55,85,,,187.47,359.55,percent of total billed charges,
FIRST HOUR IV HYDRATION <1 HOUR,96360,CDM,96360,CPT,260,RC,,,facility,both,,,425,300.9,Aetna First Health,Commercial,,361.25,85,,,188.36,361.25,percent of total billed charges,
EACH ADD'L HOUR IV HYDRATION,96361,CDM,96361,CPT,260,RC,,,facility,both,,,242,171.34,Aetna First Health,Commercial,,205.7,85,,,107.25,205.7,percent of total billed charges,
"IV INFUSION THERAPY, 1 HOUR",96365,CDM,96365,CPT,260,RC,,,facility,both,,,471,333.47,Aetna First Health,Commercial,,400.35,85,,,208.75,400.35,percent of total billed charges,
EACH ADD'L HOUR IV INFUSION <8 HOUR,96366,CDM,96366,CPT,260,RC,,,facility,both,,,242,171.34,Aetna First Health,Commercial,,205.7,85,,,107.25,205.7,percent of total billed charges,
EACH ADD'L SEQUENTIAL IV INFUSION <1 HOUR,96367,CDM,96367,CPT,260,RC,,,facility,both,,,249,176.29,Aetna First Health,Commercial,,211.65,85,,,110.36,211.65,percent of total billed charges,
CONCURRENT INFUSION,96368,CDM,96368,CPT,260,RC,,,facility,both,,,195,138.06,Aetna First Health,Commercial,,165.75,85,,,86.42,165.75,percent of total billed charges,
"INJECTION, SUBQ/IM",96372,CDM,96372,CPT,260,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,,90.1,85,,,46.98,90.1,percent of total billed charges,
INJECTION (INTRA-ARTERIAL),96373,CDM,96373,CPT,260,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,,106.25,85,,,55.4,106.25,percent of total billed charges,
"IV PUSH, SINGLE/1ST DRUG",96374,CDM,96374,CPT,260,RC,,,facility,both,,,254,179.83,Aetna First Health,Commercial,,215.9,85,,,112.57,215.9,percent of total billed charges,
EACH ADD'L SEQUENTIAL PUSH NEW DRUG,96375,CDM,96375,CPT,260,RC,,,facility,both,,,190,134.52,Aetna First Health,Commercial,,161.5,85,,,84.21,161.5,percent of total billed charges,
TX/PRO/DX INJ SAME DRUG ADON,96376,CDM,96376,CPT,260,RC,,,facility,both,,,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,96377,CDM,96377,CPT,260,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
"CHEMOTHERAPY ADMINISTRATION, SUBQ/IM NON-HORMONAL ANTI-NEOPLASTIC",96401,CDM,96401,CPT,335,RC,,,facility,both,,,322,227.98,Aetna First Health,Commercial,,273.7,85,,,142.71,273.7,percent of total billed charges,
"CHEMOTHERAPY ADMINISTRATION, SUBQ/IM HORMONAL ANTI-NEOPLASTIC",96402,CDM,96402,CPT,335,RC,,,facility,both,,,219,155.05,Aetna First Health,Commercial,,186.15,85,,,97.06,186.15,percent of total billed charges,
"CHEMOTHERAPY, IV PUSH, SINGLE DRUG",96409,CDM,96409,CPT,335,RC,,,facility,both,,,496,351.17,Aetna First Health,Commercial,,421.6,85,,,219.83,421.6,percent of total billed charges,
"CHEMOTHERAPY, IV PUSH, ADDITIONAL DRUG",96411,CDM,96411,CPT,335,RC,,,facility,both,,,299,211.69,Aetna First Health,Commercial,,254.15,85,,,132.52,254.15,percent of total billed charges,
"CHEMOTHERAPY, IV INFUSION, 1 HOUR",96413,CDM,96413,CPT,335,RC,,,facility,both,,,739,523.21,Aetna First Health,Commercial,,628.15,85,,,327.52,628.15,percent of total billed charges,
"CHEMOTHERAPY, IV INFUSION, ADD'L HOUR",96415,CDM,96415,CPT,335,RC,,,facility,both,,,286,202.49,Aetna First Health,Commercial,,243.1,85,,,126.76,243.1,percent of total billed charges,
CHEMOTHERAPY PROLONGED INFUSION WITH PUMP (OVER 8 HOURS),96416,CDM,96416,CPT,335,RC,,,facility,both,,,687,486.4,Aetna First Health,Commercial,,583.95,85,,,304.48,583.95,percent of total billed charges,
"CHEMOTHERAPY, IV INFUSION, EACH ADD'L SEQUENTIAL INFUSION",96417,CDM,96417,CPT,335,RC,,,facility,both,,,389,275.41,Aetna First Health,Commercial,,330.65,85,,,172.4,330.65,percent of total billed charges,
REFILL/MAINTAIN PORTABLE PUMP,96521,CDM,96521,CPT,260,RC,,,facility,both,,,257,181.96,Aetna First Health,Commercial,,218.45,85,,,113.9,218.45,percent of total billed charges,
REFILL/MAINTAIN IMPLANTABLE PUMP/RESERVOIR SYSTEMIC,96522,CDM,96522,CPT,260,RC,,,facility,both,,,253,179.12,Aetna First Health,Commercial,,215.05,85,,,112.13,215.05,percent of total billed charges,
IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS,96523,CDM,96523,CPT,260,RC,,,facility,both,,,202,143.02,Aetna First Health,Commercial,,171.7,85,,,89.53,171.7,percent of total billed charges,
HOT OR COLD PACKS THERAPY,97010,CDM,97010,CPT,420,RC,,,facility,both,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
MECHANICAL TRACTION THERAPY,97012,CDM,97012,CPT,420,RC,,,facility,both,,,110,77.88,Aetna First Health,Commercial,,93.5,85,,,48.75,93.5,percent of total billed charges,
ELECTRIC STIMULATION THERAPY,97014,CDM,97014,CPT,420,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,,97.75,85,,,50.97,97.75,percent of total billed charges,
VASOPNEUMATIC DEVICE THERAPY,97016,CDM,97016,CPT,420,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,,69.7,85,,,36.34,69.7,percent of total billed charges,
PARAFFIN BATH THERAPY,97018,CDM,97018,CPT,420,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
WHIRLPOOL THERAPY,97022,CDM,97022,CPT,420,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
INFRARED THERAPY,97026,CDM,97026,CPT,420,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
ELECTRICAL STIMULATION,97032,CDM,97032,CPT,420,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,,83.3,85,,,43.43,83.3,percent of total billed charges,
"IONTOPHORESIS, EA 15MIN",97033,CDM,97033,CPT,420,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
ULTRASOUND THERAPY,97035,CDM,97035,CPT,420,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
PHYSICAL THERAPY TREATMENT,97039,CDM,97039,CPT,420,RC,,,facility,both,,,88,62.3,Aetna First Health,Commercial,,74.8,85,,,39,74.8,percent of total billed charges,
THERAPEUTIC EXERCISES,97110,CDM,97110,CPT,420,RC,,,facility,both,,,130,92.04,Aetna First Health,Commercial,,110.5,85,,,57.62,110.5,percent of total billed charges,
NEUROMUSCULAR RE-EDUCATION,97112,CDM,97112,CPT,420,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,,79.05,85,,,41.22,79.05,percent of total billed charges,
GAIT TRAINING THERAPY,97116,CDM,97116,CPT,420,RC,,,facility,both,,,97,68.68,Aetna First Health,Commercial,,82.45,85,,,42.99,82.45,percent of total billed charges,
MASSAGE THERAPY,97124,CDM,97124,CPT,420,RC,,,facility,both,,,109,77.17,Aetna First Health,Commercial,,92.65,85,,,48.31,92.65,percent of total billed charges,
"COGNITIVE FUNCT THER INTERV, INITIAL 15 MIN",97129,CDM,97129,CPT,420,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,,90.1,85,,,46.98,90.1,percent of total billed charges,
"COGNITIVE FUNCT THER INTERV, EA ADDL 15 MIN",97130,CDM,97130,CPT,420,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,,88.4,85,,,46.09,88.4,percent of total billed charges,
"MANUAL THER TECH,1+REGIONS,EA 15 MIN",97140,CDM,97140,CPT,420,RC,,,facility,both,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
GROUP THERAPEUTIC PROCEDURES,97150,CDM,97150,CPT,420,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,,60.35,85,,,31.47,60.35,percent of total billed charges,
PHYSICAL THERAPY EVALUATION LOW COMPLEX,97161,CDM,97161,CPT,424,RC,,,facility,both,,,217,153.64,Aetna First Health,Commercial,,184.45,85,,,96.17,184.45,percent of total billed charges,
PHYSICAL THERAPY EVALUATION MOD COMPLEX,97162,CDM,97162,CPT,424,RC,,,facility,both,,,237,167.8,Aetna First Health,Commercial,,201.45,85,,,105.04,201.45,percent of total billed charges,
PHYSICAL THERAPY EVALUATION HIGH COMPLEX,97163,CDM,97163,CPT,424,RC,,,facility,both,,,258,182.66,Aetna First Health,Commercial,,219.3,85,,,114.35,219.3,percent of total billed charges,
PHYSICAL THERAPY RE-EVAL EST PLAN CARE,97164,CDM,97164,CPT,424,RC,,,facility,both,,,177,125.32,Aetna First Health,Commercial,,150.45,85,,,78.45,150.45,percent of total billed charges,
OCCUPATIONAL THERAPY EVAL LOW COMPLEX,97165,CDM,97165,CPT,434,RC,,,facility,both,,,222,157.18,Aetna First Health,Commercial,,188.7,85,,,98.39,188.7,percent of total billed charges,
OCCUPATIONAL THERAPY EVAL MOD COMPLEX,97166,CDM,97166,CPT,434,RC,,,facility,both,,,243,172.04,Aetna First Health,Commercial,,206.55,85,,,107.7,206.55,percent of total billed charges,
OCCUPATIONAL THERAPY EVAL HIGH COMPLEX,97167,CDM,97167,CPT,434,RC,,,facility,both,,,263,186.2,Aetna First Health,Commercial,,223.55,85,,,116.56,223.55,percent of total billed charges,
OCCUPATIONAL THER RE-EVAL EST PLAN CARE,97168,CDM,97168,CPT,434,RC,,,facility,both,,,179,126.73,Aetna First Health,Commercial,,152.15,85,,,79.33,152.15,percent of total billed charges,
THERAPEUTIC ACTIVITIES,97530,CDM,97530,CPT,420,RC,,,facility,both,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
"SENSORY INTEGRATIVE DEV, EA 15 MIN",97533,CDM,97533,CPT,420,RC,,,facility,both,,,69,48.85,Aetna First Health,Commercial,,58.65,85,,,30.58,58.65,percent of total billed charges,
SELF CARE MNGMENT TRAINING,97535,CDM,97535,CPT,420,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
COMMUNITY/WORK REINTEGRATION,97537,CDM,97537,CPT,420,RC,,,facility,both,,,96,67.97,Aetna First Health,Commercial,,81.6,85,,,42.55,81.6,percent of total billed charges,
WHEELCHAIR MNGEMENT TRAINING,97542,CDM,97542,CPT,420,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,,79.05,85,,,41.22,79.05,percent of total billed charges,
"WORK HARDENING/CONDN,0-2 HR",97545,CDM,97545,CPT,420,RC,,,facility,both,,,204,144.43,Aetna First Health,Commercial,,173.4,85,,,90.41,173.4,percent of total billed charges,
"CAREGIVER TRAINING FOR FUNCT PERFORMANCE;HOME/COMMUNITY, INTIAL 30 MIN",97550,CDM,97550,CPT,420,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,,85,85,,,44.32,85,percent of total billed charges,
"SELECTIVE DEBRIDEMENT, W/O ANESTHESIA, SURFACE AREA 20 SQ CM OR LESS",97597,CDM,97597,CPT,420,RC,,,facility,both,,,194,137.35,Aetna First Health,Commercial,,164.9,85,,,85.98,164.9,percent of total billed charges,
PHYSICAL PERFORMANCE TEST,97750,CDM,97750,CPT,420,RC,,,facility,both,,,118,83.54,Aetna First Health,Commercial,,100.3,85,,,52.3,100.3,percent of total billed charges,
"ORTHOTICS MANAGEMENT AND TRAINING, INITIAL, EACH 15 MINS",97760,CDM,97760,CPT,420,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,,96.9,85,,,50.52,96.9,percent of total billed charges,
"PROSTHETIC TRAINING, INITIAL, EACH 15 MINS",97761,CDM,97761,CPT,420,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,,62.05,85,,,32.35,62.05,percent of total billed charges,
"MANAGE/TRAIN ORTHOTIC/PROSTHETIC, PER 15 MIN",97763,CDM,97763,CPT,420,RC,,,facility,both,,,139,98.41,Aetna First Health,Commercial,,118.15,85,,,61.6,118.15,percent of total billed charges,
"NUTRITION THRPY, 15 MIN",97802,CDM,97802,CPT,942,RC,,,facility,both,,,88,62.3,Aetna First Health,Commercial,,74.8,85,,,39,74.8,percent of total billed charges,
"NTRTN THRPY, F/U 15 MIN",97803,CDM,97803,CPT,942,RC,,,facility,both,,,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
"NUTRITION THERAPY, 15 MIN F/UP",97803.01,CDM,97803,CPT,942,RC,,,facility,both,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
"NTRTN THRPY, GROUP 30 MIN",97804,CDM,97804,CPT,942,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
"SPECIMEN HANDLING,DR OFF->LAB",99000,CDM,99000,CPT,300,RC,,,facility,both,,,38,26.9,Aetna First Health,Commercial,,32.3,85,,,16.84,32.3,percent of total billed charges,
"SPECIMEN HANDLING,PT->LAB",99001,CDM,99001,CPT,300,RC,,,facility,both,,,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
ACE WRAP 6 INCH,99070.93,CDM,A6450,CPT,272,RC,,,facility,inpatient,,,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
ACE WRAP 4 INCH,99070.97,CDM,A6449,CPT,272,RC,,,facility,inpatient,,,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
MOD SED SAME PHYS/QHP EACH ADDL 15 MINS,99153,CDM,99153,CPT,370,RC,,,facility,both,,,352,249.22,Aetna First Health,Commercial,,299.2,85,,,156.01,299.2,percent of total billed charges,
PHLEBOTOMY,99195,CDM,99195,CPT,940,RC,,,facility,both,,,292,206.74,Aetna First Health,Commercial,,248.2,85,,,129.41,248.2,percent of total billed charges,
OB MEDICAL SCREENING FOR LABOR,99211.05,CDM,99211,CPT,761,RC,,,facility,both,,,260,184.08,Aetna First Health,Commercial,,221,85,,,115.23,221,percent of total billed charges,
OFFICE/OUTPT COVID COLLECTION ONLY,99211.06,CDM,99211,CPT,983,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
"VENIPUNCTURE, LAB",3641502,CDM,36415,CPT,300,RC,,,facility,both,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
FETAL NON-STRESS TEST,5902501,CDM,59025,CPT,720,RC,,,facility,both,,,566,400.73,Aetna First Health,Commercial,TC,481.1,85,,,250.85,481.1,percent of total billed charges,
XRAY EYE FOREIGN BODY,7003001,CDM,70030,CPT,320,RC,,,facility,both,,,394,278.95,Aetna First Health,Commercial,TC,334.9,85,,,174.62,334.9,percent of total billed charges,
XRAY MANDIBLE  PARTIAL  LESS THAN 4 VWS,7010001,CDM,70100,CPT,320,RC,,,facility,both,,,307,217.36,Aetna First Health,Commercial,TC,260.95,85,,,136.06,260.95,percent of total billed charges,
"XRAY MANDIBLE COMPL, MIN 4 VWS",7011001,CDM,70110,CPT,320,RC,,,facility,both,,,519,367.45,Aetna First Health,Commercial,TC,441.15,85,,,230.02,441.15,percent of total billed charges,
XRAY FACIAL BONES  LESS THAN 3 VWS,7014001,CDM,70140,CPT,320,RC,,,facility,both,,,472,334.18,Aetna First Health,Commercial,TC,401.2,85,,,209.19,401.2,percent of total billed charges,
XRAY FACIAL BONES  MINIMUM 3 VWS,7015001,CDM,70150,CPT,320,RC,,,facility,both,,,504,356.83,Aetna First Health,Commercial,TC,428.4,85,,,223.37,428.4,percent of total billed charges,
XRAY NASAL BONES MINIMUM  3 VWS,7016001,CDM,70160,CPT,320,RC,,,facility,both,,,312,220.9,Aetna First Health,Commercial,TC,265.2,85,,,138.28,265.2,percent of total billed charges,
XRAY ORBITS OPTIC FORAMINA,7019001,CDM,70190,CPT,320,RC,,,facility,both,,,144,101.95,Aetna First Health,Commercial,TC,122.4,85,,,63.82,122.4,percent of total billed charges,
XRAY ORBITS MINIMUM  4 VWS,7020001,CDM,70200,CPT,320,RC,,,facility,both,,,458,324.26,Aetna First Health,Commercial,TC,389.3,85,,,202.99,389.3,percent of total billed charges,
XRAY SINUSES LESS THAN 3 VWS,7021001,CDM,70210,CPT,320,RC,,,facility,both,,,242,171.34,Aetna First Health,Commercial,TC,205.7,85,,,107.25,205.7,percent of total billed charges,
XRAY SINUSES MINIMUM 3 VWS,7022001,CDM,70220,CPT,320,RC,,,facility,both,,,430,304.44,Aetna First Health,Commercial,TC,365.5,85,,,190.58,365.5,percent of total billed charges,
XRAY SKULL  LESS THAN 4 VWS,7025001,CDM,70250,CPT,320,RC,,,facility,both,,,338,239.3,Aetna First Health,Commercial,TC,287.3,85,,,149.8,287.3,percent of total billed charges,
XRAY SKULL 4 + TC,7026001,CDM,70260,CPT,320,RC,,,facility,both,,,462,327.1,Aetna First Health,Commercial,TC,392.7,85,,,204.76,392.7,percent of total billed charges,
XRAY TEMPOROMANDIB JNT  UNILAT,7032801,CDM,70328,CPT,320,RC,,,facility,both,,,172,121.78,Aetna First Health,Commercial,TC,146.2,85,,,76.23,146.2,percent of total billed charges,
MRI TEMPORMANDIBULAR JNT,7033601,CDM,70336,CPT,610,RC,,,facility,both,,,2533,1793.36,Aetna First Health,Commercial,TC,2153.05,85,,,1122.63,2153.05,percent of total billed charges,
ORTHOPANTOGRAM,7035501,CDM,70355,CPT,320,RC,,,facility,both,,,333,235.76,Aetna First Health,Commercial,TC,283.05,85,,,147.59,283.05,percent of total billed charges,
"XRAY NECK, SOFT TISSUE",7036001,CDM,70360,CPT,320,RC,,,facility,both,,,280,198.24,Aetna First Health,Commercial,TC,238,85,,,124.1,238,percent of total billed charges,
CT HEAD/BRAIN W/O DYE,7045001,CDM,70450,CPT,350,RC,,,facility,both,,,1850,1309.8,Aetna First Health,Commercial,TC,1572.5,85,,,819.92,1572.5,percent of total billed charges,
CT HEAD/BRAIN W/DYE,7046001,CDM,70460,CPT,350,RC,,,facility,both,,,1775,1256.7,Aetna First Health,Commercial,TC,1508.75,85,,,786.68,1508.75,percent of total billed charges,
CT HEAD/BRAIN W/O & W/DYE,7047001,CDM,70470,CPT,350,RC,,,facility,both,,,2212,1566.1,Aetna First Health,Commercial,TC,1880.2,85,,,980.36,1880.2,percent of total billed charges,
CT ORBIT/EAR/FOSA W/O DYE,7048001,CDM,70480,CPT,350,RC,,,facility,both,,,1755,1242.54,Aetna First Health,Commercial,TC,1491.75,85,,,777.82,1491.75,percent of total billed charges,
CT ORBIT/EAR/FOSSA W/DYE,7048101,CDM,70481,CPT,350,RC,,,facility,both,,,2016,1427.33,Aetna First Health,Commercial,TC,1713.6,85,,,893.49,1713.6,percent of total billed charges,
CT ORBIT/EAR/FOSSA W/O & W/DYE,7048201,CDM,70482,CPT,350,RC,,,facility,both,,,2152,1523.62,Aetna First Health,Commercial,TC,1829.2,85,,,953.77,1829.2,percent of total billed charges,
CT MAXILLOFACIALW/O DYE,7048601,CDM,70486,CPT,350,RC,,,facility,both,,,1850,1309.8,Aetna First Health,Commercial,TC,1572.5,85,,,819.92,1572.5,percent of total billed charges,
CT MAXILLOFACIAL W/DYE,7048701,CDM,70487,CPT,350,RC,,,facility,both,,,1957,1385.56,Aetna First Health,Commercial,TC,1663.45,85,,,867.34,1663.45,percent of total billed charges,
CT MAXILLOFACIAL W/O & W/DYE,7048801,CDM,70488,CPT,350,RC,,,facility,both,,,2310,1635.48,Aetna First Health,Commercial,TC,1963.5,85,,,1023.79,1963.5,percent of total billed charges,
CT SOFT TISSUE NECK W/O DYE,7049001,CDM,70490,CPT,350,RC,,,facility,both,,,1636,1158.29,Aetna First Health,Commercial,TC,1390.6,85,,,725.08,1390.6,percent of total billed charges,
CT SOFT TISSUE NECK W/DYE,7049101,CDM,70491,CPT,350,RC,,,facility,both,,,1992,1410.34,Aetna First Health,Commercial,TC,1693.2,85,,,882.85,1693.2,percent of total billed charges,
CT SFT TSUE NCK W/O & W/DYE,7049201,CDM,70492,CPT,350,RC,,,facility,both,,,2120,1500.96,Aetna First Health,Commercial,TC,1802,85,,,939.58,1802,percent of total billed charges,
"CT ANGIOGRAPHY, HEAD",7049601,CDM,70496,CPT,350,RC,,,facility,both,,,2614,1850.71,Aetna First Health,Commercial,TC,2221.9,85,,,1158.52,2221.9,percent of total billed charges,
"CT ANGIOGRAPHY, NECK",7049801,CDM,70498,CPT,350,RC,,,facility,both,,,2611,1848.59,Aetna First Health,Commercial,TC,2219.35,85,,,1157.2,2219.35,percent of total billed charges,
MRI ORBIT/FACE/NECK TC,7054001,CDM,70540,CPT,610,RC,,,facility,both,,,2605,1844.34,Aetna First Health,Commercial,TC,2214.25,85,,,1154.54,2214.25,percent of total billed charges,
MRI ORBIT-FACE-NECK+CONT,7054201,CDM,70542,CPT,610,RC,,,facility,both,,,2775,1964.7,Aetna First Health,Commercial,TC,2358.75,85,,,1229.88,2358.75,percent of total billed charges,
MRI ORB-FAC-NEC W/O+W/CON,7054301,CDM,70543,CPT,610,RC,,,facility,both,,,3708,2625.26,Aetna First Health,Commercial,TC,3151.8,85,,,1643.39,3151.8,percent of total billed charges,
"MRA, HEAD W/OUT CONTRAST",7054401,CDM,70544,CPT,610,RC,,,facility,both,,,2935,2077.98,Aetna First Health,Commercial,TC,2494.75,85,,,1300.79,2494.75,percent of total billed charges,
"MRA, HEAD W/CONTRAST",7054501,CDM,70545,CPT,610,RC,,,facility,both,,,2170,1536.36,Aetna First Health,Commercial,TC,1844.5,85,,,961.74,1844.5,percent of total billed charges,
"MRA, HEAD W/O+W/ CONTRAST",7054601,CDM,70546,CPT,610,RC,,,facility,both,,,3471,2457.47,Aetna First Health,Commercial,TC,2950.35,85,,,1538.35,2950.35,percent of total billed charges,
"MRA, NECK W/OUT CONTRAST",7054701,CDM,70547,CPT,610,RC,,,facility,both,,,2626,1859.21,Aetna First Health,Commercial,TC,2232.1,85,,,1163.84,2232.1,percent of total billed charges,
"MRA, NECK WITH CONTRAST",7054801,CDM,70548,CPT,610,RC,,,facility,both,,,2765,1957.62,Aetna First Health,Commercial,TC,2350.25,85,,,1225.45,2350.25,percent of total billed charges,
"MRA, NECK W/O+W/ CONTRAST",7054901,CDM,70549,CPT,610,RC,,,facility,both,,,3707,2624.56,Aetna First Health,Commercial,TC,3150.95,85,,,1642.94,3150.95,percent of total billed charges,
MRI BRAIN WO CONTRAST TC,7055101,CDM,70551,CPT,610,RC,,,facility,both,,,2878,2037.62,Aetna First Health,Commercial,TC,2446.3,85,,,1275.53,2446.3,percent of total billed charges,
MRI BRAIN W CONTRAST TC,7055201,CDM,70552,CPT,610,RC,,,facility,both,,,2995,2120.46,Aetna First Health,Commercial,TC,2545.75,85,,,1327.38,2545.75,percent of total billed charges,
MRI BRAIN W & WO CONTRAST,7055301,CDM,70553,CPT,610,RC,,,facility,both,,,3975,2814.3,Aetna First Health,Commercial,TC,3378.75,85,,,1761.72,3378.75,percent of total billed charges,
X-RAY EXAM CHEST 1 VIEW,7104501,CDM,71045,CPT,320,RC,,,facility,both,,,370,261.96,Aetna First Health,Commercial,TC,314.5,85,,,163.98,314.5,percent of total billed charges,
X-RAY EXAM CHEST 2 VIEWS,7104601,CDM,71046,CPT,320,RC,,,facility,both,,,385,272.58,Aetna First Health,Commercial,TC,327.25,85,,,170.63,327.25,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS,7104701,CDM,71047,CPT,320,RC,,,facility,both,,,345,244.26,Aetna First Health,Commercial,TC,293.25,85,,,152.9,293.25,percent of total billed charges,
XRAY RIBS UNILAT 2 VWS,7110001,CDM,71100,CPT,320,RC,,,facility,both,,,303,214.52,Aetna First Health,Commercial,TC,257.55,85,,,134.29,257.55,percent of total billed charges,
XRAY RIBS UNILAT 2 VWS WITH PA CHEST,7110101,CDM,71101,CPT,320,RC,,,facility,both,,,521,368.87,Aetna First Health,Commercial,TC,442.85,85,,,230.91,442.85,percent of total billed charges,
XRAY RIBS BIL 3VWS TC,7111001,CDM,71110,CPT,320,RC,,,facility,both,,,344,243.55,Aetna First Health,Commercial,TC,292.4,85,,,152.46,292.4,percent of total billed charges,
XRAY RIBS BILAT 3 VWS WITH PA CHEST,7111101,CDM,71111,CPT,320,RC,,,facility,both,,,525,371.7,Aetna First Health,Commercial,TC,446.25,85,,,232.68,446.25,percent of total billed charges,
XRAY STERNUM 2VWS TC,7112001,CDM,71120,CPT,320,RC,,,facility,both,,,410,290.28,Aetna First Health,Commercial,TC,348.5,85,,,181.71,348.5,percent of total billed charges,
XRAY STERNOCLAVICULAR JNT MIN 3 VWS,7113001,CDM,71130,CPT,320,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,TC,88.4,85,,,46.09,88.4,percent of total billed charges,
DIAGNOSTIC CT THORAX W/O CONTRAST (TC),7125001,CDM,71250,CPT,350,RC,,,facility,both,,,1831,1296.35,Aetna First Health,Commercial,TC,1556.35,85,,,811.5,1556.35,percent of total billed charges,
DIAGNOSTIC CT THORAX W/ CONTRAST (TC),7126001,CDM,71260,CPT,350,RC,,,facility,both,,,2075,1469.1,Aetna First Health,Commercial,TC,1763.75,85,,,919.64,1763.75,percent of total billed charges,
DIAGNOSTIC CT THORAX W&WO CONTRAST (TC),7127001,CDM,71270,CPT,350,RC,,,facility,both,,,2085,1476.18,Aetna First Health,Commercial,TC,1772.25,85,,,924.07,1772.25,percent of total billed charges,
LOW DOSE CT LUNG CA SCREEN WO CONTRAST,7127101,CDM,71271,CPT,350,RC,,,facility,both,,,1792,1268.74,Aetna First Health,Commercial,TC,1523.2,85,,,794.21,1523.2,percent of total billed charges,
"CT ANGIOGRAPHY, CHEST",7127501,CDM,71275,CPT,350,RC,,,facility,both,,,2656,1880.45,Aetna First Health,Commercial,TC,2257.6,85,,,1177.14,2257.6,percent of total billed charges,
MRI CHEST W/O TC,7155001,CDM,71550,CPT,610,RC,,,facility,both,,,2541,1799.03,Aetna First Health,Commercial,TC,2159.85,85,,,1126.17,2159.85,percent of total billed charges,
"MRI, CHEST W/O+W/CONTRAST",7155201,CDM,71552,CPT,610,RC,,,facility,both,,,3237,2291.8,Aetna First Health,Commercial,TC,2751.45,85,,,1434.64,2751.45,percent of total billed charges,
MRI ANGIO CHEST TC,7155501,CDM,71555,CPT,610,RC,,,facility,both,,,4547,3219.28,Aetna First Health,Commercial,TC,3864.95,85,,,2015.23,3864.95,percent of total billed charges,
XRAY SPINE SINGLE TC,7202001,CDM,72020,CPT,320,RC,,,facility,both,,,305,215.94,Aetna First Health,Commercial,TC,259.25,85,,,135.18,259.25,percent of total billed charges,
XRAY CERVICAL SPINE 2 OR 3 VWS,7204001,CDM,72040,CPT,320,RC,,,facility,both,,,582,412.06,Aetna First Health,Commercial,TC,494.7,85,,,257.94,494.7,percent of total billed charges,
XRAY CERVICAL SPINE 4 OR 5 VWS,7205001,CDM,72050,CPT,320,RC,,,facility,both,,,672,475.78,Aetna First Health,Commercial,TC,571.2,85,,,297.83,571.2,percent of total billed charges,
XRAY CERVICAL SPINE 6 OR MORE VWS,7205201,CDM,72052,CPT,320,RC,,,facility,both,,,786,556.49,Aetna First Health,Commercial,TC,668.1,85,,,348.36,668.1,percent of total billed charges,
XRAY THORACIC SPINE 2 VWS,7207001,CDM,72070,CPT,320,RC,,,facility,both,,,353,249.92,Aetna First Health,Commercial,TC,300.05,85,,,156.45,300.05,percent of total billed charges,
XRAY THORACIC SPINE 3 VWS,7207201,CDM,72072,CPT,320,RC,,,facility,both,,,545,385.86,Aetna First Health,Commercial,TC,463.25,85,,,241.54,463.25,percent of total billed charges,
XRAY THORACOLUMBAR 2 VWS,7208001,CDM,72080,CPT,320,RC,,,facility,both,,,324,229.39,Aetna First Health,Commercial,TC,275.4,85,,,143.6,275.4,percent of total billed charges,
X-RAY EXAM ENTIRE SPINE 1VW,7208101,CDM,72081,CPT,320,RC,,,facility,both,,,339,240.01,Aetna First Health,Commercial,TC,288.15,85,,,150.24,288.15,percent of total billed charges,
X-RAY EXAM ENTIRE SPINE 2-3 VWS,7208201,CDM,72082,CPT,320,RC,,,facility,both,,,406,287.45,Aetna First Health,Commercial,TC,345.1,85,,,179.94,345.1,percent of total billed charges,
X-RAY EXAM ENTIRE SPINE 4-5 VWS,7208301,CDM,72083,CPT,320,RC,,,facility,both,,,401,283.91,Aetna First Health,Commercial,TC,340.85,85,,,177.72,340.85,percent of total billed charges,
XRAY LUMBOSACRAL 2 OR 3 VWS,7210001,CDM,72100,CPT,320,RC,,,facility,both,,,582,412.06,Aetna First Health,Commercial,TC,494.7,85,,,257.94,494.7,percent of total billed charges,
XRAY LUMBOSACRAL MINIMUM 4 VWS,7211001,CDM,72110,CPT,320,RC,,,facility,both,,,662,468.7,Aetna First Health,Commercial,TC,562.7,85,,,293.4,562.7,percent of total billed charges,
XRAY LUMBOSACRAL MIN 6 VWS INCL BEND,7211401,CDM,72114,CPT,320,RC,,,facility,both,,,498,352.58,Aetna First Health,Commercial,TC,423.3,85,,,220.71,423.3,percent of total billed charges,
XRAY LS SPINE BEND TC,7212001,CDM,72120,CPT,320,RC,,,facility,both,,,430,304.44,Aetna First Health,Commercial,TC,365.5,85,,,190.58,365.5,percent of total billed charges,
CT NECK SPINE W/O DYE,7212501,CDM,72125,CPT,350,RC,,,facility,both,,,2150,1522.2,Aetna First Health,Commercial,TC,1827.5,85,,,952.88,1827.5,percent of total billed charges,
CT NECK SPINE W/DYE,7212601,CDM,72126,CPT,350,RC,,,facility,both,,,2039,1443.61,Aetna First Health,Commercial,TC,1733.15,85,,,903.68,1733.15,percent of total billed charges,
CT NECK SPINE W/O & W/DYE,7212701,CDM,72127,CPT,350,RC,,,facility,both,,,2033,1439.36,Aetna First Health,Commercial,TC,1728.05,85,,,901.03,1728.05,percent of total billed charges,
CT CHEST SPINE W/O DYE,7212801,CDM,72128,CPT,350,RC,,,facility,both,,,1903,1347.32,Aetna First Health,Commercial,TC,1617.55,85,,,843.41,1617.55,percent of total billed charges,
CT CHEST SPINE W/DYE,7212901,CDM,72129,CPT,350,RC,,,facility,both,,,1839,1302.01,Aetna First Health,Commercial,TC,1563.15,85,,,815.04,1563.15,percent of total billed charges,
CT CHEST SPINE W/O & W/DYE,7213001,CDM,72130,CPT,350,RC,,,facility,both,,,2253,1595.12,Aetna First Health,Commercial,TC,1915.05,85,,,998.53,1915.05,percent of total billed charges,
CT LUMBAR SPINE W/O DYE,7213101,CDM,72131,CPT,350,RC,,,facility,both,,,1961,1388.39,Aetna First Health,Commercial,TC,1666.85,85,,,869.12,1666.85,percent of total billed charges,
CT LUMBAR SPINE W/DYE,7213201,CDM,72132,CPT,350,RC,,,facility,both,,,2032,1438.66,Aetna First Health,Commercial,TC,1727.2,85,,,900.58,1727.2,percent of total billed charges,
CT LUMBAR SPINE W/O & W/DYE,7213301,CDM,72133,CPT,350,RC,,,facility,both,,,2601,1841.51,Aetna First Health,Commercial,TC,2210.85,85,,,1152.76,2210.85,percent of total billed charges,
MRI C-SPINE WO CONTRAST,7214101,CDM,72141,CPT,610,RC,,,facility,both,,,2882,2040.46,Aetna First Health,Commercial,TC,2449.7,85,,,1277.3,2449.7,percent of total billed charges,
MRI C SPINE W CONTRAST TC,7214201,CDM,72142,CPT,610,RC,,,facility,both,,,2681,1898.15,Aetna First Health,Commercial,TC,2278.85,85,,,1188.22,2278.85,percent of total billed charges,
MRI T SPINE WO CONTRAST,7214601,CDM,72146,CPT,610,RC,,,facility,both,,,2886,2043.29,Aetna First Health,Commercial,TC,2453.1,85,,,1279.08,2453.1,percent of total billed charges,
MRI T SPINE W CONTRAST TC,7214701,CDM,72147,CPT,610,RC,,,facility,both,,,3164,2240.11,Aetna First Health,Commercial,TC,2689.4,85,,,1402.28,2689.4,percent of total billed charges,
MRI L SPINE WO CONTRAST,7214801,CDM,72148,CPT,610,RC,,,facility,both,,,2886,2043.29,Aetna First Health,Commercial,TC,2453.1,85,,,1279.08,2453.1,percent of total billed charges,
MRI L SPINE W CONTRAST TC,7214901,CDM,72149,CPT,610,RC,,,facility,both,,,3119,2208.25,Aetna First Health,Commercial,TC,2651.15,85,,,1382.34,2651.15,percent of total billed charges,
MRI C SPINE W&WO CONTRAST,7215601,CDM,72156,CPT,610,RC,,,facility,both,,,3731,2641.55,Aetna First Health,Commercial,TC,3171.35,85,,,1653.58,3171.35,percent of total billed charges,
MRI T SPINE W&WO CONTRAST,7215701,CDM,72157,CPT,610,RC,,,facility,both,,,3670,2598.36,Aetna First Health,Commercial,TC,3119.5,85,,,1626.54,3119.5,percent of total billed charges,
MRI L SPINE W&WO CONTRAST,7215801,CDM,72158,CPT,610,RC,,,facility,both,,,3808,2696.06,Aetna First Health,Commercial,TC,3236.8,85,,,1687.71,3236.8,percent of total billed charges,
XRAY PELVIS  1 OR 2 VWS,7217001,CDM,72170,CPT,320,RC,,,facility,both,,,410,290.28,Aetna First Health,Commercial,TC,348.5,85,,,181.71,348.5,percent of total billed charges,
XRAY PELVIS COMPL 3+ TC,7219001,CDM,72190,CPT,320,RC,,,facility,both,,,382,270.46,Aetna First Health,Commercial,TC,324.7,85,,,169.3,324.7,percent of total billed charges,
CT ANGIOGRAPH PELV W/O&W/DYE,7219101,CDM,72191,CPT,350,RC,,,facility,both,,,2293,1623.44,Aetna First Health,Commercial,TC,1949.05,85,,,1016.26,1949.05,percent of total billed charges,
CT PELVIS W/O DYE,7219201,CDM,72192,CPT,350,RC,,,facility,both,,,1832,1297.06,Aetna First Health,Commercial,TC,1557.2,85,,,811.94,1557.2,percent of total billed charges,
CT PELVIS W/DYE,7219301,CDM,72193,CPT,350,RC,,,facility,both,,,1909,1351.57,Aetna First Health,Commercial,TC,1622.65,85,,,846.07,1622.65,percent of total billed charges,
CT PELVIS W/O & W/DYE,7219401,CDM,72194,CPT,350,RC,,,facility,both,,,2293,1623.44,Aetna First Health,Commercial,TC,1949.05,85,,,1016.26,1949.05,percent of total billed charges,
"MRI,PELVIS W/OUT CONTRAST",7219501,CDM,72195,CPT,610,RC,,,facility,both,,,2899,2052.49,Aetna First Health,Commercial,TC,2464.15,85,,,1284.84,2464.15,percent of total billed charges,
MRI PELVIS W/CONTRAST TC,7219601,CDM,72196,CPT,610,RC,,,facility,both,,,2417,1711.24,Aetna First Health,Commercial,TC,2054.45,85,,,1071.21,2054.45,percent of total billed charges,
"MRI, PELVIS, W/O THEN W/",7219701,CDM,72197,CPT,610,RC,,,facility,both,,,3751,2655.71,Aetna First Health,Commercial,TC,3188.35,85,,,1662.44,3188.35,percent of total billed charges,
MRI ANGIO PELVIS TC,7219801,CDM,72198,CPT,610,RC,,,facility,both,,,2923,2069.48,Aetna First Health,Commercial,TC,2484.55,85,,,1295.47,2484.55,percent of total billed charges,
XRAY SACROILIAC JNTS LESS THAN 3 VWS,7220001,CDM,72200,CPT,320,RC,,,facility,both,,,270,191.16,Aetna First Health,Commercial,TC,229.5,85,,,119.66,229.5,percent of total billed charges,
XRAY SACROILIAC JNTS 3 OR MORE VWS,7220201,CDM,72202,CPT,320,RC,,,facility,both,,,490,346.92,Aetna First Health,Commercial,TC,416.5,85,,,217.17,416.5,percent of total billed charges,
XRAY SACRUM/ COCCYX MINIMUM 2 VWS,7222001,CDM,72220,CPT,320,RC,,,facility,both,,,552,390.82,Aetna First Health,Commercial,TC,469.2,85,,,244.65,469.2,percent of total billed charges,
XRAY CLAVICLE  COMPLETE,7300001,CDM,73000,CPT,320,RC,,,facility,both,,,402,284.62,Aetna First Health,Commercial,TC,341.7,85,,,178.17,341.7,percent of total billed charges,
XRAY SCAPULA COMPLETE,7301001,CDM,73010,CPT,320,RC,,,facility,both,,,342,242.14,Aetna First Health,Commercial,TC,290.7,85,,,151.57,290.7,percent of total billed charges,
XRAY SHOULDER  1 VW,7302001,CDM,73020,CPT,320,RC,,,facility,both,,,379,268.33,Aetna First Health,Commercial,TC,322.15,85,,,167.97,322.15,percent of total billed charges,
XRAY SHOULDER MINIMUM 2 VWS,7303001,CDM,73030,CPT,320,RC,,,facility,both,,,473,334.88,Aetna First Health,Commercial,TC,402.05,85,,,209.63,402.05,percent of total billed charges,
"ARTHROGRAM, SHOULDER S&I",7304001,CDM,73040,CPT,320,RC,,,facility,both,,,994,703.75,Aetna First Health,Commercial,TC,844.9,85,,,440.54,844.9,percent of total billed charges,
XRAY AC JOINTS(BILATERAL),7305001,CDM,73050,CPT,320,RC,,,facility,both,,,337,238.6,Aetna First Health,Commercial,TC,286.45,85,,,149.36,286.45,percent of total billed charges,
XRAY HUMERUS MINIMUM 2 VWS,7306001,CDM,73060,CPT,320,RC,,,facility,both,,,419,296.65,Aetna First Health,Commercial,TC,356.15,85,,,185.7,356.15,percent of total billed charges,
XRAY ELBOW 2 VWS,7307001,CDM,73070,CPT,320,RC,,,facility,both,,,393,278.24,Aetna First Health,Commercial,TC,334.05,85,,,174.18,334.05,percent of total billed charges,
XRAY ELBOW 3+VWS TC,7308001,CDM,73080,CPT,320,RC,,,facility,both,,,468,331.34,Aetna First Health,Commercial,TC,397.8,85,,,207.42,397.8,percent of total billed charges,
XRAY ARTHROGRAM ELBOW TC,7308501,CDM,73085,CPT,320,RC,,,facility,both,,,750,531,Aetna First Health,Commercial,TC,637.5,85,,,332.4,637.5,percent of total billed charges,
XRAY FOREARM 2 VWS,7309001,CDM,73090,CPT,320,RC,,,facility,both,,,393,278.24,Aetna First Health,Commercial,TC,334.05,85,,,174.18,334.05,percent of total billed charges,
"XRAY UPPER EXT, INFANT MINIMUM 2 VWS",7309201,CDM,73092,CPT,320,RC,,,facility,both,,,270,191.16,Aetna First Health,Commercial,TC,229.5,85,,,119.66,229.5,percent of total billed charges,
XRAY WRIST 2 VWS,7310001,CDM,73100,CPT,320,RC,,,facility,both,,,393,278.24,Aetna First Health,Commercial,TC,334.05,85,,,174.18,334.05,percent of total billed charges,
XRAY WRIST MINIMUM 3 VWS,7311001,CDM,73110,CPT,320,RC,,,facility,both,,,415,293.82,Aetna First Health,Commercial,TC,352.75,85,,,183.93,352.75,percent of total billed charges,
XRAY WRIST ARTHROGRAM S&I,7311501,CDM,73115,CPT,320,RC,,,facility,both,,,557,394.36,Aetna First Health,Commercial,TC,473.45,85,,,246.86,473.45,percent of total billed charges,
XRAY HAND 2VWS TC,7312001,CDM,73120,CPT,320,RC,,,facility,both,,,295,208.86,Aetna First Health,Commercial,TC,250.75,85,,,130.74,250.75,percent of total billed charges,
XRAY HAND 3VWS TC,7313001,CDM,73130,CPT,320,RC,,,facility,both,,,335,237.18,Aetna First Health,Commercial,TC,284.75,85,,,148.47,284.75,percent of total billed charges,
XRAY FINGER(S) TC,7314001,CDM,73140,CPT,320,RC,,,facility,both,,,318,225.14,Aetna First Health,Commercial,TC,270.3,85,,,140.94,270.3,percent of total billed charges,
CT UPPER EXTREMITY W/O DYE,7320001,CDM,73200,CPT,350,RC,,,facility,both,,,1747,1236.88,Aetna First Health,Commercial,TC,1484.95,85,,,774.27,1484.95,percent of total billed charges,
CT UPPER EXTREMITY W/DYE,7320101,CDM,73201,CPT,350,RC,,,facility,both,,,2057,1456.36,Aetna First Health,Commercial,TC,1748.45,85,,,911.66,1748.45,percent of total billed charges,
CT UPPER EXTREMITY W/O&W/DYE,7320201,CDM,73202,CPT,350,RC,,,facility,both,,,1981,1402.55,Aetna First Health,Commercial,TC,1683.85,85,,,877.98,1683.85,percent of total billed charges,
CT ANGIO UPR EXTRM W/O&W/DYE,7320601,CDM,73206,CPT,350,RC,,,facility,both,,,2231,1579.55,Aetna First Health,Commercial,TC,1896.35,85,,,988.78,1896.35,percent of total billed charges,
"MRI,UP EXT,NO JNT,NO CONT",7321801,CDM,73218,CPT,610,RC,,,facility,both,,,2956,2092.85,Aetna First Health,Commercial,TC,2512.6,85,,,1310.1,2512.6,percent of total billed charges,
"MRI,UPR EXT,NO JNT,W/CONT",7321901,CDM,73219,CPT,610,RC,,,facility,both,,,2339,1656.01,Aetna First Health,Commercial,TC,1988.15,85,,,1036.64,1988.15,percent of total billed charges,
MRI UPPER W/O+W TC,7322001,CDM,73220,CPT,610,RC,,,facility,both,,,3634,2572.87,Aetna First Health,Commercial,TC,3088.9,85,,,1610.59,3088.9,percent of total billed charges,
MRI UP EXTREMITY JOINT W/O TC,7322101,CDM,73221,CPT,610,RC,,,facility,both,,,2850,2017.8,Aetna First Health,Commercial,TC,2422.5,85,,,1263.12,2422.5,percent of total billed charges,
"MRI,UPR EXT, JOINT,W/CONT",7322201,CDM,73222,CPT,610,RC,,,facility,both,,,3207,2270.56,Aetna First Health,Commercial,TC,2725.95,85,,,1421.34,2725.95,percent of total billed charges,
"MRI,UPREXT JNT W/O+W/CONT",7322301,CDM,73223,CPT,610,RC,,,facility,both,,,3711,2627.39,Aetna First Health,Commercial,TC,3154.35,85,,,1644.72,3154.35,percent of total billed charges,
"X-RAY EXAM HIP,UNILAT W/PELVIS 1VW",7350101,CDM,73501,CPT,320,RC,,,facility,both,,,386,273.29,Aetna First Health,Commercial,TC,328.1,85,,,171.08,328.1,percent of total billed charges,
"X-RAY EXAM HIP,UNILAT W/PELVIS 2-3 VWS",7350201,CDM,73502,CPT,320,RC,,,facility,both,,,374,264.79,Aetna First Health,Commercial,TC,317.9,85,,,165.76,317.9,percent of total billed charges,
"X-RAY EXAM HIP,UNILAT W/PELVIS MIN 4 VWS",7350301,CDM,73503,CPT,320,RC,,,facility,both,,,485,343.38,Aetna First Health,Commercial,TC,412.25,85,,,214.95,412.25,percent of total billed charges,
"X-RAY EXAM HIP,BILAT W/PELVIS 2 VWS",7352101,CDM,73521,CPT,320,RC,,,facility,both,,,513,363.2,Aetna First Health,Commercial,TC,436.05,85,,,227.36,436.05,percent of total billed charges,
"X-RAY EXAM HIP,BILAT W/PELVIS 3-4 VWS",7352201,CDM,73522,CPT,320,RC,,,facility,both,,,541,383.03,Aetna First Health,Commercial,TC,459.85,85,,,239.77,459.85,percent of total billed charges,
"X-RAY EXAM HIP,BILAT W/PELVIS MIN 5 VWS",7352301,CDM,73523,CPT,320,RC,,,facility,both,,,582,412.06,Aetna First Health,Commercial,TC,494.7,85,,,257.94,494.7,percent of total billed charges,
ARTHROGRAM HIP S&I TC,7352501,CDM,73525,CPT,320,RC,,,facility,both,,,456,322.85,Aetna First Health,Commercial,TC,387.6,85,,,202.1,387.6,percent of total billed charges,
X-RAY EXAM FEMUR 1 VW,7355101,CDM,73551,CPT,320,RC,,,facility,both,,,399,282.49,Aetna First Health,Commercial,TC,339.15,85,,,176.84,339.15,percent of total billed charges,
X-RAY EXAM FEMUR MIN 2 VWS,7355201,CDM,73552,CPT,320,RC,,,facility,both,,,433,306.56,Aetna First Health,Commercial,TC,368.05,85,,,191.91,368.05,percent of total billed charges,
XRAY KNEE  1 OR 2 VWS,7356001,CDM,73560,CPT,320,RC,,,facility,both,,,389,275.41,Aetna First Health,Commercial,TC,330.65,85,,,172.4,330.65,percent of total billed charges,
XRAY KNEE 3 VWS,7356201,CDM,73562,CPT,320,RC,,,facility,both,,,339,240.01,Aetna First Health,Commercial,TC,288.15,85,,,150.24,288.15,percent of total billed charges,
XRAY KNEE 4 OR MORE VWS,7356401,CDM,73564,CPT,320,RC,,,facility,both,,,536,379.49,Aetna First Health,Commercial,TC,455.6,85,,,237.56,455.6,percent of total billed charges,
XRAY KNEE (BOTH) AP STAND,7356501,CDM,73565,CPT,320,RC,,,facility,both,,,306,216.65,Aetna First Health,Commercial,TC,260.1,85,,,135.62,260.1,percent of total billed charges,
"ARTHROGRAM, KNEE S&I TC",7358001,CDM,73580,CPT,320,RC,,,facility,both,,,776,549.41,Aetna First Health,Commercial,TC,659.6,85,,,343.92,659.6,percent of total billed charges,
XRAY TIBIA & FIBULA 2 VWS,7359001,CDM,73590,CPT,320,RC,,,facility,both,,,419,296.65,Aetna First Health,Commercial,TC,356.15,85,,,185.7,356.15,percent of total billed charges,
XRAY LOWER EXTREMTIY INFANT MIN 2 VWS,7359201,CDM,73592,CPT,320,RC,,,facility,both,,,264,186.91,Aetna First Health,Commercial,TC,224.4,85,,,117,224.4,percent of total billed charges,
XRAY ANKLE 2 VWS,7360001,CDM,73600,CPT,320,RC,,,facility,both,,,393,278.24,Aetna First Health,Commercial,TC,334.05,85,,,174.18,334.05,percent of total billed charges,
XRAY ANKLE MINIMUM 3 VWS,7361001,CDM,73610,CPT,320,RC,,,facility,both,,,441,312.23,Aetna First Health,Commercial,TC,374.85,85,,,195.45,374.85,percent of total billed charges,
XRAY FOOT 2 VWS,7362001,CDM,73620,CPT,320,RC,,,facility,both,,,385,272.58,Aetna First Health,Commercial,TC,327.25,85,,,170.63,327.25,percent of total billed charges,
XRAY FOOT MINIMUM 3 VWS,7363001,CDM,73630,CPT,320,RC,,,facility,both,,,404,286.03,Aetna First Health,Commercial,TC,343.4,85,,,179.05,343.4,percent of total billed charges,
XRAY CALCANEUS MINIMUM 2 VWS,7365001,CDM,73650,CPT,320,RC,,,facility,both,,,271,191.87,Aetna First Health,Commercial,TC,230.35,85,,,120.11,230.35,percent of total billed charges,
XRAY TOE(S) TC,7366001,CDM,73660,CPT,320,RC,,,facility,both,,,318,225.14,Aetna First Health,Commercial,TC,270.3,85,,,140.94,270.3,percent of total billed charges,
CT LOWER EXTREMITY W/O DYE,7370001,CDM,73700,CPT,350,RC,,,facility,both,,,1965,1391.22,Aetna First Health,Commercial,TC,1670.25,85,,,870.89,1670.25,percent of total billed charges,
CT LOWER EXTREMITY W/DYE,7370101,CDM,73701,CPT,350,RC,,,facility,both,,,2044,1447.15,Aetna First Health,Commercial,TC,1737.4,85,,,905.9,1737.4,percent of total billed charges,
CT LWR EXTREMITY W/O&W/DYE,7370201,CDM,73702,CPT,350,RC,,,facility,both,,,2692,1905.94,Aetna First Health,Commercial,TC,2288.2,85,,,1193.09,2288.2,percent of total billed charges,
CT ANGIO LWR EXTR W/O&W/DYE,7370601,CDM,73706,CPT,350,RC,,,facility,both,,,2517,1782.04,Aetna First Health,Commercial,TC,2139.45,85,,,1115.53,2139.45,percent of total billed charges,
"MRI,LWREXT,NO JNT,NO CONT",7371801,CDM,73718,CPT,610,RC,,,facility,both,,,2934,2077.27,Aetna First Health,Commercial,TC,2493.9,85,,,1300.35,2493.9,percent of total billed charges,
"MRI,LWREXT,NO JNT, W/CONT",7371901,CDM,73719,CPT,610,RC,,,facility,both,,,2409,1705.57,Aetna First Health,Commercial,TC,2047.65,85,,,1067.67,2047.65,percent of total billed charges,
MRI LOWER W/O+W TC,7372001,CDM,73720,CPT,610,RC,,,facility,both,,,3650,2584.2,Aetna First Health,Commercial,TC,3102.5,85,,,1617.68,3102.5,percent of total billed charges,
MRI LOW EXT JNT WO/CONT TC,7372101,CDM,73721,CPT,610,RC,,,facility,both,,,2874,2034.79,Aetna First Health,Commercial,TC,2442.9,85,,,1273.76,2442.9,percent of total billed charges,
"MRI, LWREXT,JOINT, W/CONT",7372201,CDM,73722,CPT,610,RC,,,facility,both,,,3331,2358.35,Aetna First Health,Commercial,TC,2831.35,85,,,1476.3,2831.35,percent of total billed charges,
"MRI,LWREXT,JNT W/O+W/CONT",7372301,CDM,73723,CPT,610,RC,,,facility,both,,,3577,2532.52,Aetna First Health,Commercial,TC,3040.45,85,,,1585.33,3040.45,percent of total billed charges,
MRI ANGIO LOW EXTREMITY,7372501,CDM,73725,CPT,610,RC,,,facility,both,,,3058,2165.06,Aetna First Health,Commercial,TC,2599.3,85,,,1355.31,2599.3,percent of total billed charges,
X-RAY EXAM ABDOMEN 1 VIEW,7401801,CDM,74018,CPT,320,RC,,,facility,both,,,389,275.41,Aetna First Health,Commercial,TC,330.65,85,,,172.4,330.65,percent of total billed charges,
X-RAY EXAM ABDOMEN 2 VIEWS,7401901,CDM,74019,CPT,320,RC,,,facility,both,,,557,394.36,Aetna First Health,Commercial,TC,473.45,85,,,246.86,473.45,percent of total billed charges,
X-RAY ABDOMEN 2+ VIEWS W/ SINGLE VW CHEST (TC),7402201,CDM,74022,CPT,320,RC,,,facility,both,,,492,348.34,Aetna First Health,Commercial,TC,418.2,85,,,218.05,418.2,percent of total billed charges,
CT ABDOMEN W/O DYE,7415001,CDM,74150,CPT,350,RC,,,facility,both,,,1657,1173.16,Aetna First Health,Commercial,TC,1408.45,85,,,734.38,1408.45,percent of total billed charges,
CT ABDOMEN W/DYE,7416001,CDM,74160,CPT,350,RC,,,facility,both,,,2046,1448.57,Aetna First Health,Commercial,TC,1739.1,85,,,906.79,1739.1,percent of total billed charges,
CT ABDOMEN W/O & W/DYE,7417001,CDM,74170,CPT,350,RC,,,facility,both,,,2490,1762.92,Aetna First Health,Commercial,TC,2116.5,85,,,1103.57,2116.5,percent of total billed charges,
CT ANGIO ABD&PELV W/O&W/DYE,7417401,CDM,74174,CPT,350,RC,,,facility,both,,,4282,3031.66,Aetna First Health,Commercial,TC,3639.7,85,,,1897.78,3639.7,percent of total billed charges,
CT ANGIO ABDOM W/O & W/DYE,7417501,CDM,74175,CPT,350,RC,,,facility,both,,,2749,1946.29,Aetna First Health,Commercial,TC,2336.65,85,,,1218.36,2336.65,percent of total billed charges,
CT ABD & PELVIS W/O CONTRAST,7417601,CDM,74176,CPT,350,RC,,,facility,both,,,3200,2265.6,Aetna First Health,Commercial,TC,2720,85,,,1418.24,2720,percent of total billed charges,
CT ABDOMEN&PELVIS W/CONTRAST,7417701,CDM,74177,CPT,350,RC,,,facility,both,,,3825,2708.1,Aetna First Health,Commercial,TC,3251.25,85,,,1695.24,3251.25,percent of total billed charges,
CT ABD&PELV 1+ SECTION/REGNS,7417801,CDM,74178,CPT,350,RC,,,facility,both,,,3900,2761.2,Aetna First Health,Commercial,TC,3315,85,,,1728.48,3315,percent of total billed charges,
MRI ABDOMEN W/O TC,7418101,CDM,74181,CPT,610,RC,,,facility,both,,,2992,2118.34,Aetna First Health,Commercial,TC,2543.2,85,,,1326.05,2543.2,percent of total billed charges,
"MRI, ABDOMEN, W/CONTRAST",7418201,CDM,74182,CPT,610,RC,,,facility,both,,,2760,1954.08,Aetna First Health,Commercial,TC,2346,85,,,1223.23,2346,percent of total billed charges,
"MRI, ABDOMEN W/O+ W/CONTR",7418301,CDM,74183,CPT,610,RC,,,facility,both,,,3929,2781.73,Aetna First Health,Commercial,TC,3339.65,85,,,1741.33,3339.65,percent of total billed charges,
MRI ANGIO ABDOMEN TC,7418501,CDM,74185,CPT,610,RC,,,facility,both,,,3191,2259.23,Aetna First Health,Commercial,TC,2712.35,85,,,1414.25,2712.35,percent of total billed charges,
CONTRAST XRAY ESOPHAGUS; INCL SCOUT & DELAY (TC),7422001,CDM,74220,CPT,320,RC,,,facility,both,,,623,441.08,Aetna First Health,Commercial,TC,529.55,85,,,276.11,529.55,percent of total billed charges,
"DBL CONTRAST X-RAY, ESOPHAGUS - RADIOLOGY",7422101,CDM,74221,CPT,320,RC,,,facility,both,,,540,382.32,Aetna First Health,Commercial,TC,459,85,,,239.33,459,percent of total billed charges,
"CONTRAST XRAY SWALLOWING FUNCT INT, CINE/VID; INCLSCOUT & DELAY (TC)",7423001,CDM,74230,CPT,320,RC,,,facility,both,,,627,443.92,Aetna First Health,Commercial,TC,532.95,85,,,277.89,532.95,percent of total billed charges,
"X-RAY EXAM, UPPER GI TRACT, INCL SCOUT & DELAY; SINGLE CONTRAST (TC)",7424001,CDM,74240,CPT,320,RC,,,facility,both,,,664,470.11,Aetna First Health,Commercial,TC,564.4,85,,,294.28,564.4,percent of total billed charges,
"X-RAY EXAM, UPPR GI TRACT, INCL SCOUT & DELAY; DOUBLE CONTRAST",7424601,CDM,74246,CPT,320,RC,,,facility,both,,,774,547.99,Aetna First Health,Commercial,TC,657.9,85,,,343.04,657.9,percent of total billed charges,
RADIOLOGIC SMALL INTESTINE FOLLOW-THRU STDY,7424801,CDM,74248,CPT,320,RC,,,facility,both,,,754,533.83,Aetna First Health,Commercial,TC,640.9,85,,,334.17,640.9,percent of total billed charges,
"X-RAY EXAM, SMALL BOWEL, INCL MULTI & SCOUT; SINGLE CONTRAST (TC)",7425001,CDM,74250,CPT,320,RC,,,facility,both,,,783,554.36,Aetna First Health,Commercial,TC,665.55,85,,,347.03,665.55,percent of total billed charges,
"X-RAY EXAM, COLON, INCL SCOUT & DELAY; SINGLE CONTRAST (TC)",7427001,CDM,74270,CPT,320,RC,,,facility,both,,,817,578.44,Aetna First Health,Commercial,TC,694.45,85,,,362.09,694.45,percent of total billed charges,
"X-RAY EXAM, COLON, INCL SCOUT & DELAY; DOUBLE CONTRAST (TC)",7428001,CDM,74280,CPT,320,RC,,,facility,both,,,1188,841.1,Aetna First Health,Commercial,TC,1009.8,85,,,526.52,1009.8,percent of total billed charges,
BARIUM ENEMA FOR INTUSS,7428301,CDM,74283,CPT,320,RC,,,facility,both,,,658,465.86,Aetna First Health,Commercial,TC,559.3,85,,,291.63,559.3,percent of total billed charges,
X-RAY BILE DUCTS/PANCREAS,7430001,CDM,74300,CPT,320,RC,,,facility,both,,,1025,725.7,Aetna First Health,Commercial,TC,871.25,85,,,454.28,871.25,percent of total billed charges,
XRAYS AT SURGERY ADD-ON,7430101,CDM,74301,CPT,320,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,TC,97.75,85,,,50.97,97.75,percent of total billed charges,
X-RAY BILE DUCT ENDOSCOPY,7432801,CDM,74328,CPT,320,RC,,,facility,both,,,2590,1833.72,Aetna First Health,Commercial,TC,2201.5,85,,,1147.89,2201.5,percent of total billed charges,
XR ERCP PANCREATIC ONLY,7432901,CDM,74329,CPT,320,RC,,,facility,both,,,2539,1797.61,Aetna First Health,Commercial,TC,2158.15,85,,,1125.28,2158.15,percent of total billed charges,
ERCP OR-# OF FILMS TAKEN,7433001,CDM,74330,CPT,320,RC,,,facility,both,,,2539,1797.61,Aetna First Health,Commercial,TC,2158.15,85,,,1125.28,2158.15,percent of total billed charges,
X-RAY GUIDE FOR GI TUBE,7434001,CDM,74340,CPT,320,RC,,,facility,both,,,479,339.13,Aetna First Health,Commercial,TC,407.15,85,,,212.29,407.15,percent of total billed charges,
FLUOROSCOPY SUP & TC,7436001,CDM,74360,CPT,320,RC,,,facility,both,,,840,594.72,Aetna First Health,Commercial,TC,714,85,,,372.29,714,percent of total billed charges,
"UROGRAPHY, IVP TC",7440001,CDM,74400,CPT,320,RC,,,facility,both,,,560,396.48,Aetna First Health,Commercial,TC,476,85,,,248.19,476,percent of total billed charges,
RETROGRADE UROGRAPHY TC,7442001,CDM,74420,CPT,320,RC,,,facility,both,,,971,687.47,Aetna First Health,Commercial,TC,825.35,85,,,430.35,825.35,percent of total billed charges,
"CONTRST X-RAY, URINARY TRACT (TC)",7442501,CDM,74425,CPT,320,RC,,,facility,both,,,797,564.28,Aetna First Health,Commercial,TC,677.45,85,,,353.23,677.45,percent of total billed charges,
XRAY CYSTOGRAPHY 3VW S&I,7443001,CDM,74430,CPT,320,RC,,,facility,both,,,919,650.65,Aetna First Health,Commercial,TC,781.15,85,,,407.3,781.15,percent of total billed charges,
URETHROCYSTOGRAPHY TC,7445001,CDM,74450,CPT,320,RC,,,facility,both,,,673,476.48,Aetna First Health,Commercial,TC,572.05,85,,,298.27,572.05,percent of total billed charges,
"URETHROCYSTO,VOIDING S&I",7445501,CDM,74455,CPT,320,RC,,,facility,both,,,916,648.53,Aetna First Health,Commercial,TC,778.6,85,,,405.97,778.6,percent of total billed charges,
X-RAY RENAL CYST XLUMBAR+CONTRST,7447001,CDM,74470,CPT,320,RC,,,facility,both,,,306,216.65,Aetna First Health,Commercial,TC,260.1,85,,,135.62,260.1,percent of total billed charges,
DILATE URETER/URETHRA S&I,7448501,CDM,74485,CPT,320,RC,,,facility,both,,,1871,1324.67,Aetna First Health,Commercial,TC,1590.35,85,,,829.23,1590.35,percent of total billed charges,
HYSTEROSALPINGOGRAPHY S&I,7474001,CDM,74740,CPT,320,RC,,,facility,both,,,802,567.82,Aetna First Health,Commercial,TC,681.7,85,,,355.45,681.7,percent of total billed charges,
CT HRT W/3D IMAGE,7557201,CDM,75572,CPT,350,RC,,,facility,both,,,294,208.15,Aetna First Health,Commercial,TC,249.9,85,,,130.3,249.9,percent of total billed charges,
CT ANGIO HRT W/3D IMAGE,7557401,CDM,75574,CPT,350,RC,,,facility,both,,,2992,2118.34,Aetna First Health,Commercial,TC,2543.2,85,,,1326.05,2543.2,percent of total billed charges,
ANGIO AORTOGRAM THORACIC,7560001,CDM,75600,CPT,320,RC,,,facility,both,,,3596,2545.97,Aetna First Health,Commercial,TC,3056.6,85,,,1593.75,3056.6,percent of total billed charges,
AORTOGRAPHY ABDOMINAL S&I(T),7562501,CDM,75625,CPT,320,RC,,,facility,both,,,3829,2710.93,Aetna First Health,Commercial,TC,3254.65,85,,,1697.01,3254.65,percent of total billed charges,
ANGIO AORTOBIFEMORAL W CATH(T),7563001,CDM,75630,CPT,320,RC,,,facility,both,,,4279,3029.53,Aetna First Health,Commercial,TC,3637.15,85,,,1896.45,3637.15,percent of total billed charges,
CT ANGIO ABDOMINAL ARTERIES,7563501,CDM,75635,CPT,350,RC,,,facility,both,,,3103,2196.92,Aetna First Health,Commercial,TC,2637.55,85,,,1375.25,2637.55,percent of total billed charges,
ANGIO EXTREMITY-UNI S&I(T),7571001,CDM,75710,CPT,320,RC,,,facility,both,,,4513,3195.2,Aetna First Health,Commercial,TC,3836.05,85,,,2000.16,3836.05,percent of total billed charges,
"ARTERY X-RAYS, ARMS/LEGS(T)",7571601,CDM,75716,CPT,320,RC,,,facility,both,,,3992,2826.34,Aetna First Health,Commercial,TC,3393.2,85,,,1769.25,3393.2,percent of total billed charges,
ANGIO VISCERAL SELECT/SUBSL(T),7572601,CDM,75726,CPT,320,RC,,,facility,both,,,3101,2195.51,Aetna First Health,Commercial,TC,2635.85,85,,,1374.36,2635.85,percent of total billed charges,
ANGIO EA ADDL SELECTV VESSL(T),7577401,CDM,75774,CPT,320,RC,,,facility,both,,,1827,1293.52,Aetna First Health,Commercial,TC,1552.95,85,,,809.73,1552.95,percent of total billed charges,
SHUNTOGRAM S&I TC,7580901,CDM,75809,CPT,320,RC,,,facility,both,,,173,122.48,Aetna First Health,Commercial,TC,147.05,85,,,76.67,147.05,percent of total billed charges,
VENOGRAM EXTREM UNILAT,7582001,CDM,75820,CPT,320,RC,,,facility,both,,,1760,1246.08,Aetna First Health,Commercial,TC,1496,85,,,780.03,1496,percent of total billed charges,
INFERIOR VENACAVAGRAM TC,7582501,CDM,75825,CPT,320,RC,,,facility,both,,,5858,4147.46,Aetna First Health,Commercial,TC,4979.3,85,,,2596.27,4979.3,percent of total billed charges,
VENOGRAM SUPER VENA CAVA,7582701,CDM,75827,CPT,320,RC,,,facility,both,,,2545,1801.86,Aetna First Health,Commercial,TC,2163.25,85,,,1127.94,2163.25,percent of total billed charges,
CHANGE PERC DRAIN CATH TC,7598401,CDM,75984,CPT,320,RC,,,facility,both,,,992,702.34,Aetna First Health,Commercial,TC,843.2,85,,,439.65,843.2,percent of total billed charges,
DRAIN ABSCESS/COLLECTION,7598901,CDM,75989,CPT,320,RC,,,facility,both,,,1444,1022.35,Aetna First Health,Commercial,TC,1227.4,85,,,639.98,1227.4,percent of total billed charges,
FLUOROSCOPE EXAMINATION TC,7600001,CDM,76000,CPT,320,RC,,,facility,both,,,723,511.88,Aetna First Health,Commercial,TC,614.55,85,,,320.43,614.55,percent of total billed charges,
XRAY NOXE TO RECTUM TC,7601001,CDM,76010,CPT,320,RC,,,facility,both,,,288,203.9,Aetna First Health,Commercial,TC,244.8,85,,,127.64,244.8,percent of total billed charges,
XRAY FISTUAL TC ONLY,7608001,CDM,76080,CPT,320,RC,,,facility,both,,,1032,730.66,Aetna First Health,Commercial,TC,877.2,85,,,457.38,877.2,percent of total billed charges,
"X-RAY, SURGICAL SPECIMEN TC",7609801,CDM,76098,CPT,320,RC,,,facility,both,,,576,407.81,Aetna First Health,Commercial,TC,489.6,85,,,255.28,489.6,percent of total billed charges,
3D RENDR TOMO MODLTY W/O PP(T),7637601,CDM,76376,CPT,350,RC,,,facility,both,,,184,130.27,Aetna First Health,Commercial,TC,156.4,85,,,81.55,156.4,percent of total billed charges,
3D RENDR TOMO MODLTY W/ PP(T),7637701,CDM,76377,CPT,350,RC,,,facility,both,,,390,276.12,Aetna First Health,Commercial,TC,331.5,85,,,172.85,331.5,percent of total billed charges,
CT LTD/LOCALIZED FU STUDY,7638001,CDM,76380,CPT,350,RC,,,facility,both,,,898,635.78,Aetna First Health,Commercial,TC,763.3,85,,,397.99,763.3,percent of total billed charges,
US NEONATAL HEAD TC,7650601,CDM,76506,CPT,402,RC,,,facility,both,,,353,249.92,Aetna First Health,Commercial,TC,300.05,85,,,156.45,300.05,percent of total billed charges,
B-SCAN GLOBAL,7651201,CDM,76512,CPT,402,RC,,,facility,both,,,122,86.38,Aetna First Health,Commercial,TC,103.7,85,,,54.07,103.7,percent of total billed charges,
US HEAD/NECK TC,7653601,CDM,76536,CPT,402,RC,,,facility,both,,,632,447.46,Aetna First Health,Commercial,TC,537.2,85,,,280.1,537.2,percent of total billed charges,
US CHEST TC,7660401,CDM,76604,CPT,402,RC,,,facility,both,,,513,363.2,Aetna First Health,Commercial,TC,436.05,85,,,227.36,436.05,percent of total billed charges,
ULTRASOUND BREAST COMPLETE,7664101,CDM,76641,CPT,402,RC,,,facility,both,,,606,429.05,Aetna First Health,Commercial,TC,515.1,85,,,268.58,515.1,percent of total billed charges,
ULTRASOUND BREAST LIMITED,7664201,CDM,76642,CPT,402,RC,,,facility,both,,,476,337.01,Aetna First Health,Commercial,TC,404.6,85,,,210.96,404.6,percent of total billed charges,
US ABDOMEN TC,7670001,CDM,76700,CPT,402,RC,,,facility,both,,,976,691.01,Aetna First Health,Commercial,TC,829.6,85,,,432.56,829.6,percent of total billed charges,
US ABDOMEN LIMITED TC,7670501,CDM,76705,CPT,402,RC,,,facility,both,,,727,514.72,Aetna First Health,Commercial,TC,617.95,85,,,322.21,617.95,percent of total billed charges,
AAA US SCREEN TC,7670601,CDM,76706,CPT,402,RC,,,facility,both,,,560,396.48,Aetna First Health,Commercial,TC,476,85,,,248.19,476,percent of total billed charges,
US RETROPERITONEAL TC,7677001,CDM,76770,CPT,402,RC,,,facility,both,,,729,516.13,Aetna First Health,Commercial,TC,619.65,85,,,323.09,619.65,percent of total billed charges,
US RENAL RETROPERIT LTD,7677501,CDM,76775,CPT,402,RC,,,facility,both,,,642,454.54,Aetna First Health,Commercial,TC,545.7,85,,,284.53,545.7,percent of total billed charges,
US RENAL RETROPERIT LTD,7677502,CDM,76775,CPT,402,RC,,,facility,both,,,642,454.54,Aetna First Health,Commercial,TC,545.7,85,,,284.53,545.7,percent of total billed charges,
US KIDNEY TRANSPLT UNTRSD,7677601,CDM,76776,CPT,402,RC,,,facility,both,,,750,531,Aetna First Health,Commercial,TC,637.5,85,,,332.4,637.5,percent of total billed charges,
US SPINAL CANAL & CONTENT,7680001,CDM,76800,CPT,402,RC,,,facility,both,,,475,336.3,Aetna First Health,Commercial,TC,403.75,85,,,210.52,403.75,percent of total billed charges,
"OB US < 14 WKS, SINGLE FETUS - RADIOLOGY, TECH",7680101,CDM,76801,CPT,402,RC,,,facility,both,,,707,500.56,Aetna First Health,Commercial,TC,600.95,85,,,313.34,600.95,percent of total billed charges,
"US, PREG. UTERUS, FETAL/MAT. EVAL., 1ST TRIM. (14 WKS 0 DYS), TRANSABD; EACH ADD'L GEST., TECH",7680201,CDM,76802,CPT,402,RC,,,facility,both,,,655,463.74,Aetna First Health,Commercial,TC,556.75,85,,,290.3,556.75,percent of total billed charges,
"US,PREG. UTERUS,FETAL/MAT.EVAL.,>1ST TRIM.(>/= 14 WKS 0 DYS),TRANSABD;SINGLE/FIRST GEST., TECH",7680501,CDM,76805,CPT,402,RC,,,facility,both,,,766,542.33,Aetna First Health,Commercial,TC,651.1,85,,,339.49,651.1,percent of total billed charges,
"US,PREG. UTERUS,FETAL/MAT.EVAL.,>1ST TRIM.(>/= 14 WKS 0 DYS),TRANSABD; EACH ADD'L GEST., TECH",7681001,CDM,76810,CPT,402,RC,,,facility,both,,,565,400.02,Aetna First Health,Commercial,TC,480.25,85,,,250.41,480.25,percent of total billed charges,
"OB US NUCHAL MEASURE,1GEST TC",7681301,CDM,76813,CPT,402,RC,,,facility,both,,,526,372.41,Aetna First Health,Commercial,TC,447.1,85,,,233.12,447.1,percent of total billed charges,
US PREGNANCY TC LIMITED,7681501,CDM,76815,CPT,402,RC,,,facility,both,,,544,385.15,Aetna First Health,Commercial,TC,462.4,85,,,241.1,462.4,percent of total billed charges,
"OB US, LIMITED, FETUS(S)",7681502,CDM,76815,CPT,402,RC,,,facility,both,,,375,265.5,Aetna First Health,Commercial,TC,318.75,85,,,166.2,318.75,percent of total billed charges,
US PREGNANCY TC FOLLOW-UP,7681601,CDM,76816,CPT,402,RC,,,facility,both,,,632,447.46,Aetna First Health,Commercial,TC,537.2,85,,,280.1,537.2,percent of total billed charges,
"TRANSVAGINAL US, OBSTETRIC",7681701,CDM,76817,CPT,402,RC,,,facility,both,,,554,392.23,Aetna First Health,Commercial,TC,470.9,85,,,245.53,470.9,percent of total billed charges,
FETAL PROFILE W/O STRESS,7681901,CDM,76819,CPT,402,RC,,,facility,both,,,671,475.07,Aetna First Health,Commercial,TC,570.35,85,,,297.39,570.35,percent of total billed charges,
"DOPPLER VELOCIMETRY, FETAL, UMBILICAL ARTERY, TECH",7682001,CDM,76820,CPT,402,RC,,,facility,both,,,398,281.78,Aetna First Health,Commercial,TC,338.3,85,,,176.39,338.3,percent of total billed charges,
US TRANSVAGINAL TC,7683001,CDM,76830,CPT,402,RC,,,facility,both,,,606,429.05,Aetna First Health,Commercial,TC,515.1,85,,,268.58,515.1,percent of total billed charges,
"ECHO EXAM, UTERUS TC",7683101,CDM,76831,CPT,402,RC,,,facility,both,,,741,524.63,Aetna First Health,Commercial,TC,629.85,85,,,328.41,629.85,percent of total billed charges,
US PELVIC TC COMPLETE,7685601,CDM,76856,CPT,402,RC,,,facility,both,,,762,539.5,Aetna First Health,Commercial,TC,647.7,85,,,337.72,647.7,percent of total billed charges,
US FOLLICLES-LIMITED TC,7685701,CDM,76857,CPT,402,RC,,,facility,both,,,512,362.5,Aetna First Health,Commercial,TC,435.2,85,,,226.92,435.2,percent of total billed charges,
US SCROTUM & CONTENTS TC,7687001,CDM,76870,CPT,402,RC,,,facility,both,,,668,472.94,Aetna First Health,Commercial,TC,567.8,85,,,296.06,567.8,percent of total billed charges,
ECHOGRAPHY PROSTATE TC,7687201,CDM,76872,CPT,402,RC,,,facility,both,,,609,431.17,Aetna First Health,Commercial,TC,517.65,85,,,269.91,517.65,percent of total billed charges,
"ECHO,TRANSRECTAL,PROSTATE VOL",7687301,CDM,76873,CPT,402,RC,,,facility,both,,,2305,1631.94,Aetna First Health,Commercial,TC,1959.25,85,,,1021.58,1959.25,percent of total billed charges,
"US EXT NON-VASC LIMITED, REALTIME W/ IMG TC",7688201,CDM,76882,CPT,402,RC,,,facility,both,,,535,378.78,Aetna First Health,Commercial,TC,454.75,85,,,237.11,454.75,percent of total billed charges,
"US EXT NON-VASC LIMITED, REALTIME W/ IMG TC",7688202,CDM,76882,CPT,402,RC,,,facility,both,,,535,378.78,Aetna First Health,Commercial,TC,454.75,85,,,237.11,454.75,percent of total billed charges,
"ECHO EXAM,INFANT HIP DYN",7688501,CDM,76885,CPT,402,RC,,,facility,both,,,561,397.19,Aetna First Health,Commercial,TC,476.85,85,,,248.64,476.85,percent of total billed charges,
"ECHO EXAM, INFANT HIP LIM",7688601,CDM,76886,CPT,402,RC,,,facility,both,,,316,223.73,Aetna First Health,Commercial,TC,268.6,85,,,140.05,268.6,percent of total billed charges,
"US GUIDE, VASCULAR ACCESS",7693701,CDM,76937,CPT,402,RC,,,facility,both,,,680,481.44,Aetna First Health,Commercial,TC,578,85,,,301.38,578,percent of total billed charges,
"US GUIDE, VASCULAR ACCESS TECH",7693702,CDM,76937,CPT,402,RC,,,facility,both,,,680,481.44,Aetna First Health,Commercial,TC,578,85,,,301.38,578,percent of total billed charges,
US GUIDE NEEDLE BX S&I,7694201,CDM,76942,CPT,402,RC,,,facility,both,,,754,533.83,Aetna First Health,Commercial,TC,640.9,85,,,334.17,640.9,percent of total billed charges,
US GUIDE AMNIOCENTESIS TC,7694601,CDM,76946,CPT,402,RC,,,facility,both,,,244,172.75,Aetna First Health,Commercial,TC,207.4,85,,,108.14,207.4,percent of total billed charges,
ECHO GUIDANCE RADIOTHERAPY,7696501,CDM,76965,CPT,402,RC,,,facility,both,,,635,449.58,Aetna First Health,Commercial,TC,539.75,85,,,281.43,539.75,percent of total billed charges,
"ULTRASOUND, ELASTOGRAPHY; PARENCHYMA (EG, ORGAN)",7698101,CDM,76981,CPT,402,RC,,,facility,both,,,456,322.85,Aetna First Health,Commercial,TC,387.6,85,,,202.1,387.6,percent of total billed charges,
"US GUIDANCE, INTRAOPERATIVE",7699801,CDM,76998,CPT,402,RC,,,facility,both,,,228,161.42,Aetna First Health,Commercial,TC,193.8,85,,,101.05,193.8,percent of total billed charges,
FLUORO GUIDE-CENTRAL VENOUS,7700101,CDM,77001,CPT,320,RC,,,facility,both,,,795,562.86,Aetna First Health,Commercial,TC,675.75,85,,,352.34,675.75,percent of total billed charges,
FLUOROSCOPY GUID NEEDLE PLCMT TC,7700201,CDM,77002,CPT,320,RC,,,facility,both,,,640,453.12,Aetna First Health,Commercial,TC,544,85,,,283.65,544,percent of total billed charges,
FLUORO GUID/LOCAL NEEDLE/CATH PLCMT TC,7700301,CDM,77003,CPT,320,RC,,,facility,both,,,504,356.83,Aetna First Health,Commercial,TC,428.4,85,,,223.37,428.4,percent of total billed charges,
CT SCAN FOR NEEDLE BIOPSY,7701201,CDM,77012,CPT,351,RC,,,facility,both,,,1903,1347.32,Aetna First Health,Commercial,TC,1617.55,85,,,843.41,1617.55,percent of total billed charges,
"CT GUIDE,RADIATION THERA FIELD",7701401,CDM,77014,CPT,350,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,TC,68,85,,,35.46,68,percent of total billed charges,
CT SCAN FOR THERAPY GUIDE,7701402,CDM,77014,CPT,350,RC,,,facility,both,,,749,530.29,Aetna First Health,Commercial,TC,636.65,85,,,331.96,636.65,percent of total billed charges,
"MAGNETIC RESONANCE IMAGING, BREAST, W/O CONTRAST MATERIAL; UNILATERAL",7704601,CDM,77046,CPT,610,RC,,,facility,both,,,2530,1791.24,Aetna First Health,Commercial,TC,2150.5,85,,,1121.3,2150.5,percent of total billed charges,
"MAGNETIC RESONANCE IMAGING, BREAST, W/O CONTRAST MATERIAL; BILATERAL",7704701,CDM,77047,CPT,610,RC,,,facility,both,,,3774,2671.99,Aetna First Health,Commercial,TC,3207.9,85,,,1672.64,3207.9,percent of total billed charges,
"MRI, BREAST, W/WO CONTRAST MATERIAL; INCL CAD UNILATERAL",7704801,CDM,77048,CPT,610,RC,,,facility,both,,,2616,1852.13,Aetna First Health,Commercial,TC,2223.6,85,,,1159.41,2223.6,percent of total billed charges,
"MRI, BREAST, W/WO CONTRAST MATERIAL; INCL CAD BILATERAL",7704901,CDM,77049,CPT,610,RC,,,facility,both,,,3477,2461.72,Aetna First Health,Commercial,TC,2955.45,85,,,1541.01,2955.45,percent of total billed charges,
XRAY OF MAMMARY DUCT S&I,7705301,CDM,77053,CPT,320,RC,,,facility,both,,,476,337.01,Aetna First Health,Commercial,TC,404.6,85,,,210.96,404.6,percent of total billed charges,
"BREAST TOMOSYNTHESIS,DX TC UNILAT",7706101,CDM,77061,CPT,401,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,TC,69.7,85,,,36.34,69.7,percent of total billed charges,
"BREAST TOMOSYNTHESIS,DX TC BILAT",7706201,CDM,77062,CPT,401,RC,,,facility,both,,,96,67.97,Aetna First Health,Commercial,TC,81.6,85,,,42.55,81.6,percent of total billed charges,
"BREAST TOMOSYNTHESIS,SCREEN TC",7706301,CDM,77063,CPT,403,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,TC,96.05,85,,,50.08,96.05,percent of total billed charges,
"DIGITAL MAMM, DIAG, UNILAT, TC W/CAD PERF",7706501,CDM,77065,CPT,401,RC,,,facility,both,,,443,313.64,Aetna First Health,Commercial,TC,376.55,85,,,196.34,376.55,percent of total billed charges,
"DIGITAL MAMM, DIAG, BILAT, TC W/CAD PERF",7706601,CDM,77066,CPT,401,RC,,,facility,both,,,542,383.74,Aetna First Health,Commercial,TC,460.7,85,,,240.21,460.7,percent of total billed charges,
"DIGITAL MAMMOGRAM, SCREEN BIL, TC W/CAD PERF",7706701,CDM,77067,CPT,403,RC,,,facility,both,,,450,318.6,Aetna First Health,Commercial,TC,382.5,85,,,199.44,382.5,percent of total billed charges,
BONE AGE STUDIES TC,7707201,CDM,77072,CPT,320,RC,,,facility,both,,,301,213.11,Aetna First Health,Commercial,TC,255.85,85,,,133.4,255.85,percent of total billed charges,
BONE LENGTH STUDIES TC,7707301,CDM,77073,CPT,320,RC,,,facility,both,,,404,286.03,Aetna First Health,Commercial,TC,343.4,85,,,179.05,343.4,percent of total billed charges,
XRAY OSSEOUS SURVEY TC COMPLETE,7707501,CDM,77075,CPT,320,RC,,,facility,both,,,987,698.8,Aetna First Health,Commercial,TC,838.95,85,,,437.44,838.95,percent of total billed charges,
XRAY OSSEOUS SURVEY TC INFANT,7707601,CDM,77076,CPT,320,RC,,,facility,both,,,564,399.31,Aetna First Health,Commercial,TC,479.4,85,,,249.96,479.4,percent of total billed charges,
SET RADN THERAPY FIELD SIMPLE,7728001,CDM,77280,CPT,333,RC,,,facility,both,,,254,179.83,Aetna First Health,Commercial,TC,215.9,85,,,112.57,215.9,percent of total billed charges,
SET RADN THERAPY FIELD INTERME,7728501,CDM,77285,CPT,333,RC,,,facility,both,,,394.64,279.41,Aetna First Health,Commercial,TC,335.44,85,,,174.9,335.44,percent of total billed charges,
SET RADN THERAPY FIELD COMPLEX,7729001,CDM,77290,CPT,333,RC,,,facility,both,,,394,278.95,Aetna First Health,Commercial,TC,334.9,85,,,174.62,334.9,percent of total billed charges,
SET RADIATION THERAPY FIELD,7729501,CDM,77295,CPT,333,RC,,,facility,both,,,251.62,178.15,Aetna First Health,Commercial,TC,213.88,85,,,111.52,213.88,percent of total billed charges,
RADN THERAPY DOSIMETRY CALC,7730001,CDM,77300,CPT,333,RC,,,facility,both,,,36,25.49,Aetna First Health,Commercial,TC,30.6,85,,,15.96,30.6,percent of total billed charges,
"RADIOTHERAPY DOSE PLAN, IMRT",7730101,CDM,77301,CPT,333,RC,,,facility,both,,,1540,1090.32,Aetna First Health,Commercial,TC,1309,85,,,682.53,1309,percent of total billed charges,
TELETHX ISODOSE PLAN SIMPLE W/BASIC CALC,7730601,CDM,77306,CPT,333,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,TC,63.75,85,,,33.24,63.75,percent of total billed charges,
TELETHX ISODOSE PLAN COMP W/BASIC CALC,7730701,CDM,77307,CPT,333,RC,,,facility,both,,,136,96.29,Aetna First Health,Commercial,TC,115.6,85,,,60.28,115.6,percent of total billed charges,
TELETHER ISO-PORT PLAN,7732101,CDM,77321,CPT,333,RC,,,facility,both,,,43.75,30.98,Aetna First Health,Commercial,TC,37.19,85,,,19.39,37.19,percent of total billed charges,
SPECIAL RADIATION DOSIMETRY,7733101,CDM,77331,CPT,333,RC,,,facility,both,,,18.67,13.22,Aetna First Health,Commercial,TC,15.87,85,,,8.27,15.87,percent of total billed charges,
RADN TREATMENT AID(S) SIMPLE,7733201,CDM,77332,CPT,333,RC,,,facility,both,,,15,10.62,Aetna First Health,Commercial,TC,12.75,85,,,6.65,12.75,percent of total billed charges,
RADN TREATMENT AID(S) INTERM,7733301,CDM,77333,CPT,333,RC,,,facility,both,,,101.13,71.6,Aetna First Health,Commercial,TC,85.96,85,,,44.82,85.96,percent of total billed charges,
CYB-TRTMT DEVICE COMPLEX-MASK,7733401,CDM,77334,CPT,333,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,TC,59.5,85,,,31.02,59.5,percent of total billed charges,
TREATMENT DEVICES - COMPLEX,7733407,CDM,77334,CPT,333,RC,,,facility,both,,,1186,839.69,Aetna First Health,Commercial,TC,1008.1,85,,,525.64,1008.1,percent of total billed charges,
CONTIN MEDPHY CONSULT,7733601,CDM,77336,CPT,333,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,TC,75.65,85,,,39.44,75.65,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,7733801,CDM,77338,CPT,333,RC,,,facility,both,,,254,179.83,Aetna First Health,Commercial,TC,215.9,85,,,112.57,215.9,percent of total billed charges,
CYB-SPECIAL PHYSICS CONSULT,7737001,CDM,77370,CPT,333,RC,,,facility,both,,,134,94.87,Aetna First Health,Commercial,TC,113.9,85,,,59.39,113.9,percent of total billed charges,
SPECIAL RADIATION TREATMENT,7747001,CDM,77470,CPT,333,RC,,,facility,both,,,28.98,20.52,Aetna First Health,Commercial,TC,24.63,85,,,12.84,24.63,percent of total billed charges,
INTERSTI RADIOELEM APPL COMPLX,7777801,CDM,77778,CPT,333,RC,,,facility,both,,,5675,4017.9,Aetna First Health,Commercial,TC,4823.75,85,,,2515.16,4823.75,percent of total billed charges,
THYROID IMAGING W/BLOOD FLOW W/SGL OR MLT UPTK,7801401,CDM,78014,CPT,341,RC,,,facility,both,,,1282,907.66,Aetna First Health,Commercial,TC,1089.7,85,,,568.18,1089.7,percent of total billed charges,
THYROID MET IMAGING BODY,7801801,CDM,78018,CPT,341,RC,,,facility,both,,,1674,1185.19,Aetna First Health,Commercial,TC,1422.9,85,,,741.92,1422.9,percent of total billed charges,
PARATHYROID SCAN,7807001,CDM,78070,CPT,341,RC,,,facility,both,,,1056,747.65,Aetna First Health,Commercial,TC,897.6,85,,,468.02,897.6,percent of total billed charges,
PARATHYRD PLANAR W/SPECT&CT,7807201,CDM,78072,CPT,341,RC,,,facility,both,,,920,651.36,Aetna First Health,Commercial,TC,782,85,,,407.74,782,percent of total billed charges,
LYMPHATIC GLAND IMAGING,7819501,CDM,78195,CPT,341,RC,,,facility,both,,,1887,1336,Aetna First Health,Commercial,TC,1603.95,85,,,836.32,1603.95,percent of total billed charges,
LIVER AND SPLEEN IMAGING,7821501,CDM,78215,CPT,341,RC,,,facility,both,,,1217,861.64,Aetna First Health,Commercial,TC,1034.45,85,,,539.37,1034.45,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAGING,7822601,CDM,78226,CPT,341,RC,,,facility,both,,,1667,1180.24,Aetna First Health,Commercial,TC,1416.95,85,,,738.81,1416.95,percent of total billed charges,
HEPATOBIL SYST IMAGE W/DRUG,7822701,CDM,78227,CPT,341,RC,,,facility,both,,,2091,1480.43,Aetna First Health,Commercial,TC,1777.35,85,,,926.73,1777.35,percent of total billed charges,
GASTRIC EMPTYING STUDY,7826401,CDM,78264,CPT,341,RC,,,facility,both,,,1817,1286.44,Aetna First Health,Commercial,TC,1544.45,85,,,805.29,1544.45,percent of total billed charges,
GI BLEED SCAN,7827801,CDM,78278,CPT,341,RC,,,facility,both,,,2227,1576.72,Aetna First Health,Commercial,TC,1892.95,85,,,987.01,1892.95,percent of total billed charges,
MECKELS SCAN,7829001,CDM,78290,CPT,341,RC,,,facility,both,,,482,341.26,Aetna First Health,Commercial,TC,409.7,85,,,213.62,409.7,percent of total billed charges,
PARTIAL BONE SCAN,7830001,CDM,78300,CPT,341,RC,,,facility,both,,,1319,933.85,Aetna First Health,Commercial,TC,1121.15,85,,,584.58,1121.15,percent of total billed charges,
"BONE SCAN, WHOLE BODY",7830601,CDM,78306,CPT,341,RC,,,facility,both,,,1682,1190.86,Aetna First Health,Commercial,TC,1429.7,85,,,745.46,1429.7,percent of total billed charges,
NM BONE IMAGING 3 PHASE,7831501,CDM,78315,CPT,341,RC,,,facility,both,,,1962,1389.1,Aetna First Health,Commercial,TC,1667.7,85,,,869.56,1667.7,percent of total billed charges,
"HT MUSCLE IMAGE SPECT, SING",7845101,CDM,78451,CPT,340,RC,,,facility,both,,,3162,2238.7,Aetna First Health,Commercial,TC,2687.7,85,,,1401.4,2687.7,percent of total billed charges,
"HT MUSCLE IMAGE SPECT, MULT",7845201,CDM,78452,CPT,340,RC,,,facility,both,,,3769,2668.45,Aetna First Health,Commercial,TC,3203.65,85,,,1670.42,3203.65,percent of total billed charges,
"GATED HEART, PLANAR SINGLE",7847201,CDM,78472,CPT,341,RC,,,facility,both,,,1746,1236.17,Aetna First Health,Commercial,TC,1484.1,85,,,773.83,1484.1,percent of total billed charges,
LUNG VENTILATION IMAGING,7857901,CDM,78579,CPT,341,RC,,,facility,both,,,859,608.17,Aetna First Health,Commercial,TC,730.15,85,,,380.71,730.15,percent of total billed charges,
LUNG PERFUSION IMAGING,7858001,CDM,78580,CPT,341,RC,,,facility,both,,,1012,716.5,Aetna First Health,Commercial,TC,860.2,85,,,448.52,860.2,percent of total billed charges,
LUNG VENTILAT&PERFUS IMAGING,7858201,CDM,78582,CPT,341,RC,,,facility,both,,,1701,1204.31,Aetna First Health,Commercial,TC,1445.85,85,,,753.88,1445.85,percent of total billed charges,
RENOGRAM FLOW + FUNCTION,7870701,CDM,78707,CPT,341,RC,,,facility,both,,,1385,980.58,Aetna First Health,Commercial,TC,1177.25,85,,,613.83,1177.25,percent of total billed charges,
KIDNEY FLOW/FUNC SINGLE,7870801,CDM,78708,CPT,341,RC,,,facility,both,,,1772,1254.58,Aetna First Health,Commercial,TC,1506.2,85,,,785.35,1506.2,percent of total billed charges,
URETERAL REFLUX STUDY,7874001,CDM,78740,CPT,341,RC,,,facility,both,,,470,332.76,Aetna First Health,Commercial,TC,399.5,85,,,208.3,399.5,percent of total billed charges,
"TUMOR IMAGING, SINGLE AREA, INCL VASC FLOW & BLOOD POOL IMAG (TC)",7880001,CDM,78800,CPT,341,RC,,,facility,both,,,484,342.67,Aetna First Health,Commercial,TC,411.4,85,,,214.51,411.4,percent of total billed charges,
"TUMOR IMAG, SPECT SINGLE AREA, INCL VASC FLOW & BLOOD POOL IMAG (TC)",7880301,CDM,78803,CPT,341,RC,,,facility,both,,,2451,1735.31,Aetna First Health,Commercial,TC,2083.35,85,,,1086.28,2083.35,percent of total billed charges,
"TUMOR IMAG, WHOLE BODY,INCL VASC FLOW & BLD POOL IMAG, 2+DAYS",7880401,CDM,78804,CPT,341,RC,,,facility,both,,,2472,1750.18,Aetna First Health,Commercial,TC,2101.2,85,,,1095.59,2101.2,percent of total billed charges,
PET/CT CHEST/HEAD/NECK TC,7881401,CDM,78814,CPT,404,RC,,,facility,both,,,4291,3038.03,Aetna First Health,Commercial,TC,3647.35,85,,,1901.77,3647.35,percent of total billed charges,
PET/CT SKULL-MID THIGH TC,7881501,CDM,78815,CPT,404,RC,,,facility,both,,,5886,4167.29,Aetna First Health,Commercial,TC,5003.1,85,,,2608.68,5003.1,percent of total billed charges,
PET/CT WHOLE BODY TC,7881601,CDM,78816,CPT,404,RC,,,facility,both,,,5625,3982.5,Aetna First Health,Commercial,TC,4781.25,85,,,2493,4781.25,percent of total billed charges,
RADIOPH LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMG,7883001,CDM,78830,CPT,341,RC,,,facility,both,,,2415,1709.82,Aetna First Health,Commercial,TC,2052.75,85,,,1070.33,2052.75,percent of total billed charges,
RADIOPH LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D,7883201,CDM,78832,CPT,341,RC,,,facility,both,,,2345,1660.26,Aetna First Health,Commercial,TC,1993.25,85,,,1039.3,1993.25,percent of total billed charges,
TX-131 SUBSEQUENT HYPE,7900501,CDM,79005,CPT,342,RC,,,facility,both,,,927,656.32,Aetna First Health,Commercial,TC,787.95,85,,,410.85,787.95,percent of total billed charges,
"NUCLEAR RX, IV ADMIN",7910101,CDM,79101,CPT,340,RC,,,facility,both,,,405,286.74,Aetna First Health,Commercial,TC,344.25,85,,,179.5,344.25,percent of total billed charges,
"NUCLEAR RX, INTRA-ARTERIAL",7944501,CDM,79445,CPT,340,RC,,,facility,both,,,484,342.67,Aetna First Health,Commercial,TC,411.4,85,,,214.51,411.4,percent of total billed charges,
LIPOPROTEIN PROFILE 2 - REF,8006190,CDM,80061,CPT,300,RC,,,facility,both,,,55,38.94,Aetna First Health,Commercial,90,46.75,85,,,24.38,46.75,percent of total billed charges,
ADALIMUMAB - REF,8014590,CDM,80145,CPT,300,RC,,,facility,both,,,260,184.08,Aetna First Health,Commercial,90,221,85,,,115.23,221,percent of total billed charges,
AMIKACIN - REF,8015090,CDM,80150,CPT,300,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,90,104.55,85,,,54.51,104.55,percent of total billed charges,
AMIODARONE,8015190,CDM,80151,CPT,300,RC,,,facility,both,,,27,19.12,Aetna First Health,Commercial,90,22.95,85,,,11.97,22.95,percent of total billed charges,
"CARBAMAZEPINE, TOTAL - REF",8015690,CDM,80156,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,90,72.25,85,,,37.67,72.25,percent of total billed charges,
"CARBAMAZEPINE, FREE - REF",8015790,CDM,80157,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,90,70.55,85,,,36.79,70.55,percent of total billed charges,
CYCLOSPORINE - REF,8015890,CDM,80158,CPT,300,RC,,,facility,both,,,145,102.66,Aetna First Health,Commercial,90,123.25,85,,,64.26,123.25,percent of total billed charges,
CLOZAPINE - REF,8015990,CDM,80159,CPT,300,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,90,96.9,85,,,50.52,96.9,percent of total billed charges,
"CARBAMAZEPINE;10,11-EPOXIDE",8016190,CDM,80161,CPT,300,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,90,22.1,85,,,11.52,22.1,percent of total billed charges,
VALPROIC ACID - REF,8016490,CDM,80164,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,90,72.25,85,,,37.67,72.25,percent of total billed charges,
VALPROIC ACID (DIPROPYLACETIC ACID); FREE - REF,8016590,CDM,80165,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,90,119,85,,,62.05,119,percent of total billed charges,
FELBAMATE,8016790,CDM,80167,CPT,300,RC,,,facility,both,,,51,36.11,Aetna First Health,Commercial,90,43.35,85,,,22.6,43.35,percent of total billed charges,
ETHOSUXIMIDE - REF,8016890,CDM,80168,CPT,300,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,90,66.3,85,,,34.57,66.3,percent of total billed charges,
EVEROLIMUS,8016990,CDM,80169,CPT,300,RC,,,facility,both,,,261,184.79,Aetna First Health,Commercial,,221.85,85,,,115.68,221.85,percent of total billed charges,
GABAPENTIN - REF,8017190,CDM,80171,CPT,300,RC,,,facility,both,,,25,17.7,Aetna First Health,Commercial,90,21.25,85,,,11.08,21.25,percent of total billed charges,
"HALOPERIDOL, S - REF",8017390,CDM,80173,CPT,300,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,90,83.3,85,,,43.43,83.3,percent of total billed charges,
LAMOTRIGINE - REF,8017590,CDM,80175,CPT,300,RC,,,facility,both,,,20,14.16,Aetna First Health,Commercial,90,17,85,,,8.86,17,percent of total billed charges,
LEVETIRACETAM - REF,8017790,CDM,80177,CPT,300,RC,,,facility,both,,,28,19.82,Aetna First Health,Commercial,90,23.8,85,,,12.41,23.8,percent of total billed charges,
MYCOPHENOLATE MYCOPHENOLICACID - REF,8018090,CDM,80180,CPT,300,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,90,28.9,85,,,15.07,28.9,percent of total billed charges,
FLECAINIDE,8018190,CDM,80181,CPT,300,RC,,,facility,both,,,52,36.82,Aetna First Health,Commercial,90,44.2,85,,,23.05,44.2,percent of total billed charges,
OXCARBAZEPINE - REF,8018390,CDM,80183,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,90,55.25,85,,,28.81,55.25,percent of total billed charges,
PHENOBARBITAL ASSAY - REF,8018490,CDM,80184,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,90,59.5,85,,,31.02,59.5,percent of total billed charges,
"PHYENTOIN, TOTAL - REF",8018590,CDM,80185,CPT,300,RC,,,facility,both,,,47,33.28,Aetna First Health,Commercial,90,39.95,85,,,20.83,39.95,percent of total billed charges,
"PHENYTOIN, FREE - REF",8018690,CDM,80186,CPT,300,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,90,41.65,85,,,21.72,41.65,percent of total billed charges,
POSACONAZOLE - REF,8018790,CDM,80187,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
PRIMIDONE ASSAY - REF,8018890,CDM,80188,CPT,300,RC,,,facility,both,,,55,38.94,Aetna First Health,Commercial,90,46.75,85,,,24.38,46.75,percent of total billed charges,
ITRACONAZOLE,8018990,CDM,80189,CPT,300,RC,,,facility,both,,,52,36.82,Aetna First Health,Commercial,90,44.2,85,,,23.05,44.2,percent of total billed charges,
LEFLUNOMIDE,8019390,CDM,80193,CPT,300,RC,,,facility,both,,,37,26.2,Aetna First Health,Commercial,90,31.45,85,,,16.4,31.45,percent of total billed charges,
"QUINIDINE, S",8019490,CDM,80194,CPT,300,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,90,42.5,85,,,22.16,42.5,percent of total billed charges,
RAPAMYCIN (SIROLIMUS) - REF,8019590,CDM,80195,CPT,300,RC,,,facility,both,,,55,38.94,Aetna First Health,Commercial,90,46.75,85,,,24.38,46.75,percent of total billed charges,
TACROLIMUS - REF,8019790,CDM,80197,CPT,300,RC,,,facility,both,,,92,65.14,Aetna First Health,Commercial,90,78.2,85,,,40.77,78.2,percent of total billed charges,
TIAGABINE - REF,8019990,CDM,80199,CPT,300,RC,,,facility,both,,,60,42.48,Aetna First Health,Commercial,90,51,85,,,26.59,51,percent of total billed charges,
TOPIRAMATE - REF,8020190,CDM,80201,CPT,300,RC,,,facility,both,,,117,82.84,Aetna First Health,Commercial,90,99.45,85,,,51.85,99.45,percent of total billed charges,
ZONISAMIDE - REF,8020390,CDM,80203,CPT,300,RC,,,facility,both,,,60,42.48,Aetna First Health,Commercial,90,51,85,,,26.59,51,percent of total billed charges,
RUFINAMIDE,8021090,CDM,80210,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,90,76.5,85,,,39.89,76.5,percent of total billed charges,
DRUG ASSAY HYDROXYCHLOROQUINE,8022090,CDM,80220,CPT,300,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,90,69.7,85,,,36.34,69.7,percent of total billed charges,
INFLIXIMAB - REF,8023090,CDM,80230,CPT,300,RC,,,facility,both,,,185,130.98,Aetna First Health,Commercial,90,157.25,85,,,81.99,157.25,percent of total billed charges,
LACOSAMIDE - REF,8023590,CDM,80235,CPT,300,RC,,,facility,both,,,117,82.84,Aetna First Health,Commercial,90,99.45,85,,,51.85,99.45,percent of total billed charges,
VEDOLIZUMAB - REF,8028090,CDM,80280,CPT,300,RC,,,facility,both,,,285,201.78,Aetna First Health,Commercial,90,242.25,85,,,126.31,242.25,percent of total billed charges,
VORICONAZOLE - REF,8028590,CDM,80285,CPT,300,RC,,,facility,both,,,79,55.93,Aetna First Health,Commercial,90,67.15,85,,,35.01,67.15,percent of total billed charges,
QUANTITATION DRUG NOS - REF,8029990,CDM,80299,CPT,300,RC,,,facility,both,,,151,106.91,Aetna First Health,Commercial,90,128.35,85,,,66.92,128.35,percent of total billed charges,
DRUG SCREEN CLASS LIST A - REF,8030790,CDM,80307,CPT,300,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,90,63.75,85,,,33.24,63.75,percent of total billed charges,
ALCOHOLS - REF,8032090,CDM,80320,CPT,300,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,90,53.55,85,,,27.92,53.55,percent of total billed charges,
ALCOHOL BIOMARKERS; 1 OR 2 - REF,8032190,CDM,80321,CPT,300,RC,,,facility,both,,,159,112.57,Aetna First Health,Commercial,90,135.15,85,,,70.47,135.15,percent of total billed charges,
"ALKALOIDS, NOT OTHERWISE SPECIFIED - REF",8032390,CDM,80323,CPT,300,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,90,69.7,85,,,36.34,69.7,percent of total billed charges,
AMPHETAMINES; 1 OR 2 - REF,8032490,CDM,80324,CPT,300,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,90,34.85,85,,,18.17,34.85,percent of total billed charges,
AMPHETAMINES; 3 OR 4,8032590,CDM,80325,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,90,59.5,85,,,31.02,59.5,percent of total billed charges,
AMPHETAMINES; 5 OR MORE,8032690,CDM,80326,CPT,300,RC,,,facility,both,,,36,25.49,Aetna First Health,Commercial,90,30.6,85,,,15.96,30.6,percent of total billed charges,
ANABOLIC STEROIDS; 1 OR 2 - REF,8032790,CDM,80327,CPT,300,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,90,41.65,85,,,21.72,41.65,percent of total billed charges,
"ANALGESICS, NON-OPIOID; 1 OR 2",8032990,CDM,80329,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
"ANTIDEPRESSANTS, SEROTONERGIC CLASS; 1  OR 2 - REF",8033290,CDM,80332,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,90,55.25,85,,,28.81,55.25,percent of total billed charges,
"ANTIDEPRESSANTS, SEROTONERGIC CLASS; 3-5",8033390,CDM,80333,CPT,300,RC,,,facility,both,,,66,46.73,Aetna First Health,Commercial,90,56.1,85,,,29.25,56.1,percent of total billed charges,
"ANTIDEPRESSANT, TRICYCLIC AND OTHER CYCLICALS; 1 OR 2 - REF",8033590,CDM,80335,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
"ANTIDEPRESSANT, TRICYCLIC AND OTHER CYCLICALS; 6  OR MORE",8033790,CDM,80337,CPT,300,RC,,,facility,both,,,46,32.57,Aetna First Health,Commercial,90,39.1,85,,,20.39,39.1,percent of total billed charges,
"ANTIEPILEPTICS, NOT OTHERWISE SPECIFIED; 1-3 - REF",8033990,CDM,80339,CPT,300,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,90,75.65,85,,,39.44,75.65,percent of total billed charges,
"ANTIPSYCHOTICS, NOT OTHERWISE SPECIFIED; 1-3 - REF",8034290,CDM,80342,CPT,300,RC,,,facility,both,,,178,126.02,Aetna First Health,Commercial,90,151.3,85,,,78.89,151.3,percent of total billed charges,
BARBITURATES - REF,8034590,CDM,80345,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,90,70.55,85,,,36.79,70.55,percent of total billed charges,
BENZODIAZEPINES; 1-12 - REF,8034690,CDM,80346,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
BENZODIAZEPINES; 13 OR MORE,8034790,CDM,80347,CPT,300,RC,,,facility,both,,,135,95.58,Aetna First Health,Commercial,90,114.75,85,,,59.83,114.75,percent of total billed charges,
BUPRENORPHINE - REF,8034890,CDM,80348,CPT,300,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,90,79.05,85,,,41.22,79.05,percent of total billed charges,
"CANNABINOIDS, NATURAL - REF",8034990,CDM,80349,CPT,300,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,90,41.65,85,,,21.72,41.65,percent of total billed charges,
"CANNABINOIDS, SYNTHETIC, 7 OR MORE - REF",8035290,CDM,80352,CPT,300,RC,,,facility,both,,,161,113.99,Aetna First Health,Commercial,90,136.85,85,,,71.36,136.85,percent of total billed charges,
COCAINE - REF,8035390,CDM,80353,CPT,300,RC,,,facility,both,,,60,42.48,Aetna First Health,Commercial,90,51,85,,,26.59,51,percent of total billed charges,
FENTANYL - REF,8035490,CDM,80354,CPT,300,RC,,,facility,both,,,105,74.34,Aetna First Health,Commercial,90,89.25,85,,,46.54,89.25,percent of total billed charges,
"GABAPENTIN, NON-BLOOD",8035590,CDM,80355,CPT,300,RC,,,facility,both,,,39,27.61,Aetna First Health,Commercial,90,33.15,85,,,17.28,33.15,percent of total billed charges,
HEROIN METABOLITE - REF,8035690,CDM,80356,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
METHADONE - REF,8035890,CDM,80358,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
"METHLENEDIOXYAMPHETAMINES (MDA, MDEA, MDMA) - REF",8035990,CDM,80359,CPT,300,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,90,34.85,85,,,18.17,34.85,percent of total billed charges,
"OPIATES, 1 OR MORE - REF",8036190,CDM,80361,CPT,300,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,90,34.85,85,,,18.17,34.85,percent of total billed charges,
OPIOIDS AND OPIATE ANALOGS; 1 OR 2 - REF,8036290,CDM,80362,CPT,300,RC,,,facility,both,,,84,59.47,Aetna First Health,Commercial,90,71.4,85,,,37.23,71.4,percent of total billed charges,
OPIOIDS AND OPIATE ANALOGS; 5 OR MORE,8036490,CDM,80364,CPT,300,RC,,,facility,both,,,220,155.76,Aetna First Health,Commercial,90,187,85,,,97.5,187,percent of total billed charges,
OXYCODONE - REF,8036590,CDM,80365,CPT,300,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,90,34.85,85,,,18.17,34.85,percent of total billed charges,
PREGABALIN - REF,8036690,CDM,80366,CPT,300,RC,,,facility,both,,,84,59.47,Aetna First Health,Commercial,90,71.4,85,,,37.23,71.4,percent of total billed charges,
SKELETAL MUSCLE RELAXANTS; 1 OR 2,8036990,CDM,80369,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,90,50.15,85,,,26.15,50.15,percent of total billed charges,
"STIMULANTS, SYNTHETIC - REF",8037190,CDM,80371,CPT,300,RC,,,facility,both,,,188,133.1,Aetna First Health,Commercial,90,159.8,85,,,83.32,159.8,percent of total billed charges,
TRAMADOL - REF,8037390,CDM,80373,CPT,300,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,90,42.5,85,,,22.16,42.5,percent of total billed charges,
"DRUG(S) OR SUBSTANCE(S), DEFINITIVE, QUALITATIVE OR QUANTITATIVE, NOT OTHERWISE SPECIFIED; 1-3 - REF",8037590,CDM,80375,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,90,77.35,85,,,40.33,77.35,percent of total billed charges,
"DRUG(S) OR SUBSTANCE(S), DEFINITIVE, QUALITATIVE OR QUANTITATIVE, NOT OTHERWISE SPECIFIED;7 OR MORE",8037790,CDM,80377,CPT,300,RC,,,facility,both,,,145,102.66,Aetna First Health,Commercial,90,123.25,85,,,64.26,123.25,percent of total billed charges,
URINALYSIS QUAL/SEMIQUANT EXCE - REF,8100590,CDM,81005,CPT,300,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,90,57.8,85,,,30.14,57.8,percent of total billed charges,
BRCA1&BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS - REF,8116290,CDM,81162,CPT,300,RC,,,facility,both,,,2040,1444.32,Aetna First Health,Commercial,90,1734,85,,,904.13,1734,percent of total billed charges,
ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS - REF,8117090,CDM,81170,CPT,300,RC,,,facility,both,,,625,442.5,Aetna First Health,Commercial,90,531.25,85,,,277,531.25,percent of total billed charges,
APC GENE FULL SEQ - REF,8120190,CDM,81201,CPT,310,RC,,,facility,both,,,1866,1321.13,Aetna First Health,Commercial,90,1586.1,85,,,827.01,1586.1,percent of total billed charges,
BCR/ABL1 P210 - REF,8120690,CDM,81206,CPT,310,RC,,,facility,both,,,729,516.13,Aetna First Health,Commercial,90,619.65,85,,,323.09,619.65,percent of total billed charges,
BCR/ABL1 MINOR - REF,8120790,CDM,81207,CPT,310,RC,,,facility,both,,,235,166.38,Aetna First Health,Commercial,90,199.75,85,,,104.15,199.75,percent of total billed charges,
BCR/ABL1 OTHER - REF,8120890,CDM,81208,CPT,310,RC,,,facility,both,,,219,155.05,Aetna First Health,Commercial,90,186.15,85,,,97.06,186.15,percent of total billed charges,
BRAF GENE ANALYSIS V600E - REF,8121090,CDM,81210,CPT,300,RC,,,facility,both,,,410,290.28,Aetna First Health,Commercial,90,348.5,85,,,181.71,348.5,percent of total billed charges,
GENE BRACA 2,8121790,CDM,81217,CPT,300,RC,,,facility,both,,,509,360.37,Aetna First Health,Commercial,90,432.65,85,,,225.59,432.65,percent of total billed charges,
CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 - REF,8121990,CDM,81219,CPT,300,RC,,,facility,both,,,371,262.67,Aetna First Health,Commercial,90,315.35,85,,,164.43,315.35,percent of total billed charges,
CFTR GENE COM VARIANTS - REF,8122090,CDM,81220,CPT,300,RC,,,facility,both,,,150,106.2,Aetna First Health,Commercial,90,127.5,85,,,66.48,127.5,percent of total billed charges,
CFTR GENE DUP/DELET VARIANTS - REF,8122290,CDM,81222,CPT,300,RC,,,facility,both,,,726,514.01,Aetna First Health,Commercial,90,617.1,85,,,321.76,617.1,percent of total billed charges,
CFTR FULL GENE SEQUENCE - REF,8122390,CDM,81223,CPT,300,RC,,,facility,both,,,727,514.72,Aetna First Health,Commercial,90,617.95,85,,,322.21,617.95,percent of total billed charges,
CYP2C19 GENE COM VARIANTS - REF,8122590,CDM,81225,CPT,300,RC,,,facility,both,,,625,442.5,Aetna First Health,Commercial,90,531.25,85,,,277,531.25,percent of total billed charges,
CYP2D6 GENE COM VARIANTS - REF,8122690,CDM,81226,CPT,300,RC,,,facility,both,,,501,354.71,Aetna First Health,Commercial,90,425.85,85,,,222.04,425.85,percent of total billed charges,
CYP2C9 GENE COM VARIANTS - REF,8122790,CDM,81227,CPT,300,RC,,,facility,both,,,650,460.2,Aetna First Health,Commercial,90,552.5,85,,,288.08,552.5,percent of total billed charges,
CYTOGEN MICRARRAY COPY NMBR - REF,8122890,CDM,81228,CPT,300,RC,,,facility,both,,,1837,1300.6,Aetna First Health,Commercial,90,1561.45,85,,,814.16,1561.45,percent of total billed charges,
CYTOGEN M ARRAY - REF,8122990,CDM,81229,CPT,310,RC,,,facility,both,,,1892,1339.54,Aetna First Health,Commercial,90,1608.2,85,,,838.53,1608.2,percent of total billed charges,
"CYP3A5 (CYTOCHROME P450 FAMILY 3 SUBFAMILY A MEMBER 5) (DRUG METABOLISM), GENE ANLYS, CMN VARIANTS",8123190,CDM,81231,CPT,300,RC,,,facility,both,,,1560,1104.48,Aetna First Health,Commercial,90,1326,85,,,691.39,1326,percent of total billed charges,
"DPYD (DIHYDROPYRIMIDINE DEHYDROGENASE), GENE ANLYS, CMN VARIANTS - REF",8123290,CDM,81232,CPT,300,RC,,,facility,both,,,720,509.76,Aetna First Health,Commercial,90,612,85,,,319.1,612,percent of total billed charges,
EGFR GENE - REF,8123590,CDM,81235,CPT,310,RC,,,facility,both,,,1576,1115.81,Aetna First Health,Commercial,90,1339.6,85,,,698.48,1339.6,percent of total billed charges,
F2 GENE - REF,8124090,CDM,81240,CPT,300,RC,,,facility,both,,,619,438.25,Aetna First Health,Commercial,90,526.15,85,,,274.34,526.15,percent of total billed charges,
F5 GENE - REF,8124190,CDM,81241,CPT,300,RC,,,facility,both,,,507,358.96,Aetna First Health,Commercial,90,430.95,85,,,224.7,430.95,percent of total billed charges,
FMR1 GENE ANALYSIS - REF,8124390,CDM,81243,CPT,310,RC,,,facility,both,,,433,306.56,Aetna First Health,Commercial,90,368.05,85,,,191.91,368.05,percent of total billed charges,
FMR1 GENE CHARACTERIZATION - REF,8124490,CDM,81244,CPT,300,RC,,,facility,both,,,220,155.76,Aetna First Health,Commercial,90,187,85,,,97.5,187,percent of total billed charges,
FLT3 GENE ANALYSIS INTERNAL - REF,8124590,CDM,81245,CPT,300,RC,,,facility,both,,,374,264.79,Aetna First Health,Commercial,90,317.9,85,,,165.76,317.9,percent of total billed charges,
FLT3 GENE ANALYSIS - REF,8124690,CDM,81246,CPT,300,RC,,,facility,both,,,225,159.3,Aetna First Health,Commercial,90,191.25,85,,,99.72,191.25,percent of total billed charges,
HFE GENE - REF,8125690,CDM,81256,CPT,300,RC,,,facility,both,,,502,355.42,Aetna First Health,Commercial,90,426.7,85,,,222.49,426.7,percent of total billed charges,
HBA1/HBA2 GENE - REF,8125790,CDM,81257,CPT,300,RC,,,facility,both,,,128,90.62,Aetna First Health,Commercial,90,108.8,85,,,56.73,108.8,percent of total billed charges,
HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE - REF,8125990,CDM,81259,CPT,300,RC,,,facility,both,,,761,538.79,Aetna First Health,Commercial,90,646.85,85,,,337.28,646.85,percent of total billed charges,
IGH GENE REARRANGE AMP METH - REF,8126190,CDM,81261,CPT,300,RC,,,facility,both,,,604,427.63,Aetna First Health,Commercial,90,513.4,85,,,267.69,513.4,percent of total billed charges,
"IGH, VARIABLE REGION SOMATIC MUTATION ANALYSIS",8126390,CDM,81263,CPT,310,RC,,,facility,both,,,728,515.42,Aetna First Health,Commercial,90,618.8,85,,,322.65,618.8,percent of total billed charges,
IGK REARRANGEABN CLONAL POP - REF,8126490,CDM,81264,CPT,300,RC,,,facility,both,,,420,297.36,Aetna First Health,Commercial,90,357,85,,,186.14,357,percent of total billed charges,
COMPARATIVE ANALYSIS USING STR - REF,8126590,CDM,81265,CPT,310,RC,,,facility,both,,,278,196.82,Aetna First Health,Commercial,90,236.3,85,,,123.21,236.3,percent of total billed charges,
CHIMERISM ANAL NO CELL SELEC - REF,8126790,CDM,81267,CPT,310,RC,,,facility,both,,,685,484.98,Aetna First Health,Commercial,90,582.25,85,,,303.59,582.25,percent of total billed charges,
CHIMERISM CELL SORT 1,8126890,CDM,81268,CPT,310,RC,,,facility,both,,,600,424.8,Aetna First Health,Commercial,90,510,85,,,265.92,510,percent of total billed charges,
"HBA1/HBA2 (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2), GENE ANALYSIS; DUPLICATION/DELETION VARIANTS - REF",8126990,CDM,81269,CPT,300,RC,,,facility,both,,,419,296.65,Aetna First Health,Commercial,90,356.15,85,,,185.7,356.15,percent of total billed charges,
JAK2 GENE - REF,8127090,CDM,81270,CPT,300,RC,,,facility,both,,,583,412.76,Aetna First Health,Commercial,90,495.55,85,,,258.39,495.55,percent of total billed charges,
KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS - REF,8127290,CDM,81272,CPT,300,RC,,,facility,both,,,1188,841.1,Aetna First Health,Commercial,90,1009.8,85,,,526.52,1009.8,percent of total billed charges,
KIT GENE ANALYSIS D816 VARIANT(S) - REF,8127390,CDM,81273,CPT,300,RC,,,facility,both,,,836,591.89,Aetna First Health,Commercial,90,710.6,85,,,370.52,710.6,percent of total billed charges,
KRAS GENE - REF,8127590,CDM,81275,CPT,300,RC,,,facility,both,,,730,516.84,Aetna First Health,Commercial,90,620.5,85,,,323.54,620.5,percent of total billed charges,
METHYLATION ASSAY - REF,8128790,CDM,81287,CPT,310,RC,,,facility,both,,,546,386.57,Aetna First Health,Commercial,90,464.1,85,,,241.99,464.1,percent of total billed charges,
MLH1 GENE - REF,8128890,CDM,81288,CPT,300,RC,,,facility,both,,,420,297.36,Aetna First Health,Commercial,90,357,85,,,186.14,357,percent of total billed charges,
MTHFR GENE - REF,8129190,CDM,81291,CPT,300,RC,,,facility,both,,,137,97,Aetna First Health,Commercial,90,116.45,85,,,60.72,116.45,percent of total billed charges,
MLH1 GENE FULL SEQ - REF,8129290,CDM,81292,CPT,300,RC,,,facility,both,,,552,390.82,Aetna First Health,Commercial,90,469.2,85,,,244.65,469.2,percent of total billed charges,
MSH2 GENE FULL SEQ,8129590,CDM,81295,CPT,300,RC,,,facility,both,,,518,366.74,Aetna First Health,Commercial,90,440.3,85,,,229.58,440.3,percent of total billed charges,
MSH6 GENE FULL SEQ,8129890,CDM,81298,CPT,300,RC,,,facility,both,,,914,647.11,Aetna First Health,Commercial,90,776.9,85,,,405.08,776.9,percent of total billed charges,
MICROSATELLITE INSTABILITY - REF,8130190,CDM,81301,CPT,300,RC,,,facility,both,,,495,350.46,Aetna First Health,Commercial,90,420.75,85,,,219.38,420.75,percent of total billed charges,
MYD88 GENE P.LEU265PRO VRNT,8130590,CDM,81305,CPT,300,RC,,,facility,both,,,865,612.42,Aetna First Health,Commercial,90,735.25,85,,,383.37,735.25,percent of total billed charges,
"NPM1 GENE ANALYSIS, EXON 12 - REF",8131090,CDM,81310,CPT,300,RC,,,facility,both,,,636,450.29,Aetna First Health,Commercial,90,540.6,85,,,281.88,540.6,percent of total billed charges,
NRAS GENE ANALYSIS VARIANTS IN EXON 2&3,8131190,CDM,81311,CPT,300,RC,,,facility,both,,,2651,1876.91,Aetna First Health,Commercial,90,2253.35,85,,,1174.92,2253.35,percent of total billed charges,
PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS - REF,8131490,CDM,81314,CPT,300,RC,,,facility,both,,,1080,764.64,Aetna First Health,Commercial,90,918,85,,,478.66,918,percent of total billed charges,
PML/RARALPHA - REF,8131590,CDM,81315,CPT,310,RC,,,facility,both,,,754,533.83,Aetna First Health,Commercial,90,640.9,85,,,334.17,640.9,percent of total billed charges,
PMS2 GENE ANALYSIS FULL SEQUENCE,8131790,CDM,81317,CPT,300,RC,,,facility,both,,,1205,853.14,Aetna First Health,Commercial,,1024.25,85,,,534.06,1024.25,percent of total billed charges,
PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,8131990,CDM,81319,CPT,300,RC,,,facility,both,,,342,242.14,Aetna First Health,Commercial,,290.7,85,,,151.57,290.7,percent of total billed charges,
PMP22 GENE DELETION/DUPLICATION,8132490,CDM,81324,CPT,300,RC,,,facility,both,,,712,504.1,Aetna First Health,Commercial,,605.2,85,,,315.56,605.2,percent of total billed charges,
"SMN1 GENE; DOSAGE/DELETION ANALYSIS, INC SMN2 ANALYSIS, IF PERFORMED",8132990,CDM,81329,CPT,300,RC,,,facility,both,,,714,505.51,Aetna First Health,Commercial,90,606.9,85,,,316.44,606.9,percent of total billed charges,
SNRPN/UBE3A GENE - REF,8133190,CDM,81331,CPT,300,RC,,,facility,both,,,626,443.21,Aetna First Health,Commercial,90,532.1,85,,,277.44,532.1,percent of total billed charges,
"MPL EXON 10 MUTATION , REFLEX",8133990,CDM,81339,CPT,300,RC,,,facility,both,,,361,255.59,Aetna First Health,Commercial,90,306.85,85,,,160,306.85,percent of total billed charges,
TRB@ GENE REARRANGE AMPLIFY - REF,8134090,CDM,81340,CPT,300,RC,,,facility,both,,,418,295.94,Aetna First Health,Commercial,90,355.3,85,,,185.26,355.3,percent of total billed charges,
TRG GENE REARRANGEMENT ANAL - REF,8134290,CDM,81342,CPT,300,RC,,,facility,both,,,505,357.54,Aetna First Health,Commercial,90,429.25,85,,,223.82,429.25,percent of total billed charges,
"TERT GENE ANALYSIS, TARGETED SEQUENCE ANALYSIS",8134590,CDM,81645,CPT,300,RC,,,facility,both,,,998,706.58,Aetna First Health,Commercial,90,848.3,85,,,442.31,848.3,percent of total billed charges,
"HBB (HEMOGLOBIN, SUBUNIT BETA); FULL GENE SEQUENCE - REF",8136490,CDM,81364,CPT,300,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,90,102.85,85,,,53.63,102.85,percent of total billed charges,
HLA I TYPING COMPLETE LR - REF,8137290,CDM,81372,CPT,300,RC,,,facility,both,,,529,374.53,Aetna First Health,Commercial,90,449.65,85,,,234.45,449.65,percent of total billed charges,
REFERENCE HLA PHENOTYPE,8137390,CDM,81373,CPT,300,RC,,,facility,both,,,311,220.19,Aetna First Health,Commercial,90,264.35,85,,,137.84,264.35,percent of total billed charges,
HLA II TYPING AG EQUIV LR - REF,8137590,CDM,81375,CPT,300,RC,,,facility,both,,,469,332.05,Aetna First Health,Commercial,90,398.65,85,,,207.86,398.65,percent of total billed charges,
"HLA CLASS II LOW RES, 1 LOCUS - REF",8137690,CDM,81376,CPT,310,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,90,187.85,85,,,97.95,187.85,percent of total billed charges,
HLA I TYPING 1 ALLELE HR - REF,8138190,CDM,81381,CPT,310,RC,,,facility,both,,,570,403.56,Aetna First Health,Commercial,90,484.5,85,,,252.62,484.5,percent of total billed charges,
"MOLECULAR PATH PROC, LEVEL 1 - REF",8140090,CDM,81400,CPT,310,RC,,,facility,both,,,306,216.65,Aetna First Health,Commercial,90,260.1,85,,,135.62,260.1,percent of total billed charges,
"MOLECULAR PATH PROC, LEVEL 2 - REF",8140190,CDM,81401,CPT,310,RC,,,facility,both,,,1698,1202.18,Aetna First Health,Commercial,90,1443.3,85,,,752.55,1443.3,percent of total billed charges,
MOLECULAR PATH LEVEL 3,8140290,CDM,81402,CPT,300,RC,,,facility,both,,,900,637.2,Aetna First Health,Commercial,90,765,85,,,398.88,765,percent of total billed charges,
"MOLECULAR PATH PROC, LEVEL 4 - REF",8140390,CDM,81403,CPT,310,RC,,,facility,both,,,443,313.64,Aetna First Health,Commercial,90,376.55,85,,,196.34,376.55,percent of total billed charges,
MOPATH PROCEDURE LEVEL 5 - REF,8140490,CDM,81404,CPT,300,RC,,,facility,both,,,804,569.23,Aetna First Health,Commercial,90,683.4,85,,,356.33,683.4,percent of total billed charges,
"MOLECULAR PATH PROC, LEVEL 6 - REF",8140590,CDM,81405,CPT,310,RC,,,facility,both,,,779,551.53,Aetna First Health,Commercial,90,662.15,85,,,345.25,662.15,percent of total billed charges,
MOLECULAR PATH LEVEL 7 ARRAY - REF,8140690,CDM,81406,CPT,300,RC,,,facility,both,,,3462,2451.1,Aetna First Health,Commercial,90,2942.7,85,,,1534.36,2942.7,percent of total billed charges,
MOPATH PROCEDURE LEVEL 9,8140890,CDM,81408,CPT,300,RC,,,facility,both,,,2197,1555.48,Aetna First Health,Commercial,90,1867.45,85,,,973.71,1867.45,percent of total billed charges,
AORTIC  DYSFUNCTION OR DILATION; GENOMIC SEQUENCE ANALYSIS PANEL - REF,8141090,CDM,81410,CPT,300,RC,,,facility,both,,,3090,2187.72,Aetna First Health,Commercial,90,2626.5,85,,,1369.49,2626.5,percent of total billed charges,
GENETIC TESTING SEVERN INH COND,8144390,CDM,81443,CPT,300,RC,,,facility,both,,,2633,1864.16,Aetna First Health,Commercial,,2238.05,85,,,1166.95,2238.05,percent of total billed charges,
TARGETED GENOMIC SEQUENCE ANALYSIS PANEL - REF,8144590,CDM,81445,CPT,300,RC,,,facility,both,,,1320,934.56,Aetna First Health,Commercial,90,1122,85,,,585.02,1122,percent of total billed charges,
TARGETED GENOMIC SEQUENCE ANALYSIS PANEL 5-50 GENES - REF,8145090,CDM,81450,CPT,300,RC,,,facility,both,,,2957,2093.56,Aetna First Health,Commercial,90,2513.45,85,,,1310.54,2513.45,percent of total billed charges,
UNLISTED MOLECULAR PATH PROC - REF,8147990,CDM,81479,CPT,310,RC,,,facility,both,,,649,459.49,Aetna First Health,Commercial,90,551.65,85,,,287.64,551.65,percent of total billed charges,
FETAL CONG ABNORM 4 ANALYTES - REF,8151190,CDM,81511,CPT,310,RC,,,facility,both,,,345,244.26,Aetna First Health,Commercial,90,293.25,85,,,152.9,293.25,percent of total billed charges,
"INFECTIOUS DISEASE,CHRONIC HEP C VIRUS,SIX ASSAYS, UTILIZING SERUM",8159690,CDM,81596,CPT,300,RC,,,facility,both,,,300,212.4,Aetna First Health,Commercial,90,255,85,,,132.96,255,percent of total billed charges,
"ACETONE, QUANTITATIVE - REF",8201090,CDM,82010,CPT,300,RC,,,facility,both,,,66,46.73,Aetna First Health,Commercial,90,56.1,85,,,29.25,56.1,percent of total billed charges,
"ACYLCARNITINES, QUANT - REF",8201790,CDM,82017,CPT,300,RC,,,facility,both,,,133,94.16,Aetna First Health,Commercial,90,113.05,85,,,58.95,113.05,percent of total billed charges,
ACTH - REF,8202490,CDM,82024,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
"ALBUMIN, SERUM - REF",8204090,CDM,82040,CPT,300,RC,,,facility,both,,,25,17.7,Aetna First Health,Commercial,90,21.25,85,,,11.08,21.25,percent of total billed charges,
"ALBUMIN, OTHR SOURCE - REF",8204290,CDM,82042,CPT,300,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,90,22.1,85,,,11.52,22.1,percent of total billed charges,
"ALBUMIN, URINE",8204390,CDM,82043,CPT,300,RC,,,facility,both,,,14,9.91,Aetna First Health,Commercial,90,11.9,85,,,6.2,11.9,percent of total billed charges,
ALDOLASE - REF,8208590,CDM,82085,CPT,300,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,90,29.75,85,,,15.51,29.75,percent of total billed charges,
ALDOSTERONE - REF,8208890,CDM,82088,CPT,300,RC,,,facility,both,,,167,118.24,Aetna First Health,Commercial,90,141.95,85,,,74.01,141.95,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN, TOT - REF",8210390,CDM,82103,CPT,300,RC,,,facility,both,,,101,71.51,Aetna First Health,Commercial,90,85.85,85,,,44.76,85.85,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN, PHEN - REF",8210490,CDM,82104,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,90,77.35,85,,,40.33,77.35,percent of total billed charges,
"ALPHA-FETOPROTEIN, SERUM - REF",8210590,CDM,82105,CPT,300,RC,,,facility,both,,,52,36.82,Aetna First Health,Commercial,90,44.2,85,,,23.05,44.2,percent of total billed charges,
ALUMINUM - REF,8210890,CDM,82108,CPT,300,RC,,,facility,both,,,148.5,105.14,Aetna First Health,Commercial,90,126.22,85,,,65.82,126.22,percent of total billed charges,
AMINOLEVUNLINIC ACID - REF,8213590,CDM,82135,CPT,300,RC,,,facility,both,,,96,67.97,Aetna First Health,Commercial,90,81.6,85,,,42.55,81.6,percent of total billed charges,
AMINO ACIDS-2-5 QUANT - REF,8213690,CDM,82136,CPT,300,RC,,,facility,both,,,291,206.03,Aetna First Health,Commercial,90,247.35,85,,,128.97,247.35,percent of total billed charges,
AMINO ACIDS-6+ QUANT - REF,8213990,CDM,82139,CPT,300,RC,,,facility,both,,,335,237.18,Aetna First Health,Commercial,90,284.75,85,,,148.47,284.75,percent of total billed charges,
ASSAY OF AMMONIA - REF,8214090,CDM,82140,CPT,300,RC,,,facility,both,,,145,102.66,Aetna First Health,Commercial,90,123.25,85,,,64.26,123.25,percent of total billed charges,
AMYLASE - REF,8215090,CDM,82150,CPT,300,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,90,85,85,,,44.32,85,percent of total billed charges,
ANDROSETENEDIONE - REF,8215790,CDM,82157,CPT,300,RC,,,facility,both,,,143,101.24,Aetna First Health,Commercial,90,121.55,85,,,63.38,121.55,percent of total billed charges,
ACE - REF,8216490,CDM,82164,CPT,300,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,90,42.5,85,,,22.16,42.5,percent of total billed charges,
APOLIPOPROTEIN - REF,8217290,CDM,82172,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,90,76.5,85,,,39.89,76.5,percent of total billed charges,
ARSENIC - REF,8217590,CDM,82175,CPT,300,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,90,97.75,85,,,50.97,97.75,percent of total billed charges,
ACORBIC ACID - REF,8218090,CDM,82180,CPT,300,RC,,,facility,both,,,105,74.34,Aetna First Health,Commercial,90,89.25,85,,,46.54,89.25,percent of total billed charges,
BETA-2-MICROGLOBULIN - REF,8223290,CDM,82232,CPT,300,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,90,88.4,85,,,46.09,88.4,percent of total billed charges,
BILE ACIDS TOTAL,8223990,CDM,82239,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
BIOTINIDASE - REF,8226190,CDM,82261,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,90,48.45,85,,,25.26,48.45,percent of total billed charges,
CADMIUM - REF,8230090,CDM,82300,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
VITAMIN D 25-OH - REF,8230690,CDM,82306,CPT,300,RC,,,facility,both,,,185,130.98,Aetna First Health,Commercial,90,157.25,85,,,81.99,157.25,percent of total billed charges,
CALCITONIN - REF,8230890,CDM,82308,CPT,300,RC,,,facility,both,,,97,68.68,Aetna First Health,Commercial,90,82.45,85,,,42.99,82.45,percent of total billed charges,
CALCIUM - REF,8231090,CDM,82310,CPT,300,RC,,,facility,both,,,14,9.91,Aetna First Health,Commercial,90,11.9,85,,,6.2,11.9,percent of total billed charges,
"CALCIUM, URINE - REF",8234090,CDM,82340,CPT,300,RC,,,facility,both,,,81,57.35,Aetna First Health,Commercial,90,68.85,85,,,35.9,68.85,percent of total billed charges,
"CALCULUS, INFRARED SPEC - REF",8236590,CDM,82365,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,90,59.5,85,,,31.02,59.5,percent of total billed charges,
ASSAY CARB DEFICIENT TRANSFER - REF,8237390,CDM,82373,CPT,300,RC,,,facility,both,,,188,133.1,Aetna First Health,Commercial,90,159.8,85,,,83.32,159.8,percent of total billed charges,
CARCINOEMBRYONIC ANTIGEN - REF,8237890,CDM,82378,CPT,300,RC,,,facility,both,,,159,112.57,Aetna First Health,Commercial,90,135.15,85,,,70.47,135.15,percent of total billed charges,
CARNITINE - REF,8237990,CDM,82379,CPT,300,RC,,,facility,both,,,143,101.24,Aetna First Health,Commercial,90,121.55,85,,,63.38,121.55,percent of total billed charges,
CAROTENE - REF,8238090,CDM,82380,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
"CATECHOLAMINES, FRACTION - REF",8238490,CDM,82384,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,90,96.05,85,,,50.08,96.05,percent of total billed charges,
CERULOPLASMIN - REF,8239090,CDM,82390,CPT,300,RC,,,facility,both,,,39,27.61,Aetna First Health,Commercial,90,33.15,85,,,17.28,33.15,percent of total billed charges,
CHEMILUMINESCENT ASSAY - REF,8239790,CDM,82397,CPT,300,RC,,,facility,both,,,96,67.97,Aetna First Health,Commercial,90,81.6,85,,,42.55,81.6,percent of total billed charges,
"CHLORIDE, URINE - REF",8243690,CDM,82436,CPT,300,RC,,,facility,both,,,40,28.32,Aetna First Health,Commercial,90,34,85,,,17.73,34,percent of total billed charges,
ASSAY OTHER FLUID CHLORIDES - REF,8243890,CDM,82438,CPT,300,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,90,37.4,85,,,19.5,37.4,percent of total billed charges,
"CHOLESTEROL, TOTAL - REF",8246590,CDM,82465,CPT,300,RC,,,facility,both,,,23,16.28,Aetna First Health,Commercial,90,19.55,85,,,10.19,19.55,percent of total billed charges,
CHOLINESTERASE; SERUM - REF,8248090,CDM,82480,CPT,300,RC,,,facility,both,,,48,33.98,Aetna First Health,Commercial,90,40.8,85,,,21.27,40.8,percent of total billed charges,
CHROMIUM - REF,8249590,CDM,82495,CPT,300,RC,,,facility,both,,,156,110.45,Aetna First Health,Commercial,90,132.6,85,,,69.14,132.6,percent of total billed charges,
CITRATE - REF,8250790,CDM,82507,CPT,300,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,90,83.3,85,,,43.43,83.3,percent of total billed charges,
COLLAGEN CROSS LINKS - REF,8252390,CDM,82523,CPT,300,RC,,,facility,both,,,130,92.04,Aetna First Health,Commercial,90,110.5,85,,,57.62,110.5,percent of total billed charges,
"COPPER, SERUM - REF",8252590,CDM,82525,CPT,300,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,90,88.4,85,,,46.09,88.4,percent of total billed charges,
"CORTISOL, FREE - REF",8253090,CDM,82530,CPT,300,RC,,,facility,both,,,110,77.88,Aetna First Health,Commercial,90,93.5,85,,,48.75,93.5,percent of total billed charges,
CORTISOL SERUM - REF,8253390,CDM,82533,CPT,300,RC,,,facility,both,,,133,94.16,Aetna First Health,Commercial,90,113.05,85,,,58.95,113.05,percent of total billed charges,
CREATINE - REF,8254090,CDM,82540,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,90,48.45,85,,,25.26,48.45,percent of total billed charges,
"COLUMN CHROM MS, QUANT - REF",8254290,CDM,82542,CPT,300,RC,,,facility,both,,,209,147.97,Aetna First Health,Commercial,90,177.65,85,,,92.63,177.65,percent of total billed charges,
CK ISO - REF,8255290,CDM,82552,CPT,300,RC,,,facility,both,,,47,33.28,Aetna First Health,Commercial,90,39.95,85,,,20.83,39.95,percent of total billed charges,
"CREATININE, OTHER SOURCE - REF",8257090,CDM,82570,CPT,300,RC,,,facility,both,,,15,10.62,Aetna First Health,Commercial,90,12.75,85,,,6.65,12.75,percent of total billed charges,
ASSAY OF CRYOGLOBULIN - REF,8259590,CDM,82595,CPT,300,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,90,10.2,85,,,5.32,10.2,percent of total billed charges,
CYANIDE - REF,8260090,CDM,82600,CPT,300,RC,,,facility,both,,,139,98.41,Aetna First Health,Commercial,90,118.15,85,,,61.6,118.15,percent of total billed charges,
B-12 ASSAY - REF,8260790,CDM,82607,CPT,300,RC,,,facility,both,,,14,9.91,Aetna First Health,Commercial,90,11.9,85,,,6.2,11.9,percent of total billed charges,
UNSATURATED BINDING CAPACITY - REF,8260890,CDM,82608,CPT,300,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,90,83.3,85,,,43.43,83.3,percent of total billed charges,
DHEA - REF,8262690,CDM,82626,CPT,300,RC,,,facility,both,,,69,48.85,Aetna First Health,Commercial,90,58.65,85,,,30.58,58.65,percent of total billed charges,
DHEA-S - REF,8262790,CDM,82627,CPT,300,RC,,,facility,both,,,66,46.73,Aetna First Health,Commercial,90,56.1,85,,,29.25,56.1,percent of total billed charges,
DIHYDROTESTOSTERONE (DHT),8264290,CDM,82642,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,90,45.9,85,,,23.93,45.9,percent of total billed charges,
DIHYDROXYVITAMIN D - REF,8265290,CDM,82652,CPT,300,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,90,97.75,85,,,50.97,97.75,percent of total billed charges,
ELASTASE PANCREATIC FECAL QUANTITATIVE,8265390,CDM,82653,CPT,300,RC,,,facility,both,,,99,70.09,Aetna First Health,Commercial,90,84.15,85,,,43.88,84.15,percent of total billed charges,
"ENZYME ACT, NONRADIOACT - REF",8265790,CDM,82657,CPT,300,RC,,,facility,both,,,295,208.86,Aetna First Health,Commercial,90,250.75,85,,,130.74,250.75,percent of total billed charges,
"ELECTROPHORESIS, NOS - REF",8266490,CDM,82664,CPT,300,RC,,,facility,both,,,119,84.25,Aetna First Health,Commercial,90,101.15,85,,,52.74,101.15,percent of total billed charges,
ERYTHROPIETIN - REF,8266890,CDM,82668,CPT,300,RC,,,facility,both,,,56,39.65,Aetna First Health,Commercial,90,47.6,85,,,24.82,47.6,percent of total billed charges,
ESTRADIOL - REF,8267090,CDM,82670,CPT,300,RC,,,facility,both,,,110,77.88,Aetna First Health,Commercial,90,93.5,85,,,48.75,93.5,percent of total billed charges,
ESTROGENS; FRACTIONATED,8267190,CDM,82671,CPT,300,RC,,,facility,both,,,304,215.23,Aetna First Health,Commercial,90,258.4,85,,,134.73,258.4,percent of total billed charges,
ESTRIOL - REF,8267790,CDM,82677,CPT,300,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,90,37.4,85,,,19.5,37.4,percent of total billed charges,
ESTRONE - REF,8267990,CDM,82679,CPT,300,RC,,,facility,both,,,142,100.54,Aetna First Health,Commercial,90,120.7,85,,,62.93,120.7,percent of total billed charges,
"FAT/LIPIDS, FECES, QUANT - REF",8271090,CDM,82710,CPT,300,RC,,,facility,both,,,143,101.24,Aetna First Health,Commercial,90,121.55,85,,,63.38,121.55,percent of total billed charges,
"FATTY ACIDS, NONESTERIFIED - REF",8272590,CDM,82725,CPT,300,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,90,41.65,85,,,21.72,41.65,percent of total billed charges,
VERY LONG CHAIN FATTY ACD - REF,8272690,CDM,82726,CPT,300,RC,,,facility,both,,,32,22.66,Aetna First Health,Commercial,90,27.2,85,,,14.18,27.2,percent of total billed charges,
FERRITIN - REF,8272890,CDM,82728,CPT,300,RC,,,facility,both,,,165,116.82,Aetna First Health,Commercial,90,140.25,85,,,73.13,140.25,percent of total billed charges,
FLUORIDE,8273590,CDM,82735,CPT,300,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,90,126.65,85,,,66.04,126.65,percent of total billed charges,
FOLIC ACID RBC - REF,8274790,CDM,82747,CPT,300,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,90,106.25,85,,,55.4,106.25,percent of total billed charges,
"GPUT, QUANT",8277590,CDM,82775,CPT,300,RC,,,facility,both,,,64,45.31,Aetna First Health,Commercial,90,54.4,85,,,28.36,54.4,percent of total billed charges,
"GAMMAGLOBULIN; IGA, DG,M - REF",8278490,CDM,82784,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
GAMMAGLOBULIN; IGE - REF,8278590,CDM,82785,CPT,300,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,90,29.75,85,,,15.51,29.75,percent of total billed charges,
IMMUNOGLOBULIN SUBCLASSES - REF,8278790,CDM,82787,CPT,300,RC,,,facility,both,,,31,21.95,Aetna First Health,Commercial,90,26.35,85,,,13.74,26.35,percent of total billed charges,
HGB 02 AFFINITY - REF,8282090,CDM,82820,CPT,300,RC,,,facility,both,,,103,72.92,Aetna First Health,Commercial,90,87.55,85,,,45.65,87.55,percent of total billed charges,
GASTRIN - REF,8294190,CDM,82941,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,90,55.25,85,,,28.81,55.25,percent of total billed charges,
GLUCAGON - REF,8294390,CDM,82943,CPT,300,RC,,,facility,both,,,153,108.32,Aetna First Health,Commercial,90,130.05,85,,,67.81,130.05,percent of total billed charges,
GLUCOSE QUANT BLOOD - REF,8294790,CDM,82947,CPT,300,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,90,22.1,85,,,11.52,22.1,percent of total billed charges,
G6PD; QUANT SCREEN - REF,8295590,CDM,82955,CPT,300,RC,,,facility,both,,,95,67.26,Aetna First Health,Commercial,90,80.75,85,,,42.1,80.75,percent of total billed charges,
GLUCOSIDASE; BETA - REF,8296390,CDM,82963,CPT,300,RC,,,facility,both,,,156,110.45,Aetna First Health,Commercial,90,132.6,85,,,69.14,132.6,percent of total billed charges,
GLYCATED PROTEIN - REF,8298590,CDM,82985,CPT,300,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,90,37.4,85,,,19.5,37.4,percent of total billed charges,
GONADOTROPIN (LH) - REF,8300290,CDM,83002,CPT,300,RC,,,facility,both,,,133,94.16,Aetna First Health,Commercial,90,113.05,85,,,58.95,113.05,percent of total billed charges,
GROWTH HORMONE (HGH) - REF,8300390,CDM,83003,CPT,300,RC,,,facility,both,,,42,29.74,Aetna First Health,Commercial,90,35.7,85,,,18.61,35.7,percent of total billed charges,
H. PYLORI UREA BREATH TST - REF,8301390,CDM,83013,CPT,300,RC,,,facility,both,,,142,100.54,Aetna First Health,Commercial,90,120.7,85,,,62.93,120.7,percent of total billed charges,
HEAVY METAL QUANTITATIVE - REF,8301890,CDM,83018,CPT,300,RC,,,facility,both,,,178,126.02,Aetna First Health,Commercial,90,151.3,85,,,78.89,151.3,percent of total billed charges,
HGB FRACTIONATION; ELP - REF,8302090,CDM,83020,CPT,300,RC,,,facility,both,,,108,76.46,Aetna First Health,Commercial,90,91.8,85,,,47.87,91.8,percent of total billed charges,
HGB FRACTION; CHROMATOG - REF,8302190,CDM,83021,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,90,119,85,,,62.05,119,percent of total billed charges,
HEMOGLOBIN; GLYCOSYLATED(A1C),8303690,CDM,83036,CPT,300,RC,,,facility,both,,,95,67.26,Aetna First Health,Commercial,90,80.75,85,,,42.1,80.75,percent of total billed charges,
"HGB, PLASMA - REF",8305190,CDM,83051,CPT,300,RC,,,facility,both,,,48,33.98,Aetna First Health,Commercial,90,40.8,85,,,21.27,40.8,percent of total billed charges,
UNSTABLE HGB SCREEN - REF,8306890,CDM,83068,CPT,300,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,90,90.1,85,,,46.98,90.1,percent of total billed charges,
"HEMOSIDERIN, QUAL - REF",8307090,CDM,83070,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,90,45.9,85,,,23.93,45.9,percent of total billed charges,
B-HESOSAMINIDASE,8308090,CDM,83080,CPT,300,RC,,,facility,both,,,94,66.55,Aetna First Health,Commercial,90,79.9,85,,,41.66,79.9,percent of total billed charges,
HISTAMINE - REF,8308890,CDM,83088,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,90,109.65,85,,,57.17,109.65,percent of total billed charges,
ASSAY OF HOMOCYSTINE - REF,8309090,CDM,83090,CPT,300,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,90,41.65,85,,,21.72,41.65,percent of total billed charges,
HVA - REF,8315090,CDM,83150,CPT,300,RC,,,facility,both,,,127,89.92,Aetna First Health,Commercial,90,107.95,85,,,56.29,107.95,percent of total billed charges,
HIAA - REF,8349790,CDM,83497,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,90,48.45,85,,,25.26,48.45,percent of total billed charges,
"HYDROXYPROGESTERONE, 17-D - REF",8349890,CDM,83498,CPT,300,RC,,,facility,both,,,66,46.73,Aetna First Health,Commercial,90,56.1,85,,,29.25,56.1,percent of total billed charges,
IMMUNOASSAY - REF,8351690,CDM,83516,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,90,76.5,85,,,39.89,76.5,percent of total billed charges,
IMMUNOASSAY BY RADIOPHARM - REF,8351990,CDM,83519,CPT,300,RC,,,facility,both,,,192,135.94,Aetna First Health,Commercial,90,163.2,85,,,85.09,163.2,percent of total billed charges,
IMMUNOASSAY NOS - REF,8352090,CDM,83520,CPT,300,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,90,75.65,85,,,39.44,75.65,percent of total billed charges,
IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,8352190,CDM,83521,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,90,52.7,85,,,27.48,52.7,percent of total billed charges,
"ASSAY OF INSULIN, TOTAL - REF",8352590,CDM,83525,CPT,300,RC,,,facility,both,,,97,68.68,Aetna First Health,Commercial,90,82.45,85,,,42.99,82.45,percent of total billed charges,
INSULIN; FREE - REF,8352790,CDM,83527,CPT,300,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,90,75.65,85,,,39.44,75.65,percent of total billed charges,
ASSAY OF INTERLEUKIN-6 (IL-6),8352990,CDM,83529,CPT,300,RC,,,facility,both,,,120,84.96,Aetna First Health,Commercial,90,102,85,,,53.18,102,percent of total billed charges,
IRON - REF,8354090,CDM,83540,CPT,300,RC,,,facility,both,,,147,104.08,Aetna First Health,Commercial,90,124.95,85,,,65.15,124.95,percent of total billed charges,
IRON-BINDING CAPACITY,8355090,CDM,83550,CPT,300,RC,,,facility,both,,,16,11.33,Aetna First Health,Commercial,90,13.6,85,,,7.09,13.6,percent of total billed charges,
LACTATE (LACTIC ACID),8360590,CDM,83605,CPT,300,RC,,,facility,both,,,20,14.16,Aetna First Health,Commercial,90,17,85,,,8.86,17,percent of total billed charges,
LDH - REF,8361590,CDM,83615,CPT,300,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,90,36.55,85,,,19.06,36.55,percent of total billed charges,
LDH ISO - REF,8362590,CDM,83625,CPT,300,RC,,,facility,both,,,122,86.38,Aetna First Health,Commercial,90,103.7,85,,,54.07,103.7,percent of total billed charges,
LEAD - REF,8365590,CDM,83655,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,90,77.35,85,,,40.33,77.35,percent of total billed charges,
"LIPASE, BODY FLUID - REF",8369090,CDM,83690,CPT,300,RC,,,facility,both,,,107,75.76,Aetna First Health,Commercial,90,90.95,85,,,47.42,90.95,percent of total billed charges,
LIPOPROTEIN (A) - REF,8369590,CDM,83695,CPT,300,RC,,,facility,both,,,53,37.52,Aetna First Health,Commercial,90,45.05,85,,,23.49,45.05,percent of total billed charges,
LIPOPROTEINS & SUBCLASSES - REF,8370490,CDM,83704,CPT,300,RC,,,facility,both,,,128,90.62,Aetna First Health,Commercial,90,108.8,85,,,56.73,108.8,percent of total billed charges,
HDL CHOLESTEROL - REF,8371890,CDM,83718,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,90,45.9,85,,,23.93,45.9,percent of total billed charges,
MAGNESIUM - REF,8373590,CDM,83735,CPT,300,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,90,64.6,85,,,33.68,64.6,percent of total billed charges,
MANGANESE - REF,8378590,CDM,83785,CPT,300,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,90,83.3,85,,,43.43,83.3,percent of total billed charges,
"MASS SPEC, QUANTITATIVE - REF",8378990,CDM,83789,CPT,300,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,90,62.05,85,,,32.35,62.05,percent of total billed charges,
MERCURY - REF,8382590,CDM,83825,CPT,300,RC,,,facility,both,,,53,37.52,Aetna First Health,Commercial,90,45.05,85,,,23.49,45.05,percent of total billed charges,
METANEPHRINES - REF,8383590,CDM,83835,CPT,300,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,90,104.55,85,,,54.51,104.55,percent of total billed charges,
MUCOPOLYSACCHARIDES; QNT - REF,8386490,CDM,83864,CPT,300,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,90,85,85,,,44.32,85,percent of total billed charges,
MYOGLOBIN - REF,8387490,CDM,83874,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
NATRIURETIC PEPTIDE - REF,8388090,CDM,83880,CPT,300,RC,,,facility,both,,,172,121.78,Aetna First Health,Commercial,90,146.2,85,,,76.23,146.2,percent of total billed charges,
"NEPHELOMETRY, EACH, NOS - REF",8388390,CDM,83883,CPT,300,RC,,,facility,both,,,150,106.2,Aetna First Health,Commercial,90,127.5,85,,,66.48,127.5,percent of total billed charges,
NUCLEOTIDASE - REF,8391590,CDM,83915,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,90,72.25,85,,,37.67,72.25,percent of total billed charges,
OLIGOCLONAL BANDS - REF,8391690,CDM,83916,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,90,62.9,85,,,32.8,62.9,percent of total billed charges,
ORGANIC ACIDS; QUAL - REF,8391990,CDM,83919,CPT,300,RC,,,facility,both,,,124,87.79,Aetna First Health,Commercial,90,105.4,85,,,54.96,105.4,percent of total billed charges,
"ORGANIC ACID, SINGLE, QNT - REF",8392190,CDM,83921,CPT,300,RC,,,facility,both,,,96,67.97,Aetna First Health,Commercial,90,81.6,85,,,42.55,81.6,percent of total billed charges,
ASSAY OF OSMOLALITY URINE - REF,8393590,CDM,83935,CPT,300,RC,,,facility,both,,,14.5,10.27,Aetna First Health,Commercial,90,12.32,85,,,6.43,12.32,percent of total billed charges,
OSTEOCALCIN - REF,8393790,CDM,83937,CPT,300,RC,,,facility,both,,,162,114.7,Aetna First Health,Commercial,90,137.7,85,,,71.8,137.7,percent of total billed charges,
OXALATE - REF,8394590,CDM,83945,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,90,59.5,85,,,31.02,59.5,percent of total billed charges,
PARATHORMONE - REF,8397090,CDM,83970,CPT,300,RC,,,facility,both,,,240,169.92,Aetna First Health,Commercial,90,204,85,,,106.37,204,percent of total billed charges,
PCP - REF,8399290,CDM,83992,CPT,300,RC,,,facility,both,,,120,84.96,Aetna First Health,Commercial,90,102,85,,,53.18,102,percent of total billed charges,
"CALPROTECTIN, FECAL - REF",8399390,CDM,83993,CPT,300,RC,,,facility,both,,,231,163.55,Aetna First Health,Commercial,90,196.35,85,,,102.38,196.35,percent of total billed charges,
"PKU, BLOOD - REF",8403090,CDM,84030,CPT,300,RC,,,facility,both,,,42,29.74,Aetna First Health,Commercial,90,35.7,85,,,18.61,35.7,percent of total billed charges,
"PHOSPHATASE, ALKALINE - REF",8407590,CDM,84075,CPT,300,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,90,37.4,85,,,19.5,37.4,percent of total billed charges,
"PHOSPH ALKALINE, ISO ENZ - REF",8408090,CDM,84080,CPT,300,RC,,,facility,both,,,116,82.13,Aetna First Health,Commercial,90,98.6,85,,,51.41,98.6,percent of total billed charges,
PHOSPHOHEXOSE ISOMERASE - REF,8408790,CDM,84087,CPT,300,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,90,62.05,85,,,32.35,62.05,percent of total billed charges,
PO4 INORGANIC (PHOSPHATE) - REF,8410090,CDM,84100,CPT,300,RC,,,facility,both,,,22,15.58,Aetna First Health,Commercial,90,18.7,85,,,9.75,18.7,percent of total billed charges,
"PO4 INORG (PHOSPHATE), UR - REF",8410590,CDM,84105,CPT,300,RC,,,facility,both,,,81,57.35,Aetna First Health,Commercial,90,68.85,85,,,35.9,68.85,percent of total billed charges,
"PORPHOBILINOGEN, QUANT - REF",8411090,CDM,84110,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,90,72.25,85,,,37.67,72.25,percent of total billed charges,
"PORPHYRINS, QUANT/FRACT - REF",8412090,CDM,84120,CPT,300,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,90,83.3,85,,,43.43,83.3,percent of total billed charges,
"PORPHYRINS, FECES, QUANT - REF",8412690,CDM,84126,CPT,300,RC,,,facility,both,,,135,95.58,Aetna First Health,Commercial,90,114.75,85,,,59.83,114.75,percent of total billed charges,
PREGNENOLONE - REF,8414090,CDM,84140,CPT,300,RC,,,facility,both,,,130,92.04,Aetna First Health,Commercial,90,110.5,85,,,57.62,110.5,percent of total billed charges,
ASSAY OF PROLACTIN - REF,8414690,CDM,84146,CPT,300,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,90,56.95,85,,,29.69,56.95,percent of total billed charges,
"PROSTAGLANDIN, EACH - REF",8415090,CDM,84150,CPT,300,RC,,,facility,both,,,372,263.38,Aetna First Health,Commercial,90,316.2,85,,,164.87,316.2,percent of total billed charges,
"PSA, TOTAL - REF",8415390,CDM,84153,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
"PSA, FREE - REF",8415490,CDM,84154,CPT,300,RC,,,facility,both,,,28,19.82,Aetna First Health,Commercial,90,23.8,85,,,12.41,23.8,percent of total billed charges,
"PROTEIN, URINE - REF",8415690,CDM,84156,CPT,300,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,90,28.9,85,,,15.07,28.9,percent of total billed charges,
PROTEIN TOTAL ASSAY OTHER,8415790,CDM,84157,CPT,300,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,90,28.9,85,,,15.07,28.9,percent of total billed charges,
PROTEIN E-PHORESIS/URINE/CSF - REF,8416690,CDM,84166,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
WESTERN BLOT TEST - REF,8418190,CDM,84181,CPT,300,RC,,,facility,both,,,154,109.03,Aetna First Health,Commercial,90,130.9,85,,,68.25,130.9,percent of total billed charges,
PROTEIN; WESTERN BLOT - REF,8418290,CDM,84182,CPT,300,RC,,,facility,both,,,244,172.75,Aetna First Health,Commercial,90,207.4,85,,,108.14,207.4,percent of total billed charges,
PROINSULIN - REF,8420690,CDM,84206,CPT,300,RC,,,facility,both,,,202,143.02,Aetna First Health,Commercial,90,171.7,85,,,89.53,171.7,percent of total billed charges,
VITAMIN B6 - REF,8420790,CDM,84207,CPT,300,RC,,,facility,both,,,218,154.34,Aetna First Health,Commercial,90,185.3,85,,,96.62,185.3,percent of total billed charges,
PYRUVATE - REF,8421090,CDM,84210,CPT,300,RC,,,facility,both,,,88,62.3,Aetna First Health,Commercial,90,74.8,85,,,39,74.8,percent of total billed charges,
"PYRUVATE KINASE, RBC - REF",8422090,CDM,84220,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
NON-ENDOCRINE RECEPASSAY - REF,8423890,CDM,84238,CPT,300,RC,,,facility,both,,,230,162.84,Aetna First Health,Commercial,90,195.5,85,,,101.94,195.5,percent of total billed charges,
RENIN - REF,8424490,CDM,84244,CPT,300,RC,,,facility,both,,,77,54.52,Aetna First Health,Commercial,90,65.45,85,,,34.13,65.45,percent of total billed charges,
"RIBOFLAVIN, VIT B12 - REF",8425290,CDM,84252,CPT,300,RC,,,facility,both,,,177,125.32,Aetna First Health,Commercial,90,150.45,85,,,78.45,150.45,percent of total billed charges,
SELENIUM - REF,8425590,CDM,84255,CPT,300,RC,,,facility,both,,,138,97.7,Aetna First Health,Commercial,90,117.3,85,,,61.16,117.3,percent of total billed charges,
SEROTONIN - REF,8426090,CDM,84260,CPT,300,RC,,,facility,both,,,182,128.86,Aetna First Health,Commercial,90,154.7,85,,,80.66,154.7,percent of total billed charges,
"SODIUM, OTHER SOURCE - REF",8430290,CDM,84302,CPT,300,RC,,,facility,both,,,37,26.2,Aetna First Health,Commercial,90,31.45,85,,,16.4,31.45,percent of total billed charges,
SOMATOMEDIN - REF,8430590,CDM,84305,CPT,300,RC,,,facility,both,,,211,149.39,Aetna First Health,Commercial,90,179.35,85,,,93.52,179.35,percent of total billed charges,
SOMATOSTATIN - REF,8430790,CDM,84307,CPT,300,RC,,,facility,both,,,294,208.15,Aetna First Health,Commercial,90,249.9,85,,,130.3,249.9,percent of total billed charges,
"SPECTROPHOTO, ANALYTE NOS - REF",8431190,CDM,84311,CPT,300,RC,,,facility,both,,,144,101.95,Aetna First Health,Commercial,90,122.4,85,,,63.82,122.4,percent of total billed charges,
"SUGARS, QUAL, EA SPEC - REF",8437690,CDM,84376,CPT,300,RC,,,facility,both,,,79,55.93,Aetna First Health,Commercial,90,67.15,85,,,35.01,67.15,percent of total billed charges,
ASSAY OF SULFATE URINE - REF,8439290,CDM,84392,CPT,300,RC,,,facility,both,,,105,74.34,Aetna First Health,Commercial,90,89.25,85,,,46.54,89.25,percent of total billed charges,
"TESTOSTERONE,FREE - REF",8440290,CDM,84402,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,90,55.25,85,,,28.81,55.25,percent of total billed charges,
"TESTOSTERONE, TOTAL - REF",8440390,CDM,84403,CPT,300,RC,,,facility,both,,,160,113.28,Aetna First Health,Commercial,90,136,85,,,70.91,136,percent of total billed charges,
ASSAY BIOVLBL TESTOSTERONE DIRECT MEASUREMENT - REF,8441090,CDM,84410,CPT,300,RC,,,facility,both,,,40,28.32,Aetna First Health,Commercial,90,34,85,,,17.73,34,percent of total billed charges,
VITAMIN B-1 - REF,8442590,CDM,84425,CPT,300,RC,,,facility,both,,,88,62.3,Aetna First Health,Commercial,90,74.8,85,,,39,74.8,percent of total billed charges,
THYROGLOBULIN - REF,8443290,CDM,84432,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,90,59.5,85,,,31.02,59.5,percent of total billed charges,
ASY THIOPURIN S-MTHYLTRNSFRS,8443390,CDM,84433,CPT,300,RC,,,facility,both,,,162,114.7,Aetna First Health,Commercial,90,137.7,85,,,71.8,137.7,percent of total billed charges,
"THYROXINE, TOTAL - REF",8443690,CDM,84436,CPT,300,RC,,,facility,both,,,83,58.76,Aetna First Health,Commercial,90,70.55,85,,,36.79,70.55,percent of total billed charges,
THYROID STIMULATING HORMONE - REF,8444390,CDM,84443,CPT,300,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,90,126.65,85,,,66.04,126.65,percent of total billed charges,
THYRSTIM IMMUN GLOB (TSI) - REF,8444590,CDM,84445,CPT,300,RC,,,facility,both,,,356,252.05,Aetna First Health,Commercial,90,302.6,85,,,157.78,302.6,percent of total billed charges,
VITAMIN E - REF,8444690,CDM,84446,CPT,300,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,90,34.85,85,,,18.17,34.85,percent of total billed charges,
"THY HORMONE UPTAKE,BIND - REF",8447990,CDM,84479,CPT,300,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,90,37.4,85,,,19.5,37.4,percent of total billed charges,
"TRIIODOTHYRONINE T3, TOT - REF",8448090,CDM,84480,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,90,50.15,85,,,26.15,50.15,percent of total billed charges,
FREE ASSAY (FT-3) - REF,8448190,CDM,84481,CPT,300,RC,,,facility,both,,,46,32.57,Aetna First Health,Commercial,90,39.1,85,,,20.39,39.1,percent of total billed charges,
"T3, REVERSE - REF",8448290,CDM,84482,CPT,300,RC,,,facility,both,,,108,76.46,Aetna First Health,Commercial,90,91.8,85,,,47.87,91.8,percent of total billed charges,
ASSAY OF TROPONIN QUANT - REF,8448490,CDM,84484,CPT,300,RC,,,facility,both,,,45,31.86,Aetna First Health,Commercial,90,38.25,85,,,19.94,38.25,percent of total billed charges,
TYROSINE - REF,8451090,CDM,84510,CPT,300,RC,,,facility,both,,,51,36.11,Aetna First Health,Commercial,90,43.35,85,,,22.6,43.35,percent of total billed charges,
UREA NITORGEN URINE - REF,8454090,CDM,84540,CPT,300,RC,,,facility,both,,,60,42.48,Aetna First Health,Commercial,90,51,85,,,26.59,51,percent of total billed charges,
(VMA) URINE - REF,8458590,CDM,84585,CPT,300,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,90,42.5,85,,,22.16,42.5,percent of total billed charges,
VASOACTIVE INTESTIN PEPT - REF,8458690,CDM,84586,CPT,300,RC,,,facility,both,,,212,150.1,Aetna First Health,Commercial,90,180.2,85,,,93.96,180.2,percent of total billed charges,
VASOPRESSIN (ADH) - REF,8458890,CDM,84588,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,90,109.65,85,,,57.17,109.65,percent of total billed charges,
VITAMIN A - REF,8459090,CDM,84590,CPT,300,RC,,,facility,both,,,53,37.52,Aetna First Health,Commercial,90,45.05,85,,,23.49,45.05,percent of total billed charges,
VITAMIN NOS - REF,8459190,CDM,84591,CPT,300,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,90,79.05,85,,,41.22,79.05,percent of total billed charges,
VITAMIN K - REF,8459790,CDM,84597,CPT,300,RC,,,facility,both,,,207,146.56,Aetna First Health,Commercial,90,175.95,85,,,91.74,175.95,percent of total billed charges,
VOLATILES - REF,8460090,CDM,84600,CPT,300,RC,,,facility,both,,,103,72.92,Aetna First Health,Commercial,90,87.55,85,,,45.65,87.55,percent of total billed charges,
"ZINC, SERUM - REF",8463090,CDM,84630,CPT,300,RC,,,facility,both,,,110,77.88,Aetna First Health,Commercial,90,93.5,85,,,48.75,93.5,percent of total billed charges,
C-PEPTIDE - REF,8468190,CDM,84681,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
"HCG, QUANTITATIVE - REF",8470290,CDM,84702,CPT,300,RC,,,facility,both,,,180,127.44,Aetna First Health,Commercial,90,153,85,,,79.78,153,percent of total billed charges,
"MISC CHEMISTRY, UNLISTED - REF",8499990,CDM,84999,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,90,119,85,,,62.05,119,percent of total billed charges,
BL SMEAR W/DIFF WBC COUNT,8500790,CDM,85007,CPT,300,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,90,28.9,85,,,15.07,28.9,percent of total billed charges,
CHROMOGENIC FVIII,8513090,CDM,85130,CPT,300,RC,,,facility,both,,,330,233.64,Aetna First Health,Commercial,90,280.5,85,,,146.26,280.5,percent of total billed charges,
"FACTOR II, PROTHROMB SPEC - REF",8521090,CDM,85210,CPT,300,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,90,96.9,85,,,50.52,96.9,percent of total billed charges,
FACTOR V ASSAY - REF,8522090,CDM,85220,CPT,300,RC,,,facility,both,,,197,139.48,Aetna First Health,Commercial,90,167.45,85,,,87.31,167.45,percent of total billed charges,
FACTOR VII - REF,8523090,CDM,85230,CPT,300,RC,,,facility,both,,,191,135.23,Aetna First Health,Commercial,90,162.35,85,,,84.65,162.35,percent of total billed charges,
"FACTOR VIII, ONE STAGE - REF",8524090,CDM,85240,CPT,300,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,90,79.05,85,,,41.22,79.05,percent of total billed charges,
"VW FACTOR, RISTOCETIN C - REF",8524590,CDM,85245,CPT,300,RC,,,facility,both,,,170,120.36,Aetna First Health,Commercial,90,144.5,85,,,75.34,144.5,percent of total billed charges,
"FACTOR VIII, VW ANTIGEN - REF",8524690,CDM,85246,CPT,300,RC,,,facility,both,,,198,140.18,Aetna First Health,Commercial,90,168.3,85,,,87.75,168.3,percent of total billed charges,
"VW FACTOR, MULTIMER ANAL - REF",8524790,CDM,85247,CPT,300,RC,,,facility,both,,,250,177,Aetna First Health,Commercial,90,212.5,85,,,110.8,212.5,percent of total billed charges,
FACTOR IX - REF,8525090,CDM,85250,CPT,300,RC,,,facility,both,,,203,143.72,Aetna First Health,Commercial,90,172.55,85,,,89.97,172.55,percent of total billed charges,
FACTOR X (STUART-PROWER) - REF,8526090,CDM,85260,CPT,300,RC,,,facility,both,,,212,150.1,Aetna First Health,Commercial,90,180.2,85,,,93.96,180.2,percent of total billed charges,
FACTOR XI (PTA) - REF,8527090,CDM,85270,CPT,300,RC,,,facility,both,,,195,138.06,Aetna First Health,Commercial,90,165.75,85,,,86.42,165.75,percent of total billed charges,
FACTOR XII (HAGEMAN) - REF,8528090,CDM,85280,CPT,300,RC,,,facility,both,,,199,140.89,Aetna First Health,Commercial,90,169.15,85,,,88.2,169.15,percent of total billed charges,
FACTOR XIII SOLUBILITY SC - REF,8529190,CDM,85291,CPT,300,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,90,90.1,85,,,46.98,90.1,percent of total billed charges,
ANTITHROMBIN III ACTIVITY - REF,8530090,CDM,85300,CPT,300,RC,,,facility,both,,,178,126.02,Aetna First Health,Commercial,90,151.3,85,,,78.89,151.3,percent of total billed charges,
ANTITHROMBIN III AG ASSAY - REF,8530190,CDM,85301,CPT,300,RC,,,facility,both,,,193,136.64,Aetna First Health,Commercial,90,164.05,85,,,85.54,164.05,percent of total billed charges,
PROTEIN C ANTIGEN - REF,8530290,CDM,85302,CPT,300,RC,,,facility,both,,,209,147.97,Aetna First Health,Commercial,90,177.65,85,,,92.63,177.65,percent of total billed charges,
PROTEIN C ACTIVITY - REF,8530390,CDM,85303,CPT,300,RC,,,facility,both,,,104,73.63,Aetna First Health,Commercial,90,88.4,85,,,46.09,88.4,percent of total billed charges,
"PROTEIN S, TOTAL - REF",8530590,CDM,85305,CPT,300,RC,,,facility,both,,,207,146.56,Aetna First Health,Commercial,90,175.95,85,,,91.74,175.95,percent of total billed charges,
"PROTEIN S, FREE - REF",8530690,CDM,85306,CPT,300,RC,,,facility,both,,,112,79.3,Aetna First Health,Commercial,90,95.2,85,,,49.64,95.2,percent of total billed charges,
APC RESISTANCE ASSAY - REF,8530790,CDM,85307,CPT,300,RC,,,facility,both,,,191,135.23,Aetna First Health,Commercial,90,162.35,85,,,84.65,162.35,percent of total billed charges,
FACTOR INHIBITOR TEST - REF,8533590,CDM,85335,CPT,300,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,90,79.05,85,,,41.22,79.05,percent of total billed charges,
FIBRINOGEN TEST - REF,8536690,CDM,85366,CPT,300,RC,,,facility,both,,,159,112.57,Aetna First Health,Commercial,90,135.15,85,,,70.47,135.15,percent of total billed charges,
"D-DIMER, QUANTITATIVE - REF",8537990,CDM,85379,CPT,300,RC,,,facility,both,,,146,103.37,Aetna First Health,Commercial,90,124.1,85,,,64.71,124.1,percent of total billed charges,
FIBRINOGEN ACTIVITY - REF,8538490,CDM,85384,CPT,300,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,90,96.9,85,,,50.52,96.9,percent of total billed charges,
FIBRINOGEN ANTIGEN,8538590,CDM,85385,CPT,300,RC,,,facility,both,,,144,101.95,Aetna First Health,Commercial,90,122.4,85,,,63.82,122.4,percent of total billed charges,
FIBRINOLYSINS SCREEN - REF,8539090,CDM,85390,CPT,300,RC,,,facility,both,,,169,119.65,Aetna First Health,Commercial,90,143.65,85,,,74.9,143.65,percent of total billed charges,
CLOTTING FUNCTION ACTIVITY - REF,8539790,CDM,85397,CPT,300,RC,,,facility,both,,,186,131.69,Aetna First Health,Commercial,90,158.1,85,,,82.44,158.1,percent of total billed charges,
PLASMINOGEN ACTIVATOR - REF,8541590,CDM,85415,CPT,300,RC,,,facility,both,,,192,135.94,Aetna First Health,Commercial,90,163.2,85,,,85.09,163.2,percent of total billed charges,
REFERENCE KLEIHAUER,8546090,CDM,85460,CPT,300,RC,,,facility,both,,,275,194.7,Aetna First Health,Commercial,,233.75,85,,,121.88,233.75,percent of total billed charges,
HEPARIN ASSAY - REF,8552090,CDM,85520,CPT,300,RC,,,facility,both,,,133,94.16,Aetna First Health,Commercial,90,113.05,85,,,58.95,113.05,percent of total billed charges,
"OSMO FRAG, RBC, INCUBATED - REF",8555790,CDM,85557,CPT,300,RC,,,facility,both,,,139,98.41,Aetna First Health,Commercial,90,118.15,85,,,61.6,118.15,percent of total billed charges,
PLATELET NEUTRALIZATION - REF,8559790,CDM,85597,CPT,300,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,90,57.8,85,,,30.14,57.8,percent of total billed charges,
HEXAGONAL PHOSPHOLIPID,8559890,CDM,85598,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
PROTHOMBIN TIME - REF,8561090,CDM,85610,CPT,300,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,90,53.55,85,,,27.92,53.55,percent of total billed charges,
"PLASMA FRACTIONS, EA PT - REF",8561190,CDM,85611,CPT,300,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,90,62.05,85,,,32.35,62.05,percent of total billed charges,
RUSSELL VIPER VENOM - REF,8561390,CDM,85613,CPT,300,RC,,,facility,both,,,24,16.99,Aetna First Health,Commercial,90,20.4,85,,,10.64,20.4,percent of total billed charges,
REPTILASE TEST - REF,8563590,CDM,85635,CPT,300,RC,,,facility,both,,,88,62.3,Aetna First Health,Commercial,90,74.8,85,,,39,74.8,percent of total billed charges,
"SICKLING OF RBC, REDUCT - REF",8566090,CDM,85660,CPT,300,RC,,,facility,both,,,55,38.94,Aetna First Health,Commercial,90,46.75,85,,,24.38,46.75,percent of total billed charges,
"THROMBIN TIME, PLASMA - REF",8567090,CDM,85670,CPT,300,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,90,66.3,85,,,34.57,66.3,percent of total billed charges,
"L (PTT), PLASMA OR WB - REF",8573090,CDM,85730,CPT,300,RC,,,facility,both,,,97,68.68,Aetna First Health,Commercial,90,82.45,85,,,42.99,82.45,percent of total billed charges,
"PLASMA FRACTIONS, EA PTT - REF",8573290,CDM,85732,CPT,300,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,90,63.75,85,,,33.24,63.75,percent of total billed charges,
"ALLERGEN IGG, QUANT EACH - REF",8600190,CDM,86001,CPT,300,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,90,28.05,85,,,14.63,28.05,percent of total billed charges,
"ALLERGEN SPECIFIC IGE, EA - REF",8600390,CDM,86003,CPT,300,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,90,37.4,85,,,19.5,37.4,percent of total billed charges,
"ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE,RECOMBINANT OR PURIFIED COMPONENT,EACH - REF",8600890,CDM,86008,CPT,300,RC,,,facility,both,,,36,25.49,Aetna First Health,Commercial,90,30.6,85,,,15.96,30.6,percent of total billed charges,
ACTIN SMOOTH MUSCLE ANTIBODY EACH,8601590,CDM,86015,CPT,300,RC,,,facility,both,,,19,13.45,Aetna First Health,Commercial,90,16.15,85,,,8.42,16.15,percent of total billed charges,
LEUCOCYTE ANTIBODIES - REF,8602190,CDM,86021,CPT,300,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,90,53.55,85,,,27.92,53.55,percent of total billed charges,
PLATELET ANTIBODIES - REF,8602290,CDM,86022,CPT,300,RC,,,facility,both,,,152,107.62,Aetna First Health,Commercial,90,129.2,85,,,67.37,129.2,percent of total billed charges,
PLAT ASSOC IMMUNGL ASSAY,8602390,CDM,86023,CPT,300,RC,,,facility,both,,,156,110.45,Aetna First Health,Commercial,90,132.6,85,,,69.14,132.6,percent of total billed charges,
ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,8603690,CDM,86036,CPT,300,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,90,24.65,85,,,12.85,24.65,percent of total billed charges,
ANTINUCLEAR ANTIBODIESANA - REF,8603890,CDM,86038,CPT,300,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,90,75.65,85,,,39.44,75.65,percent of total billed charges,
ANTINUCLEAR AB(ANA) TITER - REF,8603990,CDM,86039,CPT,300,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,90,77.35,85,,,40.33,77.35,percent of total billed charges,
"ANTISTREPTOLYSIN O, TITER - REF",8606090,CDM,86060,CPT,300,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,90,41.65,85,,,21.72,41.65,percent of total billed charges,
C-REACTIVE PROTEIN - REF,8614090,CDM,86140,CPT,300,RC,,,facility,both,,,52,36.82,Aetna First Health,Commercial,90,44.2,85,,,23.05,44.2,percent of total billed charges,
"BETA 2 GLYCOPROT 1 AB,EA - REF",8614690,CDM,86146,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,90,50.15,85,,,26.15,50.15,percent of total billed charges,
"CARDIOLIPIN AB, EA LG - REF",8614790,CDM,86147,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,90,52.7,85,,,27.48,52.7,percent of total billed charges,
"COLD AGGLUTININ, TITER - REF",8615790,CDM,86157,CPT,300,RC,,,facility,both,,,42,29.74,Aetna First Health,Commercial,90,35.7,85,,,18.61,35.7,percent of total billed charges,
"COMPLIMENT, AG EA - REF",8616090,CDM,86160,CPT,300,RC,,,facility,both,,,110,77.88,Aetna First Health,Commercial,90,93.5,85,,,48.75,93.5,percent of total billed charges,
"COMPLIMENT, FUNCT ACT. EA - REF",8616190,CDM,86161,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,90,62.9,85,,,32.8,62.9,percent of total billed charges,
"COMPLIMENT, TOTAL  (CH50) - REF",8616290,CDM,86162,CPT,300,RC,,,facility,both,,,58,41.06,Aetna First Health,Commercial,90,49.3,85,,,25.71,49.3,percent of total billed charges,
"CCP, ANTIBODY - REF",8620090,CDM,86200,CPT,300,RC,,,facility,both,,,77,54.52,Aetna First Health,Commercial,90,65.45,85,,,34.13,65.45,percent of total billed charges,
"DEOXYRIBONUCLEASE, AB - REF",8621590,CDM,86215,CPT,300,RC,,,facility,both,,,112,79.3,Aetna First Health,Commercial,90,95.2,85,,,49.64,95.2,percent of total billed charges,
"DNA, AB, NATIVE/DBL STRND - REF",8622590,CDM,86225,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,90,55.25,85,,,28.81,55.25,percent of total billed charges,
"EXTRACTABLE NUCLEAR ANTIGEN, EACH ANTIBODY - REF",8623590,CDM,86235,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,90,109.65,85,,,57.17,109.65,percent of total billed charges,
"FLUOR NONINFECT AB SC, EA - REF",8625590,CDM,86255,CPT,300,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,90,57.8,85,,,30.14,57.8,percent of total billed charges,
"FLR NONINFECT TITER, EA AB - REF",8625690,CDM,86256,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,90,109.65,85,,,57.17,109.65,percent of total billed charges,
GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS,8625890,CDM,86258,CPT,300,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,90,24.65,85,,,12.85,24.65,percent of total billed charges,
"IMMUNOASSAY,CA15-3(27.29) - REF",8630090,CDM,86300,CPT,300,RC,,,facility,both,,,89,63.01,Aetna First Health,Commercial,90,75.65,85,,,39.44,75.65,percent of total billed charges,
"IMMUNO FOR TUMOR AG, QN - REF",8631690,CDM,86316,CPT,300,RC,,,facility,both,,,138,97.7,Aetna First Health,Commercial,90,117.3,85,,,61.16,117.3,percent of total billed charges,
"IMMUNO FOR INFECTIOUS, AB - REF",8631790,CDM,86317,CPT,300,RC,,,facility,both,,,79,55.93,Aetna First Health,Commercial,90,67.15,85,,,35.01,67.15,percent of total billed charges,
"GEL DIF, QL, EA AG OR AB - REF",8633190,CDM,86331,CPT,300,RC,,,facility,both,,,92,65.14,Aetna First Health,Commercial,90,78.2,85,,,40.77,78.2,percent of total billed charges,
"IMMUNOFIX ELP, FLUIDS - REF",8633590,CDM,86335,CPT,300,RC,,,facility,both,,,213,150.8,Aetna First Health,Commercial,90,181.05,85,,,94.4,181.05,percent of total billed charges,
INHIBIN A ANTIBODIES - REF,8633690,CDM,86336,CPT,300,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,90,24.65,85,,,12.85,24.65,percent of total billed charges,
INSULIN AB - REF,8633790,CDM,86337,CPT,300,RC,,,facility,both,,,121,85.67,Aetna First Health,Commercial,90,102.85,85,,,53.63,102.85,percent of total billed charges,
INTRINSIC FACTOR ABS - REF,8634090,CDM,86340,CPT,300,RC,,,facility,both,,,109,77.17,Aetna First Health,Commercial,90,92.65,85,,,48.31,92.65,percent of total billed charges,
ISLET CELL ANTIBODY - REF,8634190,CDM,86341,CPT,300,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,90,106.25,85,,,55.4,106.25,percent of total billed charges,
CELLULAR FUNCTION ASSAY - REF,8635290,CDM,86352,CPT,300,RC,,,facility,both,,,378,267.62,Aetna First Health,Commercial,90,321.3,85,,,167.53,321.3,percent of total billed charges,
LAB LYMPH BLAST AG B - REF,8635390,CDM,86353,CPT,300,RC,,,facility,both,,,311,220.19,Aetna First Health,Commercial,90,264.35,85,,,137.84,264.35,percent of total billed charges,
"B CELLS, TOTAL COUNT - REF",8635590,CDM,86355,CPT,300,RC,,,facility,both,,,155,109.74,Aetna First Health,Commercial,90,131.75,85,,,68.7,131.75,percent of total billed charges,
MONONUCLEAR CELL ANTIGEN - REF,8635690,CDM,86356,CPT,300,RC,,,facility,both,,,276,195.41,Aetna First Health,Commercial,90,234.6,85,,,122.32,234.6,percent of total billed charges,
"(NK) CELLS, TOTAL COUNT - REF",8635790,CDM,86357,CPT,300,RC,,,facility,both,,,177,125.32,Aetna First Health,Commercial,90,150.45,85,,,78.45,150.45,percent of total billed charges,
"T CELLS, TOTAL COUNT - REF",8635990,CDM,86359,CPT,300,RC,,,facility,both,,,183,129.56,Aetna First Health,Commercial,90,155.55,85,,,81.11,155.55,percent of total billed charges,
"T CELL, ABSOLUTE COUNT/RATIO - REF",8636090,CDM,86360,CPT,300,RC,,,facility,both,,,215,152.22,Aetna First Health,Commercial,90,182.75,85,,,95.29,182.75,percent of total billed charges,
"T CELL, ABSOLUTE CD4 COUNT - REF",8636190,CDM,86361,CPT,300,RC,,,facility,both,,,231,163.55,Aetna First Health,Commercial,90,196.35,85,,,102.38,196.35,percent of total billed charges,
TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS,8636490,CDM,86364,CPT,300,RC,,,facility,both,,,23,16.28,Aetna First Health,Commercial,90,19.55,85,,,10.19,19.55,percent of total billed charges,
MICROSOMAL ANTIBODIES - REF,8637690,CDM,86376,CPT,300,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,90,104.55,85,,,54.51,104.55,percent of total billed charges,
MITOCHONDRIAL ANTIBODY EACH,8638190,CDM,86381,CPT,300,RC,,,facility,both,,,13,9.2,Aetna First Health,Commercial,90,11.05,85,,,5.76,11.05,percent of total billed charges,
VIRAL NEUTRALIZATION - REF,8638290,CDM,86382,CPT,300,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,90,106.25,85,,,55.4,106.25,percent of total billed charges,
"RHEUMATOID FACTOR, QUANT - REF",8643190,CDM,86431,CPT,300,RC,,,facility,both,,,60,42.48,Aetna First Health,Commercial,90,51,85,,,26.59,51,percent of total billed charges,
TB TEST ENUMERATION OF T-CELLS - REF,8648190,CDM,86481,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
"SYPHILIS TEST, QUAL - REF",8659290,CDM,86592,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,90,48.45,85,,,25.26,48.45,percent of total billed charges,
SYPHILIS TEST NON-TREP QUANT - REF,8659390,CDM,86593,CPT,300,RC,,,facility,both,,,18,12.74,Aetna First Health,Commercial,90,15.3,85,,,7.98,15.3,percent of total billed charges,
ASPERGILLUS ANTIBODY - REF,8660690,CDM,86606,CPT,300,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,90,73.95,85,,,38.56,73.95,percent of total billed charges,
"BACTERIUM NOS, ANTIBODY - REF",8660990,CDM,86609,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,90,76.5,85,,,39.89,76.5,percent of total billed charges,
BARTONELLA ANTIBODY - REF,8661190,CDM,86611,CPT,300,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,90,69.7,85,,,36.34,69.7,percent of total billed charges,
BLASTOMYCES ANTIBODY - REF,8661290,CDM,86612,CPT,300,RC,,,facility,both,,,82,58.06,Aetna First Health,Commercial,90,69.7,85,,,36.34,69.7,percent of total billed charges,
BORDETELLA ANTIBODY - REF,8661590,CDM,86615,CPT,300,RC,,,facility,both,,,99,70.09,Aetna First Health,Commercial,90,84.15,85,,,43.88,84.15,percent of total billed charges,
"LYME DISEASE, CONFIRM TST - REF",8661790,CDM,86617,CPT,300,RC,,,facility,both,,,47,33.28,Aetna First Health,Commercial,90,39.95,85,,,20.83,39.95,percent of total billed charges,
"LYME DISEASE, ANTIBODY - REF",8661890,CDM,86618,CPT,300,RC,,,facility,both,,,142,100.54,Aetna First Health,Commercial,90,120.7,85,,,62.93,120.7,percent of total billed charges,
BRUCELLA ANTIBODY - REF,8662290,CDM,86622,CPT,300,RC,,,facility,both,,,69,48.85,Aetna First Health,Commercial,90,58.65,85,,,30.58,58.65,percent of total billed charges,
CAMPYLOBACTER ANTIBODY - REF,8662590,CDM,86625,CPT,300,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,90,79.05,85,,,41.22,79.05,percent of total billed charges,
CANDIDA ANTIBODY - REF,8662890,CDM,86628,CPT,300,RC,,,facility,both,,,77,54.52,Aetna First Health,Commercial,90,65.45,85,,,34.13,65.45,percent of total billed charges,
CHLAMYDIA ANTIBODY - REF,8663190,CDM,86631,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,90,52.7,85,,,27.48,52.7,percent of total billed charges,
"CHLAMYDIA IGM, ANTIBODY - REF",8663290,CDM,86632,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,90,59.5,85,,,31.02,59.5,percent of total billed charges,
COCCIDIOIDES ANTIBODY - REF,8663590,CDM,86635,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,90,50.15,85,,,26.15,50.15,percent of total billed charges,
(Q FEVER) ANTIBODY - REF,8663890,CDM,86638,CPT,300,RC,,,facility,both,,,84,59.47,Aetna First Health,Commercial,90,71.4,85,,,37.23,71.4,percent of total billed charges,
CMV ANTIBODY - REF,8664490,CDM,86644,CPT,300,RC,,,facility,both,,,94,66.55,Aetna First Health,Commercial,90,79.9,85,,,41.66,79.9,percent of total billed charges,
CMV IGM ANTIBODY - REF,8664590,CDM,86645,CPT,300,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,90,85,85,,,44.32,85,percent of total billed charges,
"LA CROSSE, ANTIBODY - REF",8665190,CDM,86651,CPT,300,RC,,,facility,both,,,30,21.24,Aetna First Health,Commercial,90,25.5,85,,,13.3,25.5,percent of total billed charges,
"EASTERN EQUINE, AB - REF",8665290,CDM,86652,CPT,300,RC,,,facility,both,,,53,37.52,Aetna First Health,Commercial,90,45.05,85,,,23.49,45.05,percent of total billed charges,
"ST LOUIS, ANTIBODY - REF",8665390,CDM,86653,CPT,300,RC,,,facility,both,,,51,36.11,Aetna First Health,Commercial,90,43.35,85,,,22.6,43.35,percent of total billed charges,
"WESTERN EQUINE, AB - REF",8665490,CDM,86654,CPT,300,RC,,,facility,both,,,51,36.11,Aetna First Health,Commercial,90,43.35,85,,,22.6,43.35,percent of total billed charges,
ENTEROVIRUS ANTIBODY - REF,8665890,CDM,86658,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
EBV EARLY AG - REF,8666390,CDM,86663,CPT,300,RC,,,facility,both,,,112,79.3,Aetna First Health,Commercial,90,95.2,85,,,49.64,95.2,percent of total billed charges,
"EBV, NUCLEAR ANTIGEN - REF",8666490,CDM,86664,CPT,300,RC,,,facility,both,,,94,66.55,Aetna First Health,Commercial,90,79.9,85,,,41.66,79.9,percent of total billed charges,
"EBV, VIRAL CAPSID AB - REF",8666590,CDM,86665,CPT,300,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,90,36.55,85,,,19.06,36.55,percent of total billed charges,
EHRLICHIA (ANAPLASMA) AB - REF,8666690,CDM,86666,CPT,300,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,90,42.5,85,,,22.16,42.5,percent of total billed charges,
"FUNGUS ANTIBODY, NOS - REF",8667190,CDM,86671,CPT,300,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,90,85,85,,,44.32,85,percent of total billed charges,
"HELMINTH, NOS - REF",8668290,CDM,86682,CPT,300,RC,,,facility,both,,,108,76.46,Aetna First Health,Commercial,90,91.8,85,,,47.87,91.8,percent of total billed charges,
"HTLV OR HIV AB, CONFIRM - REF",8668990,CDM,86689,CPT,300,RC,,,facility,both,,,127,89.92,Aetna First Health,Commercial,90,107.95,85,,,56.29,107.95,percent of total billed charges,
HEPATITIS DELTA AGENT AB - REF,8669290,CDM,86692,CPT,300,RC,,,facility,both,,,105,74.34,Aetna First Health,Commercial,90,89.25,85,,,46.54,89.25,percent of total billed charges,
"HERPES SIMPLEX, TYPE 1 ANTIBODY - REF",8669590,CDM,86695,CPT,300,RC,,,facility,both,,,32,22.66,Aetna First Health,Commercial,90,27.2,85,,,14.18,27.2,percent of total billed charges,
"HERPES SIMPLEX, TYPE 2 ANTIBODY - REF",8669690,CDM,86696,CPT,300,RC,,,facility,both,,,47,33.28,Aetna First Health,Commercial,90,39.95,85,,,20.83,39.95,percent of total billed charges,
HISTOPLASMA ANTIBODY - REF,8669890,CDM,86698,CPT,300,RC,,,facility,both,,,61,43.19,Aetna First Health,Commercial,90,51.85,85,,,27.04,51.85,percent of total billed charges,
HIV-1ANTIBODY - REF,8670190,CDM,86701,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,90,45.9,85,,,23.93,45.9,percent of total billed charges,
HIV-2 ANTIBODY - REF,8670290,CDM,86702,CPT,300,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,90,28.05,85,,,14.63,28.05,percent of total billed charges,
HEPATITIS BE ANTIBODY - REF,8670790,CDM,86707,CPT,300,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,90,62.05,85,,,32.35,62.05,percent of total billed charges,
"HEPATITIS A ANTIBODY, TOT - REF",8670890,CDM,86708,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,90,45.9,85,,,23.93,45.9,percent of total billed charges,
INFLUENZA VIRUS ANTIBODY,8671090,CDM,86710,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,90,48.45,85,,,25.26,48.45,percent of total billed charges,
ANTIBODY JOHN CUNNINGHAM VIRUS - REF,8671190,CDM,86711,CPT,300,RC,,,facility,both,,,1813,1283.6,Aetna First Health,Commercial,90,1541.05,85,,,803.52,1541.05,percent of total billed charges,
LEGIONELLA ANTIBODY - REF,8671390,CDM,86713,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,90,62.9,85,,,32.8,62.9,percent of total billed charges,
LEISHMANIA ANTIBODY - REF,8671790,CDM,86717,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,90,48.45,85,,,25.26,48.45,percent of total billed charges,
LEPTOSPIRA ANTIBODY - REF,8672090,CDM,86720,CPT,300,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,90,57.8,85,,,30.14,57.8,percent of total billed charges,
MUMPS ANTIBODY - REF,8673590,CDM,86735,CPT,300,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,90,66.3,85,,,34.57,66.3,percent of total billed charges,
MYCOPLASMA ANTIBODY,8673890,CDM,86738,CPT,300,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,90,29.75,85,,,15.51,29.75,percent of total billed charges,
PARVOVIRUS ANTIBODY - REF,8674790,CDM,86747,CPT,300,RC,,,facility,both,,,95,67.26,Aetna First Health,Commercial,90,80.75,85,,,42.1,80.75,percent of total billed charges,
"PROTOZOA ANTIBODY, NOS - REF",8675390,CDM,86753,CPT,300,RC,,,facility,both,,,85,60.18,Aetna First Health,Commercial,90,72.25,85,,,37.67,72.25,percent of total billed charges,
RICKETTSIA ANTIBODY - REF,8675790,CDM,86757,CPT,300,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,90,36.55,85,,,19.06,36.55,percent of total billed charges,
RUBELLA ANTIBODY - REF,8676290,CDM,86762,CPT,300,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,90,62.9,85,,,32.8,62.9,percent of total billed charges,
RUBEOLA (MEASLES) ANTIBODY - REF,8676590,CDM,86765,CPT,300,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,90,42.5,85,,,22.16,42.5,percent of total billed charges,
SARS-COV-2 COVID-19 ANTIBODY ,8676990,CDM,86769,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,90,52.7,85,,,27.48,52.7,percent of total billed charges,
TOXOPLASMA ANTIBODY - REF,8677790,CDM,86777,CPT,300,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,90,63.75,85,,,33.24,63.75,percent of total billed charges,
TOXOPLASMA ANTIBODY IGM - REF,8677890,CDM,86778,CPT,300,RC,,,facility,both,,,102,72.22,Aetna First Health,Commercial,90,86.7,85,,,45.21,86.7,percent of total billed charges,
TREPONEMA PALLIDUM - REF,8678090,CDM,86780,CPT,300,RC,,,facility,both,,,48,33.98,Aetna First Health,Commercial,90,40.8,85,,,21.27,40.8,percent of total billed charges,
VARICELLA-ZOSTER ANTIBODY - REF,8678790,CDM,86787,CPT,300,RC,,,facility,both,,,54,38.23,Aetna First Health,Commercial,90,45.9,85,,,23.93,45.9,percent of total billed charges,
"WEST NILE AB, IGM - REF",8678890,CDM,86788,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
"WEST NILE AB, IGG - REF",8678990,CDM,86789,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,90,52.7,85,,,27.48,52.7,percent of total billed charges,
"MISC VIRUS ANTIBODY, NOS - REF",8679090,CDM,86790,CPT,300,RC,,,facility,both,,,119,84.25,Aetna First Health,Commercial,90,101.15,85,,,52.74,101.15,percent of total billed charges,
THYROGLOBULIN ANTIBODY,8680090,CDM,86800,CPT,300,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,90,50.15,85,,,26.15,50.15,percent of total billed charges,
"HLA A, B OR C, SINGLE AG - REF",8681290,CDM,86812,CPT,300,RC,,,facility,both,,,66,46.73,Aetna First Health,Commercial,90,56.1,85,,,29.25,56.1,percent of total billed charges,
"HLA A, B OR C, MTPL AGS - REF",8681390,CDM,86813,CPT,300,RC,,,facility,both,,,229,162.13,Aetna First Health,Commercial,90,194.65,85,,,101.49,194.65,percent of total billed charges,
HLASC-HLA CLASS I ANTIBODY SCREEN - REF,8682890,CDM,86828,CPT,300,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,90,106.25,85,,,55.4,106.25,percent of total billed charges,
"MISC IMMUNOLOGY, UNLISTED - REF",8684990,CDM,86849,CPT,300,RC,,,facility,both,,,475,336.3,Aetna First Health,Commercial,90,403.75,85,,,210.52,403.75,percent of total billed charges,
ANTIBODY SCREEN RBC EACH - REF,8685090,CDM,86850,CPT,300,RC,,,facility,both,,,268,189.74,Aetna First Health,Commercial,90,227.8,85,,,118.78,227.8,percent of total billed charges,
REF ELUTION - REF,8686090,CDM,86860,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
RBC ANTIBODY IDENTIFICATION - REF,8687090,CDM,86870,CPT,300,RC,,,facility,both,,,192,135.94,Aetna First Health,Commercial,90,163.2,85,,,85.09,163.2,percent of total billed charges,
REF DAT - REF,8688090,CDM,86880,CPT,300,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,90,28.05,85,,,14.63,28.05,percent of total billed charges,
INDIRECT ANTIBODY EACH - REF,8688690,CDM,86886,CPT,300,RC,,,facility,both,,,182,128.86,Aetna First Health,Commercial,90,154.7,85,,,80.66,154.7,percent of total billed charges,
REFERENCE ABO - REF,8690090,CDM,86900,CPT,300,RC,,,facility,both,,,40,28.32,Aetna First Health,Commercial,90,34,85,,,17.73,34,percent of total billed charges,
REFERENCE LAB RH - REF,8690190,CDM,86901,CPT,300,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,90,34.85,85,,,18.17,34.85,percent of total billed charges,
REF UNIT ANTIGEN TYPE - REF,8690290,CDM,86902,CPT,300,RC,,,facility,both,,,58,41.06,Aetna First Health,Commercial,90,49.3,85,,,25.71,49.3,percent of total billed charges,
UNIT ANTIGEN SCRENING WITH PATIENT PLASMA - REF,8690490,CDM,86904,CPT,300,RC,,,facility,both,,,48,33.98,Aetna First Health,Commercial,90,40.8,85,,,21.27,40.8,percent of total billed charges,
REF PATIENT ANTIGEN TYPE - REF,8690590,CDM,86905,CPT,300,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,90,56.95,85,,,29.69,56.95,percent of total billed charges,
REF RBC PRETREATMENT/DRUG STUDIES - REF,8697090,CDM,86970,CPT,300,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,90,41.65,85,,,21.72,41.65,percent of total billed charges,
REF ENZYME TREATMENT - REF,8697190,CDM,86971,CPT,300,RC,,,facility,both,,,56,39.65,Aetna First Health,Commercial,90,47.6,85,,,24.82,47.6,percent of total billed charges,
REF PLASMA PRETREATMENT/DTT - REF,8697590,CDM,86975,CPT,300,RC,,,facility,both,,,45,31.86,Aetna First Health,Commercial,90,38.25,85,,,19.94,38.25,percent of total billed charges,
REF NEUTRALIZATION - REF,8697790,CDM,86977,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
REF ADSORPTION - REF,8697890,CDM,86978,CPT,300,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,90,57.8,85,,,30.14,57.8,percent of total billed charges,
SPECIMEN CONCENTRATION - REF,8701590,CDM,87015,CPT,300,RC,,,facility,both,,,46,32.57,Aetna First Health,Commercial,90,39.1,85,,,20.39,39.1,percent of total billed charges,
FECES CULTURE AEROBIC BACT - REF,8704590,CDM,87045,CPT,300,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,90,56.95,85,,,29.69,56.95,percent of total billed charges,
STOOL CULTR AEROBIC BACT EA,8704690,CDM,87046,CPT,300,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,90,56.95,85,,,29.69,56.95,percent of total billed charges,
"ID AEROBIC ISOLATE, OTHER - REF",8707090,CDM,87070,CPT,300,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,90,52.7,85,,,27.48,52.7,percent of total billed charges,
"ORGANISM ID, ANAEROBIC - REF",8707690,CDM,87076,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,90,55.25,85,,,28.81,55.25,percent of total billed charges,
AEROBIC ISOLATE - REF,8707790,CDM,87077,CPT,300,RC,,,facility,both,,,79,55.93,Aetna First Health,Commercial,90,67.15,85,,,35.01,67.15,percent of total billed charges,
"CULTFOR PATHOG ORGAN,SCR - REF",8708190,CDM,87081,CPT,300,RC,,,facility,both,,,119,84.25,Aetna First Health,Commercial,90,101.15,85,,,52.74,101.15,percent of total billed charges,
FUNGAL CULTURE DERMAL - REF,8710190,CDM,87101,CPT,300,RC,,,facility,both,,,60,42.48,Aetna First Health,Commercial,90,51,85,,,26.59,51,percent of total billed charges,
"FUNGAL CULTURE, OTHER SOURCE - REF",8710290,CDM,87102,CPT,300,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,90,126.65,85,,,66.04,126.65,percent of total billed charges,
BLOOD FUNGUS CULTURE - REF,8710390,CDM,87103,CPT,300,RC,,,facility,both,,,36,25.49,Aetna First Health,Commercial,90,30.6,85,,,15.96,30.6,percent of total billed charges,
"ORGANISM ID, YEAST - REF",8710690,CDM,87106,CPT,300,RC,,,facility,both,,,92,65.14,Aetna First Health,Commercial,90,78.2,85,,,40.77,78.2,percent of total billed charges,
FUNGI IDENTIFICATION MOLD - REF,8710790,CDM,87107,CPT,300,RC,,,facility,both,,,37,26.2,Aetna First Health,Commercial,90,31.45,85,,,16.4,31.45,percent of total billed charges,
MYCOBACTERIA CULTURE - REF,8711690,CDM,87116,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,90,61.2,85,,,31.91,61.2,percent of total billed charges,
"MYCOBACTERIUM, REFERENCE ID - REF",8711890,CDM,87118,CPT,300,RC,,,facility,both,,,61,43.19,Aetna First Health,Commercial,90,51.85,85,,,27.04,51.85,percent of total billed charges,
CULTURE TYPE IMMUNOLOGIC - REF,8714790,CDM,87147,CPT,300,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,90,28.05,85,,,14.63,28.05,percent of total billed charges,
DNA/RNA AMPLIFIED PROBE - REF,8715090,CDM,87150,CPT,300,RC,,,facility,both,,,130,92.04,Aetna First Health,Commercial,90,110.5,85,,,57.62,110.5,percent of total billed charges,
ID NUCLEIC ACID SEQUENCING - REF,8715390,CDM,87153,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,90,119,85,,,62.05,119,percent of total billed charges,
TISSUE HOMOGENIZATION CULTR - REF,8717690,CDM,87176,CPT,300,RC,,,facility,both,,,22,15.58,Aetna First Health,Commercial,90,18.7,85,,,9.75,18.7,percent of total billed charges,
OVA AND PARASITES SMEARS - REF,8717790,CDM,87177,CPT,300,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,90,28.9,85,,,15.07,28.9,percent of total billed charges,
"SUSCEPTIBILITY, ANAEROBIC, MIC - REF",8718190,CDM,87181,CPT,300,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,90,22.1,85,,,11.52,22.1,percent of total billed charges,
ESBL SUSCEPTIBILITY,8718490,CDM,87184,CPT,300,RC,,,facility,both,,,132,93.46,Aetna First Health,Commercial,90,112.2,85,,,58.5,112.2,percent of total billed charges,
"ANTIBIOTIC SENS,ENZYME DETECTION,EACH - REF",8718590,CDM,87185,CPT,300,RC,,,facility,both,,,45,31.86,Aetna First Health,Commercial,90,38.25,85,,,19.94,38.25,percent of total billed charges,
NOCARDIA SUSCEPTIBILITY - REF,8718690,CDM,87186,CPT,300,RC,,,facility,both,,,112,79.3,Aetna First Health,Commercial,90,95.2,85,,,49.64,95.2,percent of total billed charges,
"SUSCEPT, MACRODILUTE, EA - REF",8718890,CDM,87188,CPT,300,RC,,,facility,both,,,397,281.08,Aetna First Health,Commercial,90,337.45,85,,,175.95,337.45,percent of total billed charges,
"FLOUR. AFSTAIN , MICRO - REF",8720690,CDM,87206,CPT,300,RC,,,facility,both,,,53,37.52,Aetna First Health,Commercial,90,45.05,85,,,23.49,45.05,percent of total billed charges,
SP STN FOR INCLUSN BODIES - REF,8720790,CDM,87207,CPT,300,RC,,,facility,both,,,87,61.6,Aetna First Health,Commercial,90,73.95,85,,,38.56,73.95,percent of total billed charges,
SMEAR COMPLEX STAIN - REF,8720990,CDM,87209,CPT,300,RC,,,facility,both,,,24,16.99,Aetna First Health,Commercial,90,20.4,85,,,10.64,20.4,percent of total billed charges,
"TISSCULT, INOCUL, OBSERV - REF",8725290,CDM,87252,CPT,300,RC,,,facility,both,,,139,98.41,Aetna First Health,Commercial,90,118.15,85,,,61.6,118.15,percent of total billed charges,
VIRUS INOCULATION SHELL VIA - REF,8725490,CDM,87254,CPT,300,RC,,,facility,both,,,436,308.69,Aetna First Health,Commercial,90,370.6,85,,,193.24,370.6,percent of total billed charges,
ASPERGILLUS AG - REF,8730590,CDM,87305,CPT,300,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,90,64.6,85,,,33.68,64.6,percent of total billed charges,
CLOSTRIDIUM AG EIA,8732490,CDM,87324,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,90,109.65,85,,,57.17,109.65,percent of total billed charges,
"HEPATITIS B S AG, BY EIA - REF",8734090,CDM,87340,CPT,300,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,90,34.85,85,,,18.17,34.85,percent of total billed charges,
HBS AG-NEUTRALIZATION REFLEX - REF,8734190,CDM,87341,CPT,300,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,90,60.35,85,,,31.47,60.35,percent of total billed charges,
"HEP BE AG DETECTION,EIA - REF",8735090,CDM,87350,CPT,300,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
HISTOPLASMA CAPSUL EIA - REF,8738590,CDM,87385,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,90,76.5,85,,,39.89,76.5,percent of total billed charges,
"INFECT AG,EIA, NOS, EA - REF",8744990,CDM,87449,CPT,300,RC,,,facility,both,,,115,81.42,Aetna First Health,Commercial,90,97.75,85,,,50.97,97.75,percent of total billed charges,
"BARTONELLA, AMPL PROBE - REF",8747190,CDM,87471,CPT,300,RC,,,facility,both,,,162,114.7,Aetna First Health,Commercial,90,137.7,85,,,71.8,137.7,percent of total billed charges,
"B.BURGDORFERI, AMP PROBE - REF",8747690,CDM,87476,CPT,300,RC,,,facility,both,,,231,163.55,Aetna First Health,Commercial,90,196.35,85,,,102.38,196.35,percent of total billed charges,
BORRELIA MIYAMOTOI AMP PRB,8747890,CDM,87478,CPT,300,RC,,,facility,both,,,108,76.46,Aetna First Health,Commercial,90,91.8,85,,,47.87,91.8,percent of total billed charges,
CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25,8748390,CDM,87483,CPT,300,RC,,,facility,both,,,556,393.65,Aetna First Health,Commercial,90,472.6,85,,,246.42,472.6,percent of total billed charges,
"C. PNEUMONIAE, AMPL.PROBE - REF",8748690,CDM,87486,CPT,300,RC,,,facility,both,,,146,103.37,Aetna First Health,Commercial,90,124.1,85,,,64.71,124.1,percent of total billed charges,
INFECT AGENT DETECT DNA OR RNA,8749190,CDM,87491,CPT,300,RC,,,facility,both,,,57,40.36,Aetna First Health,Commercial,90,48.45,85,,,25.26,48.45,percent of total billed charges,
"CMV DETECT, AMPLIFI PROBE - REF",8749690,CDM,87496,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,90,119,85,,,62.05,119,percent of total billed charges,
"CMV, QUANT - REF",8749790,CDM,87497,CPT,300,RC,,,facility,both,,,360,254.88,Aetna First Health,Commercial,90,306,85,,,159.55,306,percent of total billed charges,
ENTEROVIRUS DNA AMP PROBE - REF,8749890,CDM,87498,CPT,300,RC,,,facility,both,,,366,259.13,Aetna First Health,Commercial,90,311.1,85,,,162.21,311.1,percent of total billed charges,
NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN,8750590,CDM,87505,CPT,300,RC,,,facility,both,,,288,203.9,Aetna First Health,Commercial,90,244.8,85,,,127.64,244.8,percent of total billed charges,
IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11,8750690,CDM,87506,CPT,300,RC,,,facility,both,,,377,266.92,Aetna First Health,Commercial,90,320.45,85,,,167.09,320.45,percent of total billed charges,
"GI PATHOGEN PANEL, PCR - REF",8750790,CDM,87507,CPT,300,RC,,,facility,both,,,799,565.69,Aetna First Health,Commercial,90,679.15,85,,,354.12,679.15,percent of total billed charges,
"HEPATITIS B, QUANITIFICA - REF",8751790,CDM,87517,CPT,300,RC,,,facility,both,,,232,164.26,Aetna First Health,Commercial,90,197.2,85,,,102.82,197.2,percent of total billed charges,
HEPATITIS C RNA QUANTIFICATION - REF,8752290,CDM,87522,CPT,300,RC,,,facility,both,,,165,116.82,Aetna First Health,Commercial,90,140.25,85,,,73.13,140.25,percent of total billed charges,
"HSV DETECT, AMPLIF PROBE - REF",8752990,CDM,87529,CPT,300,RC,,,facility,both,,,167,118.24,Aetna First Health,Commercial,90,141.95,85,,,74.01,141.95,percent of total billed charges,
"HSV-6, AMPLIFIED PROBE - REF",8753290,CDM,87532,CPT,300,RC,,,facility,both,,,169,119.65,Aetna First Health,Commercial,90,143.65,85,,,74.9,143.65,percent of total billed charges,
"HIV-1, QUANTIFICATION - REF",8753690,CDM,87536,CPT,300,RC,,,facility,both,,,534,378.07,Aetna First Health,Commercial,90,453.9,85,,,236.67,453.9,percent of total billed charges,
"HIV-2, AMPLIFIED PROBE - REF",8753890,CDM,87538,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,90,119,85,,,62.05,119,percent of total billed charges,
HIV_2 RNA QUANTITATION,8753990,CDM,87539,CPT,300,RC,,,facility,both,,,389,275.41,Aetna First Health,Commercial,90,330.65,85,,,172.4,330.65,percent of total billed charges,
"MYCOBACTERIA TB,AMPL PROBE - REF",8755690,CDM,87556,CPT,300,RC,,,facility,both,,,204,144.43,Aetna First Health,Commercial,90,173.4,85,,,90.41,173.4,percent of total billed charges,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA GENITALIUM - REF,8756390,CDM,87563,CPT,300,RC,,,facility,both,,,138,97.7,Aetna First Health,Commercial,90,117.3,85,,,61.16,117.3,percent of total billed charges,
MYCOPLASM AMPLIFIED PROBE - REF,8758190,CDM,87581,CPT,300,RC,,,facility,both,,,157,111.16,Aetna First Health,Commercial,90,133.45,85,,,69.58,133.45,percent of total billed charges,
INFECT AGENT AMP PROBE - REF,8759190,CDM,87591,CPT,300,RC,,,facility,both,,,25,17.7,Aetna First Health,Commercial,90,21.25,85,,,11.08,21.25,percent of total billed charges,
HPV HIGH-RISK TYPES - REF,8762490,CDM,87624,CPT,300,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,90,109.65,85,,,57.17,109.65,percent of total billed charges,
RESP VIRUS 12-25 TARGETS,8763390,CDM,87633,CPT,300,RC,,,facility,both,,,615,435.42,Aetna First Health,Commercial,,522.75,85,,,272.57,522.75,percent of total billed charges,
SARS-COV-2 COVID-19 AMP PRB,8763590,CDM,87635,CPT,300,RC,,,facility,both,,,120,84.96,Aetna First Health,Commercial,90,102,85,,,53.18,102,percent of total billed charges,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA)B,8763690,CDM,87636,CPT,300,RC,,,facility,both,,,215,152.22,Aetna First Health,Commercial,90,182.75,85,,,95.29,182.75,percent of total billed charges,
TRICHOMONAS VAGINALIS AMPLIF - REF,8766190,CDM,87661,CPT,300,RC,,,facility,both,,,188,133.1,Aetna First Health,Commercial,90,159.8,85,,,83.32,159.8,percent of total billed charges,
"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); ZIKA VIRUS, AMPLIFIED PROBE TECHNIQUE - REF",8766290,CDM,87662,CPT,300,RC,,,facility,both,,,279,197.53,Aetna First Health,Commercial,90,237.15,85,,,123.65,237.15,percent of total billed charges,
"INFECT EA ORGAN, AMP PROB - REF",8779890,CDM,87798,CPT,300,RC,,,facility,both,,,458,324.26,Aetna First Health,Commercial,90,389.3,85,,,202.99,389.3,percent of total billed charges,
INFEC AGENT DIRECT PROBE - REF,8779990,CDM,87799,CPT,300,RC,,,facility,both,,,193,136.64,Aetna First Health,Commercial,90,164.05,85,,,85.54,164.05,percent of total billed charges,
"INFECT, ORGAN, AMP PROBE - REF",8780190,CDM,87801,CPT,300,RC,,,facility,both,,,232,164.26,Aetna First Health,Commercial,90,197.2,85,,,102.82,197.2,percent of total billed charges,
"INFECT PHENOTYPE, DRUG",8790090,CDM,87900,CPT,300,RC,,,facility,both,,,424,300.19,Aetna First Health,Commercial,90,360.4,85,,,187.92,360.4,percent of total billed charges,
HIV-1 GENOTYPE DRUG RESISTANCE - REF,8790190,CDM,87901,CPT,300,RC,,,facility,both,,,807,571.36,Aetna First Health,Commercial,90,685.95,85,,,357.66,685.95,percent of total billed charges,
"GENOTYPE ANALYSIS, HEPC - REF",8790290,CDM,87902,CPT,300,RC,,,facility,both,,,478,338.42,Aetna First Health,Commercial,90,406.3,85,,,211.85,406.3,percent of total billed charges,
INFECTIOUS AGENT GENOTYPE BY DNA OR RNA; HIV-1,8790690,CDM,87906,CPT,300,RC,,,facility,both,,,462,327.1,Aetna First Health,Commercial,,392.7,85,,,204.76,392.7,percent of total billed charges,
CYTO NON GYN,8811201,CDM,88112,CPT,310,RC,,,facility,both,,,475,336.3,Aetna First Health,Commercial,TC,403.75,85,,,210.52,403.75,percent of total billed charges,
FISH BILEDUCT CA PT 2 - REF,8811290,CDM,88112,CPT,310,RC,,,facility,both,,,461,326.39,Aetna First Health,Commercial,90,391.85,85,,,204.32,391.85,percent of total billed charges,
CYTO URINE 3-5 PROBES EA SPEC - REF,8812090,CDM,88120,CPT,310,RC,,,facility,both,,,441,312.23,Aetna First Health,Commercial,90,374.85,85,,,195.45,374.85,percent of total billed charges,
"CYTOPATH,OTHER SCR,SCRN& INTPR",8816001,CDM,88160,CPT,310,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,TC,119,85,,,62.05,119,percent of total billed charges,
"TECH-CYTOPATH EVAL, FNA, REP",8817301,CDM,88173,CPT,310,RC,,,facility,both,,,277,196.12,Aetna First Health,Commercial,TC,235.45,85,,,122.77,235.45,percent of total billed charges,
CYTO C/V AUTO THIN LYR ADDL,8817701,CDM,88177,CPT,310,RC,,,facility,both,,,46,32.57,Aetna First Health,Commercial,TC,39.1,85,,,20.39,39.1,percent of total billed charges,
"CYTOFLO, CELL OR DNA ANAL - REF",8818290,CDM,88182,CPT,310,RC,,,facility,both,,,286,202.49,Aetna First Health,Commercial,90,243.1,85,,,126.76,243.1,percent of total billed charges,
"FLOW CYTO, TECH, 1ST MRKR - REF",8818490,CDM,88184,CPT,310,RC,,,facility,both,,,286,202.49,Aetna First Health,Commercial,90,243.1,85,,,126.76,243.1,percent of total billed charges,
FLOW CYTO EA ADDTL MARKER - REF,8818590,CDM,88185,CPT,310,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,90,28.05,85,,,14.63,28.05,percent of total billed charges,
"FLOW INTERP,2-8 MARKERS - REF",8818790,CDM,88187,CPT,310,RC,,,facility,both,,,185,130.98,Aetna First Health,Commercial,90,157.25,85,,,81.99,157.25,percent of total billed charges,
FLOW CYTOMETRY READ 9TO15 MKRS - REF,8818890,CDM,88188,CPT,310,RC,,,facility,both,,,470,332.76,Aetna First Health,Commercial,90,399.5,85,,,208.3,399.5,percent of total billed charges,
"TISS CULT,NON-NEOP LYMPH - REF",8823090,CDM,88230,CPT,310,RC,,,facility,both,,,540,382.32,Aetna First Health,Commercial,90,459,85,,,239.33,459,percent of total billed charges,
"TISS CULT, NEOPL, BM, WB - REF",8823790,CDM,88237,CPT,310,RC,,,facility,both,,,298,210.98,Aetna First Health,Commercial,90,253.3,85,,,132.07,253.3,percent of total billed charges,
CHROM ANAL 15-20 CELLS - REF,8826290,CDM,88262,CPT,310,RC,,,facility,both,,,1242,879.34,Aetna First Health,Commercial,90,1055.7,85,,,550.45,1055.7,percent of total billed charges,
"CHROM ANAL, 20-25 CELLS - REF",8826490,CDM,88264,CPT,310,RC,,,facility,both,,,531,375.95,Aetna First Health,Commercial,90,451.35,85,,,235.34,451.35,percent of total billed charges,
"MOLECULAR CYTOG, EA PROBE - REF",8827190,CDM,88271,CPT,310,RC,,,facility,both,,,75,53.1,Aetna First Health,Commercial,90,63.75,85,,,33.24,63.75,percent of total billed charges,
"MOLECYTO IN SITU, 25-99 C - REF",8827490,CDM,88274,CPT,310,RC,,,facility,both,,,101,71.51,Aetna First Health,Commercial,90,85.85,85,,,44.76,85.85,percent of total billed charges,
"MOLECYTO INSITU, 100-300CL - REF",8827590,CDM,88275,CPT,310,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,90,62.9,85,,,32.8,62.9,percent of total billed charges,
CHROMOSOME ANA EA STUDY - REF,8828090,CDM,88280,CPT,310,RC,,,facility,both,,,394,278.95,Aetna First Health,Commercial,90,334.9,85,,,174.62,334.9,percent of total billed charges,
CHROMOSOME COUNT ADDITIONAL - REF,8828590,CDM,88285,CPT,300,RC,,,facility,both,,,20,14.16,Aetna First Health,Commercial,90,17,85,,,8.86,17,percent of total billed charges,
"CYTOGEN, INTERP/REPORT - REF",8829190,CDM,88291,CPT,310,RC,,,facility,both,,,243,172.04,Aetna First Health,Commercial,90,206.55,85,,,107.7,206.55,percent of total billed charges,
SURG PATH LEVEL IV - REF,8830590,CDM,88305,CPT,310,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,90,187.85,85,,,97.95,187.85,percent of total billed charges,
DECALCIFY TC,8831101,CDM,88311,CPT,310,RC,,,facility,both,,,96,67.97,Aetna First Health,Commercial,TC,81.6,85,,,42.55,81.6,percent of total billed charges,
"SPECIAL STAIN, GRP 1, MICRORG - REF",8831290,CDM,88312,CPT,310,RC,,,facility,both,,,192,135.94,Aetna First Health,Commercial,90,163.2,85,,,85.09,163.2,percent of total billed charges,
"SPECIAL STAINS, GROUP II - REF",8831390,CDM,88313,CPT,310,RC,,,facility,both,,,192,135.94,Aetna First Health,Commercial,90,163.2,85,,,85.09,163.2,percent of total billed charges,
"HISTOCHEM STAIN, FROZ SECT - REF",8831490,CDM,88314,CPT,310,RC,,,facility,both,,,188,133.1,Aetna First Health,Commercial,90,159.8,85,,,83.32,159.8,percent of total billed charges,
ENZYME HISTOCHEMISTRY TC,8831901,CDM,88319,CPT,310,RC,,,facility,both,,,240,169.92,Aetna First Health,Commercial,TC,204,85,,,106.37,204,percent of total billed charges,
MUSCLE BX PART 1 - REF,8831990,CDM,88319,CPT,310,RC,,,facility,both,,,250,177,Aetna First Health,Commercial,90,212.5,85,,,110.8,212.5,percent of total billed charges,
"CONSULT/REPORT, REFER - REF",8832190,CDM,88321,CPT,310,RC,,,facility,both,,,270,191.16,Aetna First Health,Commercial,90,229.5,85,,,119.66,229.5,percent of total billed charges,
TECH MICROSLIDE CONSULT W PREP,8832301,CDM,88323,CPT,310,RC,,,facility,both,,,159,112.57,Aetna First Health,Commercial,TC,135.15,85,,,70.47,135.15,percent of total billed charges,
"CONSULT/REPORT, REFERR - REF",8832390,CDM,88323,CPT,310,RC,,,facility,both,,,182,128.86,Aetna First Health,Commercial,90,154.7,85,,,80.66,154.7,percent of total billed charges,
COMPREHEN CONSULT REFERR - REF,8832590,CDM,88325,CPT,310,RC,,,facility,both,,,231,163.55,Aetna First Health,Commercial,90,196.35,85,,,102.38,196.35,percent of total billed charges,
"PATH CONSULT IN SURG,W ADDN FR",8833201,CDM,88332,CPT,310,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,TC,109.65,85,,,57.17,109.65,percent of total billed charges,
INTRA-OP CYTOLOGY CONSULT TC,8833301,CDM,88333,CPT,310,RC,,,facility,both,,,623,441.08,Aetna First Health,Commercial,TC,529.55,85,,,276.11,529.55,percent of total billed charges,
INTRA-OP CYTOLOGY CONSULT ADDL TC,8833401,CDM,88334,CPT,310,RC,,,facility,both,,,124,87.79,Aetna First Health,Commercial,TC,105.4,85,,,54.96,105.4,percent of total billed charges,
IMMUNOHISTO ANTIBODY SLIDE EA ADDL,8834101,CDM,88341,CPT,310,RC,,,facility,both,,,260,184.08,Aetna First Health,Commercial,TC,221,85,,,115.23,221,percent of total billed charges,
IMMUNOHISTO ANTIBODY SLIDE - REF,8834190,CDM,88341,CPT,310,RC,,,facility,both,,,317,224.44,Aetna First Health,Commercial,90,269.45,85,,,140.49,269.45,percent of total billed charges,
"IMMUNOHISTOCHEM, EA AB - REF",8834290,CDM,88342,CPT,310,RC,,,facility,both,,,244,172.75,Aetna First Health,Commercial,90,207.4,85,,,108.14,207.4,percent of total billed charges,
IMMUNOHISTO ANTIBODY SLIDE EA MULTIPLEX,8834401,CDM,88344,CPT,310,RC,,,facility,both,,,360,254.88,Aetna First Health,Commercial,TC,306,85,,,159.55,306,percent of total billed charges,
"IMMUNOFLUORESCENCE, PER SPEC; INITIAL ANTIBODY; TECH",8834601,CDM,88346,CPT,310,RC,,,facility,both,,,259,183.37,Aetna First Health,Commercial,TC,220.15,85,,,114.79,220.15,percent of total billed charges,
"IMMUNOFLUO DIRECT, EA AB - REF",8834690,CDM,88346,CPT,310,RC,,,facility,both,,,258,182.66,Aetna First Health,Commercial,90,219.3,85,,,114.35,219.3,percent of total billed charges,
"ELECTRON MICROSCOPY, DX - REF",8834890,CDM,88348,CPT,310,RC,,,facility,both,,,1166,825.53,Aetna First Health,Commercial,90,991.1,85,,,516.77,991.1,percent of total billed charges,
"IMMUNOFLUORESCENCE, PER SPEC; EACH ADD'L ANTIBODY; TECH",8835001,CDM,88350,CPT,310,RC,,,facility,both,,,235,166.38,Aetna First Health,Commercial,TC,199.75,85,,,104.15,199.75,percent of total billed charges,
IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN - REF,8835090,CDM,88350,CPT,310,RC,,,facility,both,,,252,178.42,Aetna First Health,Commercial,90,214.2,85,,,111.69,214.2,percent of total billed charges,
"MORPHOMETRIC ANALYSIS,TUMOR IMMUNOHISTOCHEMISTRY, EA ANTIBODY MANUAL , TECH",8836001,CDM,88360,CPT,310,RC,,,facility,both,,,290,205.32,Aetna First Health,Commercial,TC,246.5,85,,,128.53,246.5,percent of total billed charges,
"MORPHOMETRIC ANALYSIS, TUMOR - REF",8836090,CDM,88360,CPT,310,RC,,,facility,both,,,309,218.77,Aetna First Health,Commercial,90,262.65,85,,,136.95,262.65,percent of total billed charges,
HER2 MORPHOMETRIC ANALYSIS USING COMPUTER ASSISTED TECHNOLOGY - REF,8836190,CDM,88361,CPT,310,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,90,126.65,85,,,66.04,126.65,percent of total billed charges,
INSITU HYBRIDIZATION (FISH),8836401,CDM,88364,CPT,310,RC,,,facility,both,,,377,266.92,Aetna First Health,Commercial,TC,320.45,85,,,167.09,320.45,percent of total billed charges,
INSITU HYBRIDIZATION (FISH) - REF,8836490,CDM,88364,CPT,310,RC,,,facility,both,,,457,323.56,Aetna First Health,Commercial,90,388.45,85,,,202.54,388.45,percent of total billed charges,
"IN SITU HYBRIDIZATION (EG, FISH), EACH PROBE, TECH",8836501,CDM,88365,CPT,310,RC,,,facility,both,,,418,295.94,Aetna First Health,Commercial,TC,355.3,85,,,185.26,355.3,percent of total billed charges,
"INSITU HYBRIDIZ, EA PROBE - REF",8836590,CDM,88365,CPT,310,RC,,,facility,both,,,226,160.01,Aetna First Health,Commercial,90,192.1,85,,,100.16,192.1,percent of total billed charges,
MULTIPLEX ANTIBODY PROBE STAIN PROCEDURE,8836690,CDM,88366,CPT,310,RC,,,facility,both,,,552,390.82,Aetna First Health,Commercial,90,469.2,85,,,244.65,469.2,percent of total billed charges,
"MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, EACH PROBE; MANUAL, TECH",8836801,CDM,88368,CPT,310,RC,,,facility,both,,,313,221.6,Aetna First Health,Commercial,TC,266.05,85,,,138.72,266.05,percent of total billed charges,
"MORPHOMETRIC ANALYSIS, IN SITU HYBRID - REF",8837790,CDM,88377,CPT,310,RC,,,facility,both,,,1716,1214.93,Aetna First Health,Commercial,90,1458.6,85,,,760.53,1458.6,percent of total billed charges,
MANUAL MICRODISECTION - REF,8838190,CDM,88381,CPT,300,RC,,,facility,both,,,394,278.95,Aetna First Health,Commercial,90,334.9,85,,,174.62,334.9,percent of total billed charges,
SEMEN ANALYSIS W/MORPH CX - REF,8932290,CDM,89322,CPT,300,RC,,,facility,both,,,161,113.99,Aetna First Health,Commercial,90,136.85,85,,,71.36,136.85,percent of total billed charges,
ESOPHAGUS MOTILITY STUDY,9101001,CDM,91010,CPT,750,RC,,,facility,both,,,770,545.16,Aetna First Health,Commercial,TC,654.5,85,,,341.26,654.5,percent of total billed charges,
GASTROESOPHAGEAL REFLUX TEST,9103401,CDM,91034,CPT,750,RC,,,facility,both,,,745,527.46,Aetna First Health,Commercial,TC,633.25,85,,,330.18,633.25,percent of total billed charges,
G-ESOPH REFLX TST W/ELECTROD,9103501,CDM,91035,CPT,510,RC,,,facility,both,,,2469,1748.05,Aetna First Health,Commercial,TC,2098.65,85,,,1094.26,2098.65,percent of total billed charges,
BREATH HYDROGEN TEST,9106501,CDM,91065,CPT,750,RC,,,facility,both,,,181,128.15,Aetna First Health,Commercial,TC,153.85,85,,,80.22,153.85,percent of total billed charges,
GI TRACT CAPSULE ENDOSCOPY,9111001,CDM,91110,CPT,750,RC,,,facility,both,,,2267,1605.04,Aetna First Health,Commercial,TC,1926.95,85,,,1004.73,1926.95,percent of total billed charges,
"RECTAL SENSATION, TONE, AND COMPLIANCE TEST, TECH",9112001,CDM,91120,CPT,750,RC,,,facility,both,,,363,257,Aetna First Health,Commercial,TC,308.55,85,,,160.88,308.55,percent of total billed charges,
ANAL PRESSURE RECORD,9112201,CDM,91122,CPT,750,RC,,,facility,both,,,845,598.26,Aetna First Health,Commercial,TC,718.25,85,,,374.5,718.25,percent of total billed charges,
LIVER ELASTOGRAPHY,9120001,CDM,91200,CPT,750,RC,,,facility,both,,,235,166.38,Aetna First Health,Commercial,TC,199.75,85,,,104.15,199.75,percent of total billed charges,
EVALUATE SPEECH PRODUCTION,9252252,CDM,92522,CPT,440,RC,,,facility,both,,,267,189.04,Aetna First Health,Commercial,52,226.95,85,,,118.33,226.95,percent of total billed charges,
"EVOKED OTOACOUSTIC EMISSIONS, LIMITED",9258701,CDM,92587,CPT,470,RC,,,facility,both,,,282,199.66,Aetna First Health,Commercial,TC,239.7,85,,,124.98,239.7,percent of total billed charges,
EVALUATE SWALLOW FCTN BRIEF,9261052,CDM,92610,CPT,444,RC,,,facility,both,,,273,193.28,Aetna First Health,Commercial,52,232.05,85,,,120.99,232.05,percent of total billed charges,
"INTRAVASC US,HEART,1ST VESSEL  TC",9297801,CDM,92978,CPT,480,RC,,,facility,both,,,3813,2699.6,Aetna First Health,Commercial,TC,3241.05,85,,,1689.92,3241.05,percent of total billed charges,
"INTRAVASC CORONARY SONO,ADDN VESSEL TC",9297901,CDM,92979,CPT,480,RC,,,facility,both,,,1103,780.92,Aetna First Health,Commercial,TC,937.55,85,,,488.85,937.55,percent of total billed charges,
PM DEVICE EVAL IN PERSON TC,9328802,CDM,93288,CPT,480,RC,,,facility,both,,,266,188.33,Aetna First Health,Commercial,TC,226.1,85,,,117.89,226.1,percent of total billed charges,
PM PHONE R-STRIP DEVICE EVAL TC,9329302,CDM,93293,CPT,480,RC,,,facility,both,,,182,128.86,Aetna First Health,Commercial,TC,154.7,85,,,80.66,154.7,percent of total billed charges,
TTE CONGENITAL ANOM,9330301,CDM,93303,CPT,480,RC,,,facility,both,,,1501,1062.71,Aetna First Health,Commercial,TC,1275.85,85,,,665.24,1275.85,percent of total billed charges,
ECHO XTHORACIC CONG ANOM LIMIT,9330401,CDM,93304,CPT,480,RC,,,facility,both,,,951,673.31,Aetna First Health,Commercial,TC,808.35,85,,,421.48,808.35,percent of total billed charges,
"TTE W/DOPPLER, COMPLETE",9330601,CDM,93306,CPT,483,RC,,,facility,both,,,2100,1486.8,Aetna First Health,Commercial,TC,1785,85,,,930.72,1785,percent of total billed charges,
ECHO TT 2D COMPLETE,9330701,CDM,93307,CPT,480,RC,,,facility,both,,,1378,975.62,Aetna First Health,Commercial,TC,1171.3,85,,,610.73,1171.3,percent of total billed charges,
"ECHO HEART XTHORACIC,LIMITED",9330801,CDM,93308,CPT,480,RC,,,facility,both,,,895,633.66,Aetna First Health,Commercial,TC,760.75,85,,,396.66,760.75,percent of total billed charges,
"ECHO HEART XTHORACIC,LIMITED",9330802,CDM,93308,CPT,480,RC,,,facility,both,,,895,633.66,Aetna First Health,Commercial,TC,760.75,85,,,396.66,760.75,percent of total billed charges,
"ECHO HEART,TRANSESOPHAGEAL,COMPLETE",9331201,CDM,93312,CPT,480,RC,,,facility,both,,,2586,1830.89,Aetna First Health,Commercial,TC,2198.1,85,,,1146.12,2198.1,percent of total billed charges,
"ECHO HEART,TRANSESOPH-ACQ,INTERP",9331401,CDM,93314,CPT,480,RC,,,facility,both,,,1033,731.36,Aetna First Health,Commercial,TC,878.05,85,,,457.83,878.05,percent of total billed charges,
ECHO TE CONG ANOM COMPLETE,9331501,CDM,93315,CPT,480,RC,,,facility,both,,,1226,868.01,Aetna First Health,Commercial,TC,1042.1,85,,,543.36,1042.1,percent of total billed charges,
"DOPPLER ECHO EXAM, HEART",9332001,CDM,93320,CPT,480,RC,,,facility,both,,,576,407.81,Aetna First Health,Commercial,TC,489.6,85,,,255.28,489.6,percent of total billed charges,
"DOPPLER ECHO HEART,LIMITED,F/U",9332101,CDM,93321,CPT,480,RC,,,facility,both,,,407,288.16,Aetna First Health,Commercial,TC,345.95,85,,,180.38,345.95,percent of total billed charges,
DOPPLER COLOR FLOW ADD-ON,9332501,CDM,93325,CPT,480,RC,,,facility,both,,,606,429.05,Aetna First Health,Commercial,TC,515.1,85,,,268.58,515.1,percent of total billed charges,
ECHO TT 2D STRESS,9335001,CDM,93350,CPT,480,RC,,,facility,both,,,1590,1125.72,Aetna First Health,Commercial,TC,1351.5,85,,,704.69,1351.5,percent of total billed charges,
RIGHT HEART CATH,9345101,CDM,93451,CPT,480,RC,,,facility,both,,,6989,4948.21,Aetna First Health,Commercial,TC,5940.65,85,,,3097.52,5940.65,percent of total billed charges,
R&L HRT CATH W/VENTRCLGRPHY,9345301,CDM,93453,CPT,480,RC,,,facility,both,,,10581,7491.35,Aetna First Health,Commercial,TC,8993.85,85,,,4689.5,8993.85,percent of total billed charges,
CORONARY ARTERY ANGIO,9345401,CDM,93454,CPT,480,RC,,,facility,both,,,9561,6769.19,Aetna First Health,Commercial,TC,8126.85,85,,,4237.44,8126.85,percent of total billed charges,
CORONARY ART/GRAFT ANGIO S&I,9345501,CDM,93455,CPT,480,RC,,,facility,both,,,10328,7312.22,Aetna First Health,Commercial,TC,8778.8,85,,,4577.37,8778.8,percent of total billed charges,
R HRT  CORONARY ARTERY ANGIO,9345601,CDM,93456,CPT,480,RC,,,facility,both,,,12743,9022.04,Aetna First Health,Commercial,TC,10831.55,85,,,5647.7,10831.55,percent of total billed charges,
R HRT ART/GRAFT ANGIO,9345701,CDM,93457,CPT,480,RC,,,facility,both,,,11719,8297.05,Aetna First Health,Commercial,TC,9961.15,85,,,5193.86,9961.15,percent of total billed charges,
L HRT ARTERY/VENTRICLE ANGIO,9345801,CDM,93458,CPT,480,RC,,,facility,both,,,12495,8846.46,Aetna First Health,Commercial,TC,10620.75,85,,,5537.78,10620.75,percent of total billed charges,
L HRT ART/GRFT ANGIO,9345901,CDM,93459,CPT,480,RC,,,facility,both,,,12871,9112.67,Aetna First Health,Commercial,TC,10940.35,85,,,5704.43,10940.35,percent of total billed charges,
R & L HRT ART/VENTRICLE ANGIO,9346001,CDM,93460,CPT,480,RC,,,facility,both,,,16188,11461.1,Aetna First Health,Commercial,TC,13759.8,85,,,7174.52,13759.8,percent of total billed charges,
R&L HRT ART/VENT ANGIO BYPASS,9346101,CDM,93461,CPT,480,RC,,,facility,both,,,14175,10035.9,Aetna First Health,Commercial,TC,12048.75,85,,,6282.36,12048.75,percent of total billed charges,
EXERCISE W/HEMODYNMIC MEASURE,9346401,CDM,93464,CPT,480,RC,,,facility,both,,,1161,821.99,Aetna First Health,Commercial,TC,986.85,85,,,514.56,986.85,percent of total billed charges,
HEART FLOW RESERVE MEASURE,9357101,CDM,93571,CPT,481,RC,,,facility,both,,,3005,2127.54,Aetna First Health,Commercial,TC,2554.25,85,,,1331.82,2554.25,percent of total billed charges,
"HEART FLOW RESERVE MEASURE, EACH ADD'L VESSEL",9357201,CDM,93572,CPT,481,RC,,,facility,both,,,2110,1493.88,Aetna First Health,Commercial,TC,1793.5,85,,,935.15,1793.5,percent of total billed charges,
CARDIO TILT TABLE EVAL,9366001,CDM,93660,CPT,480,RC,,,facility,both,,,1307,925.36,Aetna First Health,Commercial,TC,1110.95,85,,,579.26,1110.95,percent of total billed charges,
"IFR WITHOUT PHARMACOLOGICAL INDUCED STRESS, INITIAL VESSEL",9379901.03,CDM,93799,CPT,480,RC,,,facility,both,,,3005,2127.54,Aetna First Health,Commercial,TC,2554.25,85,,,1331.82,2554.25,percent of total billed charges,
"IFR WITHOUT PHARMACOLOGICAL INDUCED STRESS, EACH ADDITIONAL VESSEL",9379901.04,CDM,93799,CPT,480,RC,,,facility,both,,,2009,1422.37,Aetna First Health,Commercial,TC,1707.65,85,,,890.39,1707.65,percent of total billed charges,
CV CAROTID IMAGING-BILAT,9388001,CDM,93880,CPT,921,RC,,,facility,both,,,1166,825.53,Aetna First Health,Commercial,TC,991.1,85,,,516.77,991.1,percent of total billed charges,
CV CAROTID FOLLOW-UP LTD,9388201,CDM,93882,CPT,921,RC,,,facility,both,,,686,485.69,Aetna First Health,Commercial,TC,583.1,85,,,304.04,583.1,percent of total billed charges,
EXTREMITY STUDY - VASCULAR DIAGNOSTICS,9392201,CDM,93922,CPT,921,RC,,,facility,both,,,331,234.35,Aetna First Health,Commercial,TC,281.35,85,,,146.7,281.35,percent of total billed charges,
ART LOWER EXTREMITY+UPPER,9392301,CDM,93923,CPT,921,RC,,,facility,both,,,872,617.38,Aetna First Health,Commercial,TC,741.2,85,,,386.47,741.2,percent of total billed charges,
NONINVASV LO EXTREM ART STRESS/REST,9392401,CDM,93924,CPT,921,RC,,,facility,both,,,658,465.86,Aetna First Health,Commercial,TC,559.3,85,,,291.63,559.3,percent of total billed charges,
ART LOWER EXTREMITY-BILAT,9392501,CDM,93925,CPT,921,RC,,,facility,both,,,1281,906.95,Aetna First Health,Commercial,TC,1088.85,85,,,567.74,1088.85,percent of total billed charges,
US DOPPLER LW EXT ART TC,9392601,CDM,93926,CPT,921,RC,,,facility,both,,,741,524.63,Aetna First Health,Commercial,TC,629.85,85,,,328.41,629.85,percent of total billed charges,
ART LOWER EXTREMITY-LTD,9392602,CDM,93926,CPT,921,RC,,,facility,both,,,812,574.9,Aetna First Health,Commercial,TC,690.2,85,,,359.88,690.2,percent of total billed charges,
DUPLEX UP EXTREM ART BILAT,9393001,CDM,93930,CPT,921,RC,,,facility,both,,,1045,739.86,Aetna First Health,Commercial,TC,888.25,85,,,463.14,888.25,percent of total billed charges,
ART UPPER EXTREMITY-LTD,9393101,CDM,93931,CPT,921,RC,,,facility,both,,,739,523.21,Aetna First Health,Commercial,TC,628.15,85,,,327.52,628.15,percent of total billed charges,
VEN DUPLEX BILATERAL,9397001,CDM,93970,CPT,921,RC,,,facility,both,,,1282,907.66,Aetna First Health,Commercial,TC,1089.7,85,,,568.18,1089.7,percent of total billed charges,
VENOUS DUPLEX SCAN UNI,9397101,CDM,93971,CPT,921,RC,,,facility,both,,,838,593.3,Aetna First Health,Commercial,TC,712.3,85,,,371.4,712.3,percent of total billed charges,
VEN DUPLEX LIMITED,9397102,CDM,93971,CPT,921,RC,,,facility,both,,,609,431.17,Aetna First Health,Commercial,TC,517.65,85,,,269.91,517.65,percent of total billed charges,
ABD DUPLEX ABD-FULL,9397501,CDM,93975,CPT,921,RC,,,facility,both,,,1147,812.08,Aetna First Health,Commercial,TC,974.95,85,,,508.35,974.95,percent of total billed charges,
ABD DUPLEX ABD-FULL,9397502,CDM,93975,CPT,921,RC,,,facility,both,,,1384,979.87,Aetna First Health,Commercial,TC,1176.4,85,,,613.39,1176.4,percent of total billed charges,
ABD DUPLEX ABD-FOLLOW UP(T),9397601,CDM,93976,CPT,921,RC,,,facility,both,,,662,468.7,Aetna First Health,Commercial,TC,562.7,85,,,293.4,562.7,percent of total billed charges,
ABD DUPLEX ABD -FOLLOW UP,9397602,CDM,93976,CPT,921,RC,,,facility,both,,,693,490.64,Aetna First Health,Commercial,TC,589.05,85,,,307.14,589.05,percent of total billed charges,
ABD DUPLEX AORTOILIAC,9397801,CDM,93978,CPT,921,RC,,,facility,both,,,909,643.57,Aetna First Health,Commercial,TC,772.65,85,,,402.87,772.65,percent of total billed charges,
ABD DUPLEX SCAN-AORTA,9397901,CDM,93979,CPT,921,RC,,,facility,both,,,648,458.78,Aetna First Health,Commercial,TC,550.8,85,,,287.19,550.8,percent of total billed charges,
DUPLEX HEMODIALYSIS ACCES,9399001,CDM,93990,CPT,921,RC,,,facility,both,,,683,483.56,Aetna First Health,Commercial,TC,580.55,85,,,302.71,580.55,percent of total billed charges,
ADULT VENT MGMT INPAT INIT DAY,9400201,CDM,94002,CPT,410,RC,,,facility,both,,,1386,981.29,Aetna First Health,Commercial,,1178.1,85,,,614.28,1178.1,percent of total billed charges,
ADULT VENT MGMT INPAT SUBQ DAY,9400301,CDM,94003,CPT,410,RC,,,facility,both,,,1221,864.47,Aetna First Health,Commercial,,1037.85,85,,,541.15,1037.85,percent of total billed charges,
SPIROMETRY,9401001,CDM,94010,CPT,460,RC,,,facility,both,,,196,138.77,Aetna First Health,Commercial,TC,166.6,85,,,86.87,166.6,percent of total billed charges,
SPIROMETRY INCL GRAPH REC TC,9401002,CDM,94010,CPT,460,RC,,,facility,both,,,242,171.34,Aetna First Health,Commercial,TC,205.7,85,,,107.25,205.7,percent of total billed charges,
BRONCH EVAL B/A BRONCH,9406001,CDM,94060,CPT,460,RC,,,facility,both,,,378,267.62,Aetna First Health,Commercial,TC,321.3,85,,,167.53,321.3,percent of total billed charges,
BRONCHO RESPONSE PRE & POST TC,9406002,CDM,94060,CPT,460,RC,,,facility,both,,,445,315.06,Aetna First Health,Commercial,TC,378.25,85,,,197.22,378.25,percent of total billed charges,
VITAL CAPACITY TEST,9415001,CDM,94150,CPT,460,RC,,,facility,both,,,181,128.15,Aetna First Health,Commercial,TC,153.85,85,,,80.22,153.85,percent of total billed charges,
"PULMONARY STRESS TEST-TECH, INCLUDES MEASURED HEART RATE,OXIMETRY, OXYGEN TITRATION, WHEN PERFORMED",9461801,CDM,94618,CPT,460,RC,,,facility,both,,,226,160.01,Aetna First Health,Commercial,TC,192.1,85,,,100.16,192.1,percent of total billed charges,
PULM FUNCT TST PLETHYSMOGRAP,9472601,CDM,94726,CPT,460,RC,,,facility,both,,,388,274.7,Aetna First Health,Commercial,TC,329.8,85,,,171.96,329.8,percent of total billed charges,
PULM FUNCT TST PLETHYSMOGRAP,9472602,CDM,94726,CPT,460,RC,,,facility,both,,,400,283.2,Aetna First Health,Commercial,TC,340,85,,,177.28,340,percent of total billed charges,
PULM FUNCTION TEST BY GAS,9472701,CDM,94727,CPT,460,RC,,,facility,both,,,283,200.36,Aetna First Health,Commercial,TC,240.55,85,,,125.43,240.55,percent of total billed charges,
C02/MEMBANE DIFFUSE CAPACITY,9472901,CDM,94729,CPT,460,RC,,,facility,both,,,329,232.93,Aetna First Health,Commercial,TC,279.65,85,,,145.81,279.65,percent of total billed charges,
C02/MEMBANE DIFFUSE CAPACITY,9472902,CDM,94729,CPT,460,RC,,,facility,both,,,344,243.55,Aetna First Health,Commercial,TC,292.4,85,,,152.46,292.4,percent of total billed charges,
"SLEEP STUDY, UNATTENDED",9580601,CDM,95806,CPT,740,RC,,,facility,both,,,832,589.06,Aetna First Health,Commercial,TC,707.2,85,,,368.74,707.2,percent of total billed charges,
"POLYSOMNOGRAPHY, 4 OR MORE",9581001,CDM,95810,CPT,740,RC,,,facility,both,,,4377,3098.92,Aetna First Health,Commercial,TC,3720.45,85,,,1939.89,3720.45,percent of total billed charges,
POLYSOMNOGRAPHY W/CPAP,9581101,CDM,95811,CPT,740,RC,,,facility,both,,,4377,3098.92,Aetna First Health,Commercial,TC,3720.45,85,,,1939.89,3720.45,percent of total billed charges,
"EEG UP TO 1HR, TC",9581201,CDM,95812,CPT,740,RC,,,facility,both,,,780,552.24,Aetna First Health,Commercial,TC,663,85,,,345.7,663,percent of total billed charges,
"EEG, 41-60 MINUTES",9581202,CDM,95812,CPT,740,RC,,,facility,both,,,1148,812.78,Aetna First Health,Commercial,TC,975.8,85,,,508.79,975.8,percent of total billed charges,
"EEG, EXTENDED; 61-119 MINUTES",9581301,CDM,95813,CPT,740,RC,,,facility,both,,,780,552.24,Aetna First Health,Commercial,TC,663,85,,,345.7,663,percent of total billed charges,
"EEG, EXTENDED; 61-119 MINUTES",9581302,CDM,95813,CPT,740,RC,,,facility,both,,,1002,709.42,Aetna First Health,Commercial,TC,851.7,85,,,444.09,851.7,percent of total billed charges,
EEG AWAKE/DROWSY TC,9581601,CDM,95816,CPT,740,RC,,,facility,both,,,707,500.56,Aetna First Health,Commercial,TC,600.95,85,,,313.34,600.95,percent of total billed charges,
"EEG,AWAKE/DROWSY, W/STIM",9581602,CDM,95816,CPT,740,RC,,,facility,both,,,1005,711.54,Aetna First Health,Commercial,TC,854.25,85,,,445.42,854.25,percent of total billed charges,
EEG AWAKE/ASLEEP TC,9581901,CDM,95819,CPT,740,RC,,,facility,both,,,993,703.04,Aetna First Health,Commercial,TC,844.05,85,,,440.1,844.05,percent of total billed charges,
"EEG,AWAKE/ASLEEP, W/STIMULAT",9581902,CDM,95819,CPT,740,RC,,,facility,both,,,908,642.86,Aetna First Health,Commercial,TC,771.8,85,,,402.43,771.8,percent of total billed charges,
EEG DURING SURGERY,9595501,CDM,95955,CPT,740,RC,,,facility,both,,,1252,886.42,Aetna First Health,Commercial,TC,1064.2,85,,,554.89,1064.2,percent of total billed charges,
ROOM RATE GENERAL,12000000,CDM,,,120,RC,,,facility,inpatient,,,1906,1349.45,Aetna First Health,Commercial,,1620.1,85,,,844.74,1620.1,percent of total billed charges,
ROOM RATE GENERAL ISO,12000001,CDM,,,120,RC,,,facility,inpatient,,,2029,1436.53,Aetna First Health,Commercial,,1724.65,85,,,899.25,1724.65,percent of total billed charges,
ROOM RATE FOCUS INPT,12002000,CDM,,,118,RC,,,facility,inpatient,,,979,693.13,Aetna First Health,Commercial,,832.15,85,,,433.89,832.15,percent of total billed charges,
ROOM RATE FOCUS INPT ISO,12002001,CDM,,,120,RC,,,facility,inpatient,,,1102,780.22,Aetna First Health,Commercial,,936.7,85,,,488.41,936.7,percent of total billed charges,
ROOM RATE RESPITE,12004000,CDM,H0045,CPT,120,RC,,,facility,inpatient,,,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
GENERAL ROOM RATE - BILLING,12099999,CDM,,,120,RC,,,facility,inpatient,,,1,0.71,Aetna First Health,Commercial,,0.85,85,,,0.44,0.85,percent of total billed charges,
ROOM RATE MED/SURG,12102000,CDM,,,121,RC,,,facility,inpatient,,,1850,1309.8,Aetna First Health,Commercial,,1572.5,85,,,819.92,1572.5,percent of total billed charges,
ROOM RATE MED/SURG ISO,12102001,CDM,,,121,RC,,,facility,inpatient,,,1970,1394.76,Aetna First Health,Commercial,,1674.5,85,,,873.1,1674.5,percent of total billed charges,
ROOM RATE BIRTHPLACE,12200000,CDM,,,122,RC,,,facility,inpatient,,,1906,1349.45,Aetna First Health,Commercial,,1620.1,85,,,844.74,1620.1,percent of total billed charges,
ROOM RATE BIRTHPLACE ISO,12200001,CDM,,,122,RC,,,facility,inpatient,,,2081,1473.35,Aetna First Health,Commercial,,1768.85,85,,,922.3,1768.85,percent of total billed charges,
ROOM RATE FM BIRTHPLACE,12202000,CDM,,,122,RC,,,facility,inpatient,,,1850,1309.8,Aetna First Health,Commercial,,1572.5,85,,,819.92,1572.5,percent of total billed charges,
ROOM RATE FM BIRTHPLACE ISO,12202001,CDM,,,122,RC,,,facility,inpatient,,,1970,1394.76,Aetna First Health,Commercial,,1674.5,85,,,873.1,1674.5,percent of total billed charges,
ROOM RATE PEDS,12300000,CDM,,,123,RC,,,facility,inpatient,,,1751,1239.71,Aetna First Health,Commercial,,1488.35,85,,,776.04,1488.35,percent of total billed charges,
ROOM RATE PEDS ISO,12300001,CDM,,,123,RC,,,facility,inpatient,,,1875,1327.5,Aetna First Health,Commercial,,1593.75,85,,,831,1593.75,percent of total billed charges,
ROOM RATE PEDIATRICS,12302000,CDM,,,123,RC,,,facility,inpatient,,,1700,1203.6,Aetna First Health,Commercial,,1445,85,,,753.44,1445,percent of total billed charges,
ROOM RATE PEDIATRICS ISO,12302001,CDM,,,123,RC,,,facility,inpatient,,,1820,1288.56,Aetna First Health,Commercial,,1547,85,,,806.62,1547,percent of total billed charges,
ROOM RATE GRACE INPT,12402000,CDM,,,124,RC,,,facility,inpatient,,,2215,1568.22,Aetna First Health,Commercial,,1882.75,85,,,981.69,1882.75,percent of total billed charges,
ROOM RATE GRACE INPT ISO,12402001,CDM,,,124,RC,,,facility,inpatient,,,2338,1655.3,Aetna First Health,Commercial,,1987.3,85,,,1036.2,1987.3,percent of total billed charges,
ROOM RATE NURSERY,17100000,CDM,,,171,RC,,,facility,inpatient,,,1029,728.53,Aetna First Health,Commercial,,874.65,85,,,456.05,874.65,percent of total billed charges,
ROOM RATE NURSERY ISO,17100001,CDM,,,171,RC,,,facility,inpatient,,,1470,1040.76,Aetna First Health,Commercial,,1249.5,85,,,651.5,1249.5,percent of total billed charges,
ROOM RATE NURSERY,17102010,CDM,,,171,RC,,,facility,inpatient,,,999,707.29,Aetna First Health,Commercial,,849.15,85,,,442.76,849.15,percent of total billed charges,
ROOM RATE SPEC CARE NRS,17202000,CDM,,,172,RC,,,facility,inpatient,,,1288,911.9,Aetna First Health,Commercial,,1094.8,85,,,570.84,1094.8,percent of total billed charges,
ROOM RATE ICU,20000000,CDM,,,200,RC,,,facility,inpatient,,,4841,3427.43,Aetna First Health,Commercial,,4114.85,85,,,2145.53,4114.85,percent of total billed charges,
ROOM RATE ICU ISO,20000001,CDM,,,200,RC,,,facility,inpatient,,,4965,3515.22,Aetna First Health,Commercial,,4220.25,85,,,2200.49,4220.25,percent of total billed charges,
ROOM RATE ICC,20601000,CDM,,,206,RC,,,facility,inpatient,,,2487,1760.8,Aetna First Health,Commercial,,2113.95,85,,,1102.24,2113.95,percent of total billed charges,
ROOM RATE ICC ISO,20601001,CDM,,,206,RC,,,facility,inpatient,,,2541,1799.03,Aetna First Health,Commercial,,2159.85,85,,,1126.17,2159.85,percent of total billed charges,
ROOM RATE CORONARY CARE,21000000,CDM,,,210,RC,,,facility,inpatient,,,4841,3427.43,Aetna First Health,Commercial,,4114.85,85,,,2145.53,4114.85,percent of total billed charges,
ROOM RATE CORONARY CARE ISO,21000001,CDM,,,210,RC,,,facility,inpatient,,,4820,3412.56,Aetna First Health,Commercial,,4097,85,,,2136.22,4097,percent of total billed charges,
ROOM RATE CORONARY IMC,21400010,CDM,,,214,RC,,,facility,inpatient,,,2487,1760.8,Aetna First Health,Commercial,,2113.95,85,,,1102.24,2113.95,percent of total billed charges,
ROOM RATE CORONARY IMC ISO,21400011,CDM,,,214,RC,,,facility,inpatient,,,2617,1852.84,Aetna First Health,Commercial,,2224.45,85,,,1159.85,2224.45,percent of total billed charges,
"TELEMETRY, PER DAY",23000000,CDM,,,271,RC,,,facility,both,,,258,182.66,Aetna First Health,Commercial,,219.3,85,,,114.35,219.3,percent of total billed charges,
hydrogen peroxide in 0.9% sodium chloride Solution 500 mL Bottle,25000000,CDM,,,250,RC,,,facility,both,1,ML,22,15.58,Aetna First Health,Commercial,,18.7,85,,,9.75,18.7,percent of total billed charges,
vasopressin in 0.9% sodium chloride 50 mL Bag,25000000,CDM,,,250,RC,,,facility,both,1,ML,505,357.54,Aetna First Health,Commercial,,429.25,85,,,223.82,429.25,percent of total billed charges,
denture adhesive 1 Each,25000000,CDM,,,250,RC,,,facility,both,1,EA,11.72,8.3,Aetna First Health,Commercial,,9.96,85,,,5.19,9.96,percent of total billed charges,
in EVAC 1 Each Flex Cont,25000000,CDM,,,250,RC,,,facility,both,1,EA,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
leeches 1 Each Jar,25000000,CDM,,,250,RC,,,facility,both,1,EA,106.6,75.47,Aetna First Health,Commercial,,90.61,85,,,47.25,90.61,percent of total billed charges,
Parenteral Nutrition Neonatal Order 1 Each Flex Cont,25000000,CDM,,,250,RC,,,facility,both,1,EA,315,223.02,Aetna First Health,Commercial,,267.75,85,,,139.61,267.75,percent of total billed charges,
intrasite gel Misc 15 g Box,25000000,CDM,,,250,RC,,,facility,both,1,GR,43.2,30.59,Aetna First Health,Commercial,,36.72,85,,,19.15,36.72,percent of total billed charges,
phenol 5 % Solution 8 mL Vial,25000000,CDM,,,250,RC,,,facility,both,1,ML,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
EPINEPHrine 0.2mg/0.2 mL & lidocaine 2% gel Gel 20 mL Cup,25000000,CDM,,,250,RC,,,facility,both,1,ML,22,15.58,Aetna First Health,Commercial,,18.7,85,,,9.75,18.7,percent of total billed charges,
sodium bicarbonate 8.4% & lidocaine 1% (PF) Solution 10 mL Syringe,25000000,CDM,,,250,RC,,,facility,both,1,ML,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
sodium glycerophosphate 1 MMOLE/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,,,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ceFAZolin & dexAMETHasone Solution 2.5 mL Syringe,25000000,CDM,,,250,RC,,,facility,both,1,ML,51,36.11,Aetna First Health,Commercial,,43.35,85,,,22.6,43.35,percent of total billed charges,
vasopressin in 0.9% sodium chloride 25 mL Bag,25000000,CDM,,,250,RC,,,facility,both,1,ML,51.5,36.46,Aetna First Health,Commercial,,43.78,85,,,22.82,43.78,percent of total billed charges,
papaverine in 0.9% sodium chloride Solution 3 mL Syringe,25000000,CDM,,,250,RC,,,facility,both,1,ML,90.5,64.07,Aetna First Health,Commercial,,76.92,85,,,40.11,76.92,percent of total billed charges,
papaverine in 0.9% sodium chloride Solution 6.7 mL Syringe,25000000,CDM,,,250,RC,,,facility,both,1,ML,90.5,64.07,Aetna First Health,Commercial,,76.92,85,,,40.11,76.92,percent of total billed charges,
papaverine in 0.9% sodium chloride Solution 250 mL Bag,25000000,CDM,,,250,RC,,,facility,both,1,ML,100.5,71.15,Aetna First Health,Commercial,,85.42,85,,,44.54,85.42,percent of total billed charges,
lidocaine 500 mg-EPINEPHrine 0.5 mg-sodium bicarbonate 10 mEq in 500 mL sodium chloride 0.9 % Solution 560 mL Flex Cont,25000000,CDM,,,250,RC,,,facility,both,1,ML,117,82.84,Aetna First Health,Commercial,,99.45,85,,,51.85,99.45,percent of total billed charges,
ROPIVACAINE-EPINEPHRINE FIELD BLOCK 100 mL Flex Cont,25000000,CDM,,,250,RC,,,facility,both,1,ML,223.5,158.24,Aetna First Health,Commercial,,189.98,85,,,99.06,189.98,percent of total billed charges,
tobramycin 0.3 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,,,facility,both,1,ML,225,159.3,Aetna First Health,Commercial,,191.25,85,,,99.72,191.25,percent of total billed charges,
ROPiv 250 mg-ketor 30 mg- EPI 0.5 mg-clon 0.08 mg-NS 60 mL total volume. Solution 60 mL Flex Cont,25000000,CDM,,,250,RC,,,facility,both,1,ML,314.5,222.67,Aetna First Health,Commercial,,267.32,85,,,139.39,267.32,percent of total billed charges,
doxycycline in 0.9% sodium chloride Solution 50 mL Syringe,25000000,CDM,,,250,RC,,,facility,both,1,ML,372,263.38,Aetna First Health,Commercial,,316.2,85,,,164.87,316.2,percent of total billed charges,
BUPivacaine 0.75% (PF) & lidocaine 2% & hyaluronidase Solution 5.4 mL Syringe,25000000,CDM,,,250,RC,,,facility,both,1,ML,384.5,272.23,Aetna First Health,Commercial,,326.82,85,,,170.41,326.82,percent of total billed charges,
talc in 0.9% sodium chloride 50 mL Syringe,25000000,CDM,,,250,RC,,,facility,both,1,ML,444,314.35,Aetna First Health,Commercial,,377.4,85,,,196.78,377.4,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 120 Each Syringe,25000000,CDM,,,250,RC,17856079903,NDC,facility,both,0.00833,EA,1.76,1.25,Aetna First Health,Commercial,,1.5,85,,,0.78,1.5,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,00536222075,NDC,facility,both,0.02,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,56184012041,NDC,facility,both,0.02,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,00904589430,NDC,facility,both,0.02,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 1 mL Syringe,25000000,CDM,,,250,RC,08888800753,NDC,facility,both,0.02,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 0.6 mL Syringe,25000000,CDM,,,250,RC,88888800341,NDC,facility,both,0.02,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 0.3 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,69315030802,NDC,facility,both,0.02,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
cyclopentolate 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,61314039601,NDC,facility,both,0.025,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
cyclopentolate 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,17478010002,NDC,facility,both,0.025,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 1 mL Syringe,25000000,CDM,,,250,RC,08888800753,NDC,facility,both,0.03333,ML,0.75,0.53,Aetna First Health,Commercial,,0.64,85,,,0.33,0.64,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 238 g Bottle,25000000,CDM,,,250,RC,68001050555,NDC,facility,both,0.07143,GM,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 238 g Bottle,25000000,CDM,,,250,RC,45802086802,NDC,facility,both,0.07143,GM,0.79,0.56,Aetna First Health,Commercial,,0.67,85,,,0.35,0.67,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,63323009502,NDC,facility,both,0.2,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,63323008861,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,00409114102,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,00409114112,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,63323009561,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
isoproterenol 0.2 MG/ML Solution 5 mL Ampule,25000000,CDM,,,250,RC,00187433005,NDC,facility,both,0.2,ML,805.55,570.33,Aetna First Health,Commercial,,684.72,85,,,357.02,684.72,percent of total billed charges,
ketamine 100 mg/mL Solution 5 mL Vial,25000000,CDM,,,250,RC,00409205105,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ketamine 100 mg/mL Solution 5 mL Vial,25000000,CDM,,,250,RC,42023011510,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ketamine 100 mg/mL Solution 5 mL Vial,25000000,CDM,,,250,RC,00143950901,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ketamine 100 mg/mL Solution 5 mL Vial,25000000,CDM,,,250,RC,00143950910,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ketamine 100 mg/mL Solution 5 mL Vial,25000000,CDM,,,250,RC,00409205115,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
caffeine-sodium benzoate 125-125 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00517250210,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
caffeine-sodium benzoate 125-125 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00517250201,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061200,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061210,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061100,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061110,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 30 mL Vial,25000000,CDM,,,250,RC,63323018730,NDC,facility,both,0.66667,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 30 mL Vial,25000000,CDM,,,250,RC,63323009301,NDC,facility,both,0.66667,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 30 mL Vial,25000000,CDM,,,250,RC,63323009330,NDC,facility,both,0.66667,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 1 Each Box,25000000,CDM,,,250,RC,68001047748,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 1 Each Package,25000000,CDM,,,250,RC,45802006070,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,68001047745,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Package,25000000,CDM,,,250,RC,00168011109,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Package,25000000,CDM,,,250,RC,54162001709,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Package,25000000,CDM,,,250,RC,68599118401,NDC,facility,both,1,EA,0.86,0.61,Aetna First Health,Commercial,,0.73,85,,,0.38,0.73,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,57896011109,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,57896014509,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,00904667967,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,53329008987,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,57896011114,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,00904702367,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323013013,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457043700,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323013003,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457043710,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00143938110,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00143938101,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,68382091001,NDC,facility,both,1,EA,54.36,38.49,Aetna First Health,Commercial,,46.21,85,,,24.09,46.21,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,68382091010,NDC,facility,both,1,EA,54.36,38.49,Aetna First Health,Commercial,,46.21,85,,,24.09,46.21,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,66794023702,NDC,facility,both,1,EA,56.48,39.99,Aetna First Health,Commercial,,48.01,85,,,25.03,48.01,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,66794023741,NDC,facility,both,1,EA,56.48,39.99,Aetna First Health,Commercial,,48.01,85,,,25.03,48.01,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323013011,NDC,facility,both,1,EA,59.24,41.94,Aetna First Health,Commercial,,50.35,85,,,26.26,50.35,percent of total billed charges,
doxycycline 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323013002,NDC,facility,both,1,EA,59.24,41.94,Aetna First Health,Commercial,,50.35,85,,,26.26,50.35,percent of total billed charges,
fluorescein sodium 0.6 MG Strip 300 Each Box,25000000,CDM,,,250,RC,17478040303,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781312495,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781312485,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781912495,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781912485,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,25021013910,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150012215,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,44567022110,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,70860011626,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,70860011641,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67850003100,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323032710,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00703909501,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67850003110,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781312892,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781922415,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781312815,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,55150012315,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,44567022210,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,55150012316,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,70860011741,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,70860011726,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,67850003200,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,67850003210,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,25021014010,NDC,facility,both,1,EA,50.63,35.85,Aetna First Health,Commercial,,43.04,85,,,22.44,43.04,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,00781312595,NDC,facility,both,1,EA,50.98,36.09,Aetna First Health,Commercial,,43.33,85,,,22.59,43.33,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,00781312585,NDC,facility,both,1,EA,50.99,36.1,Aetna First Health,Commercial,,43.34,85,,,22.6,43.34,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,00781912585,NDC,facility,both,1,EA,50.99,36.1,Aetna First Health,Commercial,,43.34,85,,,22.6,43.34,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,63323032820,NDC,facility,both,1,EA,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
nafcillin 2 g Recon Soln 1 Each Vial,25000000,CDM,S0032,CPT,250,RC,63323032821,NDC,facility,both,1,EA,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 1 Each Box,25000000,CDM,,,250,RC,57896014314,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 1 Each Packet,25000000,CDM,,,250,RC,00168001209,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 1 Each Packet,25000000,CDM,,,250,RC,45802006170,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 1 Each Packet,25000000,CDM,,,250,RC,45802014370,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 1 Each Packet,25000000,CDM,,,250,RC,54162008009,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 1 Each Packet,25000000,CDM,,,250,RC,00904880567,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
remifentanil 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00143939101,NDC,facility,both,1,EA,137.81,97.57,Aetna First Health,Commercial,,117.14,85,,,61.08,117.14,percent of total billed charges,
remifentanil 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00143939110,NDC,facility,both,1,EA,137.81,97.57,Aetna First Health,Commercial,,117.14,85,,,61.08,117.14,percent of total billed charges,
remifentanil 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457019803,NDC,facility,both,1,EA,137.9,97.63,Aetna First Health,Commercial,,117.22,85,,,61.12,117.22,percent of total billed charges,
remifentanil 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457019800,NDC,facility,both,1,EA,137.9,97.63,Aetna First Health,Commercial,,117.22,85,,,61.12,117.22,percent of total billed charges,
remifentanil 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457091200,NDC,facility,both,1,EA,137.9,97.63,Aetna First Health,Commercial,,117.22,85,,,61.12,117.22,percent of total billed charges,
remifentanil 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323072301,NDC,facility,both,1,EA,164.95,116.78,Aetna First Health,Commercial,,140.21,85,,,73.11,140.21,percent of total billed charges,
remifentanil 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323072303,NDC,facility,both,1,EA,164.95,116.78,Aetna First Health,Commercial,,140.21,85,,,73.11,140.21,percent of total billed charges,
remifentanil HCl 5 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457019810,NDC,facility,both,1,EA,586.83,415.48,Aetna First Health,Commercial,,498.81,85,,,260.08,498.81,percent of total billed charges,
remifentanil HCl 5 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457019898,NDC,facility,both,1,EA,586.83,415.48,Aetna First Health,Commercial,,498.81,85,,,260.08,498.81,percent of total billed charges,
rifAMPin 600 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55390012301,NDC,facility,both,1,EA,146.25,103.54,Aetna First Health,Commercial,,124.31,85,,,64.82,124.31,percent of total billed charges,
rifAMPin 600 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00069011201,NDC,facility,both,1,EA,146.25,103.54,Aetna First Health,Commercial,,124.31,85,,,64.82,124.31,percent of total billed charges,
rifAMPin 600 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,23155034031,NDC,facility,both,1,EA,243,172.04,Aetna First Health,Commercial,,206.55,85,,,107.7,206.55,percent of total billed charges,
rifAMPin 600 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323035120,NDC,facility,both,1,EA,344.25,243.73,Aetna First Health,Commercial,,292.61,85,,,152.57,292.61,percent of total billed charges,
rifAMPin 600 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457044560,NDC,facility,both,1,EA,346.73,245.48,Aetna First Health,Commercial,,294.72,85,,,153.67,294.72,percent of total billed charges,
rifAMPin 600 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00068059701,NDC,facility,both,1,EA,401.76,284.45,Aetna First Health,Commercial,,341.5,85,,,178.06,341.5,percent of total billed charges,
rifAMPin 600 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00068059901,NDC,facility,both,1,EA,401.76,284.45,Aetna First Health,Commercial,,341.5,85,,,178.06,341.5,percent of total billed charges,
thrombin 5000 units Kit 1 Each Box,25000000,CDM,,,250,RC,60793020505,NDC,facility,both,1,EA,292.84,207.33,Aetna First Health,Commercial,,248.91,85,,,129.79,248.91,percent of total billed charges,
thrombin 5000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,60793021505,NDC,facility,both,1,EA,288.52,204.27,Aetna First Health,Commercial,,245.24,85,,,127.87,245.24,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,87701055389,NDC,facility,both,1,GM,1.83,1.3,Aetna First Health,Commercial,,1.56,85,,,0.81,1.56,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,49348015472,NDC,facility,both,1,GM,3.62,2.56,Aetna First Health,Commercial,,3.08,85,,,1.6,3.08,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 28 g Tube,25000000,CDM,,,250,RC,45802006003,NDC,facility,both,1,GM,3.7,2.62,Aetna First Health,Commercial,,3.14,85,,,1.64,3.14,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,24385006003,NDC,facility,both,1,GM,5.37,3.8,Aetna First Health,Commercial,,4.56,85,,,2.38,4.56,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 28.35 g Tube,25000000,CDM,,,250,RC,58980001110,NDC,facility,both,1,GM,5.91,4.18,Aetna First Health,Commercial,,5.02,85,,,2.62,5.02,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 28.35 g Tube,25000000,CDM,,,250,RC,00168001131,NDC,facility,both,1,GM,6.63,4.69,Aetna First Health,Commercial,,5.64,85,,,2.94,5.64,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,51672207502,NDC,facility,both,1,GM,6.99,4.95,Aetna First Health,Commercial,,5.94,85,,,3.1,5.94,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,68001053146,NDC,facility,both,1,GM,6.99,4.95,Aetna First Health,Commercial,,5.94,85,,,3.1,5.94,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 238 g Bottle,25000000,CDM,,,250,RC,68001050555,NDC,facility,both,1,GM,8.21,5.81,Aetna First Health,Commercial,,6.98,85,,,3.64,6.98,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 238 g Bottle,25000000,CDM,,,250,RC,45802086802,NDC,facility,both,1,GM,11.07,7.84,Aetna First Health,Commercial,,9.41,85,,,4.91,9.41,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 238 g Bottle,25000000,CDM,,,250,RC,00722711602,NDC,facility,both,1,GM,13.57,9.61,Aetna First Health,Commercial,,11.53,85,,,6.01,11.53,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 425 g Box,25000000,CDM,,,250,RC,67777022007,NDC,facility,both,1,GM,25.5,18.05,Aetna First Health,Commercial,,21.68,85,,,11.3,21.68,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 425 g Jar,25000000,CDM,,,250,RC,16784011761,NDC,facility,both,1,GM,25.5,18.05,Aetna First Health,Commercial,,21.68,85,,,11.3,21.68,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 30 g Tube,25000000,CDM,,,250,RC,00603781878,NDC,facility,both,1,GM,28.44,20.14,Aetna First Health,Commercial,,24.17,85,,,12.6,24.17,percent of total billed charges,
erythromycin 5 MG/GM Ointment 1 g Tube,25000000,CDM,,,250,RC,00574402411,NDC,facility,both,1,GM,28.98,20.52,Aetna First Health,Commercial,,24.63,85,,,12.84,24.63,percent of total billed charges,
erythromycin 5 MG/GM Ointment 1 g Tube,25000000,CDM,,,250,RC,00574402450,NDC,facility,both,1,GM,28.98,20.52,Aetna First Health,Commercial,,24.63,85,,,12.84,24.63,percent of total billed charges,
erythromycin 5 MG/GM Ointment 1 g Tube,25000000,CDM,,,250,RC,17478007031,NDC,facility,both,1,GM,32.7,23.15,Aetna First Health,Commercial,,27.8,85,,,14.49,27.8,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 15 g Tube,25000000,CDM,,,250,RC,51672128901,NDC,facility,both,1,GM,34.86,24.68,Aetna First Health,Commercial,,29.63,85,,,15.45,29.63,percent of total billed charges,
erythromycin 5 MG/GM Ointment 1 g Tube,25000000,CDM,,,250,RC,48102005711,NDC,facility,both,1,GM,39.2,27.75,Aetna First Health,Commercial,,33.32,85,,,17.37,33.32,percent of total billed charges,
erythromycin 5 MG/GM Ointment 1 g Tube,25000000,CDM,,,250,RC,24208091019,NDC,facility,both,1,GM,39.73,28.13,Aetna First Health,Commercial,,33.77,85,,,17.61,33.77,percent of total billed charges,
erythromycin 5 MG/GM Ointment 1 g Tube,25000000,CDM,,,250,RC,03859400008,NDC,facility,both,1,GM,39.73,28.13,Aetna First Health,Commercial,,33.77,85,,,17.61,33.77,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 15 g Tube,25000000,CDM,,,250,RC,72578008901,NDC,facility,both,1,GM,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 15 g Tube,25000000,CDM,,,250,RC,00713067815,NDC,facility,both,1,GM,51.96,36.79,Aetna First Health,Commercial,,44.17,85,,,23.03,44.17,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 15 g Tube,25000000,CDM,,,250,RC,00316022115,NDC,facility,both,1,GM,51.96,36.79,Aetna First Health,Commercial,,44.17,85,,,23.03,44.17,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 30 g Tube,25000000,CDM,,,250,RC,51672128902,NDC,facility,both,1,GM,52.32,37.04,Aetna First Health,Commercial,,44.47,85,,,23.19,44.47,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 15 g Tube,25000000,CDM,,,250,RC,00603781874,NDC,facility,both,1,GM,55.44,39.25,Aetna First Health,Commercial,,47.12,85,,,24.57,47.12,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 15 g Tube,25000000,CDM,,,250,RC,45802005935,NDC,facility,both,1,GM,55.98,39.63,Aetna First Health,Commercial,,47.58,85,,,24.81,47.58,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 15 g Tube,25000000,CDM,,,250,RC,00168000715,NDC,facility,both,1,GM,55.98,39.63,Aetna First Health,Commercial,,47.58,85,,,24.81,47.58,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 15 g Tube,25000000,CDM,,,250,RC,00472016615,NDC,facility,both,1,GM,55.98,39.63,Aetna First Health,Commercial,,47.58,85,,,24.81,47.58,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 15 g Tube,25000000,CDM,,,250,RC,45802004835,NDC,facility,both,1,GM,55.98,39.63,Aetna First Health,Commercial,,47.58,85,,,24.81,47.58,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 15 g Tube,25000000,CDM,,,250,RC,00713068615,NDC,facility,both,1,GM,55.98,39.63,Aetna First Health,Commercial,,47.58,85,,,24.81,47.58,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 15 g Tube,25000000,CDM,,,250,RC,00168005415,NDC,facility,both,1,GM,55.98,39.63,Aetna First Health,Commercial,,47.58,85,,,24.81,47.58,percent of total billed charges,
erythromycin 5 MG/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,17478007035,NDC,facility,both,1,GM,59.68,42.25,Aetna First Health,Commercial,,50.73,85,,,26.45,50.73,percent of total billed charges,
erythromycin 5 MG/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,48102000835,NDC,facility,both,1,GM,59.88,42.4,Aetna First Health,Commercial,,50.9,85,,,26.54,50.9,percent of total billed charges,
erythromycin 5 MG/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00574402435,NDC,facility,both,1,GM,59.88,42.4,Aetna First Health,Commercial,,50.9,85,,,26.54,50.9,percent of total billed charges,
erythromycin 5 MG/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208091055,NDC,facility,both,1,GM,60.8,43.05,Aetna First Health,Commercial,,51.68,85,,,26.95,51.68,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 30 g Tube,25000000,CDM,,,250,RC,00713067831,NDC,facility,both,1,GM,79.92,56.58,Aetna First Health,Commercial,,67.93,85,,,35.42,67.93,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 15 g Tube,25000000,CDM,,,250,RC,51672126301,NDC,facility,both,1,GM,83.82,59.34,Aetna First Health,Commercial,,71.25,85,,,37.15,71.25,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 15 g Tube,25000000,CDM,,,250,RC,68462031417,NDC,facility,both,1,GM,83.82,59.34,Aetna First Health,Commercial,,71.25,85,,,37.15,71.25,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 15 g Tube,25000000,CDM,,,250,RC,45802088014,NDC,facility,both,1,GM,83.82,59.34,Aetna First Health,Commercial,,71.25,85,,,37.15,71.25,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 30 g Tube,25000000,CDM,,,250,RC,00168005430,NDC,facility,both,1,GM,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
nystatin 100000 UNIT/GM Cream 30 g Tube,25000000,CDM,,,250,RC,45802005911,NDC,facility,both,1,GM,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
erythromycin 5 MG/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,72485067035,NDC,facility,both,1,GM,86.84,61.48,Aetna First Health,Commercial,,73.81,85,,,38.49,73.81,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 15 g Tube,25000000,CDM,,,250,RC,00168008115,NDC,facility,both,1,GM,358.2,253.61,Aetna First Health,Commercial,,304.47,85,,,158.75,304.47,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 15 g Tube,25000000,CDM,,,250,RC,00472015015,NDC,facility,both,1,GM,358.2,253.61,Aetna First Health,Commercial,,304.47,85,,,158.75,304.47,percent of total billed charges,
estradiol 0.1 MG/GM Cream 42.5 g Tube,25000000,CDM,,,250,RC,45802009735,NDC,facility,both,1,GM,400.01,283.21,Aetna First Health,Commercial,,340.01,85,,,177.28,340.01,percent of total billed charges,
estradiol 0.1 MG/GM Cream 42.5 g Tube,25000000,CDM,,,250,RC,66993000210,NDC,facility,both,1,GM,400.01,283.21,Aetna First Health,Commercial,,340.01,85,,,177.28,340.01,percent of total billed charges,
estradiol 0.1 MG/GM Cream 42.5 g Tube,25000000,CDM,,,250,RC,00093354143,NDC,facility,both,1,GM,435.2,308.12,Aetna First Health,Commercial,,369.92,85,,,192.88,369.92,percent of total billed charges,
estradiol 0.1 MG/GM Cream 42.5 g Tube,25000000,CDM,,,250,RC,00378877035,NDC,facility,both,1,GM,631.89,447.38,Aetna First Health,Commercial,,537.11,85,,,280.05,537.11,percent of total billed charges,
estradiol 0.1 MG/GM Cream 42.5 g Tube,25000000,CDM,,,250,RC,47781010444,NDC,facility,both,1,GM,668.95,473.62,Aetna First Health,Commercial,,568.61,85,,,296.48,568.61,percent of total billed charges,
clotrimazole 1 % Cream 28 g Tube,25000000,CDM,,,250,RC,00536127222,NDC,facility,both,1,GR,3.02,2.14,Aetna First Health,Commercial,,2.57,85,,,1.34,2.57,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 14.2 g Tube,25000000,CDM,,,250,RC,46122041405,NDC,facility,both,1,GR,3.47,2.46,Aetna First Health,Commercial,,2.95,85,,,1.54,2.95,percent of total billed charges,
miconazole 2 % Cream 28 g Tube,25000000,CDM,,,250,RC,00472073556,NDC,facility,both,1,GR,3.57,2.53,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
miconazole 2 % Cream 28 g Tube,25000000,CDM,,,250,RC,61269073556,NDC,facility,both,1,GR,3.57,2.53,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 28.4 g Tube,25000000,CDM,,,250,RC,00713026831,NDC,facility,both,1,GR,4.13,2.92,Aetna First Health,Commercial,,3.51,85,,,1.83,3.51,percent of total billed charges,
miconazole 2 % Powder 71 g Bottle,25000000,CDM,,,250,RC,46122003927,NDC,facility,both,1,GR,4.69,3.32,Aetna First Health,Commercial,,3.99,85,,,2.08,3.99,percent of total billed charges,
clotrimazole 1 % Cream 15 g Tube,25000000,CDM,,,250,RC,45802043401,NDC,facility,both,1,GR,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
miconazole 2 % Powder 43 g Bottle,25000000,CDM,,,250,RC,00067094915,NDC,facility,both,1,GR,4.77,3.38,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 14.2 g Tube,25000000,CDM,,,250,RC,68001048346,NDC,facility,both,1,GR,5.11,3.62,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
miconazole 2 % Cream 42.5 g Tube,25000000,CDM,,,250,RC,00472073542,NDC,facility,both,1,GR,5.16,3.65,Aetna First Health,Commercial,,4.39,85,,,2.29,4.39,percent of total billed charges,
miconazole 2 % Cream 42.5 g Tube,25000000,CDM,,,250,RC,68001048147,NDC,facility,both,1,GR,5.16,3.65,Aetna First Health,Commercial,,4.39,85,,,2.29,4.39,percent of total billed charges,
miconazole 2 % Powder 43 g Bottle,25000000,CDM,,,250,RC,00316022515,NDC,facility,both,1,GR,5.61,3.97,Aetna First Health,Commercial,,4.77,85,,,2.49,4.77,percent of total billed charges,
clotrimazole 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,49348027972,NDC,facility,both,1,GR,6.17,4.37,Aetna First Health,Commercial,,5.24,85,,,2.73,5.24,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 14.2 g Tube,25000000,CDM,,,250,RC,00081073088,NDC,facility,both,1,GR,6.37,4.51,Aetna First Health,Commercial,,5.41,85,,,2.82,5.41,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 14.2 g Tube,25000000,CDM,,,250,RC,00081079888,NDC,facility,both,1,GR,6.43,4.55,Aetna First Health,Commercial,,5.47,85,,,2.85,5.47,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 28.4 g Tube,25000000,CDM,,,250,RC,46122041403,NDC,facility,both,1,GR,6.65,4.71,Aetna First Health,Commercial,,5.65,85,,,2.95,5.65,percent of total billed charges,
clotrimazole 1 % Cream 28.4 g Tube,25000000,CDM,,,250,RC,68001047547,NDC,facility,both,1,GR,6.82,4.83,Aetna First Health,Commercial,,5.8,85,,,3.02,5.8,percent of total billed charges,
miconazole 2 % Powder 71 g Bottle,25000000,CDM,,,250,RC,00145150103,NDC,facility,both,1,GR,6.82,4.83,Aetna First Health,Commercial,,5.8,85,,,3.02,5.8,percent of total billed charges,
clotrimazole 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,45802043411,NDC,facility,both,1,GR,6.84,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
miconazole 2 % Powder 85 g Bottle,25000000,CDM,,,250,RC,00067094930,NDC,facility,both,1,GR,7.01,4.96,Aetna First Health,Commercial,,5.96,85,,,3.11,5.96,percent of total billed charges,
miconazole 2 % Powder 71 g Can,25000000,CDM,,,250,RC,00145150605,NDC,facility,both,1,GR,7.14,5.06,Aetna First Health,Commercial,,6.07,85,,,3.16,6.07,percent of total billed charges,
miconazole 2 % Powder 71 g Bottle,25000000,CDM,,,250,RC,46122044427,NDC,facility,both,1,GR,7.24,5.13,Aetna First Health,Commercial,,6.15,85,,,3.21,6.15,percent of total billed charges,
clotrimazole 1 % Cream 15 g Tube,25000000,CDM,,,250,RC,51672200201,NDC,facility,both,1,GR,7.65,5.42,Aetna First Health,Commercial,,6.5,85,,,3.39,6.5,percent of total billed charges,
miconazole 2 % Powder 71 g Bottle,25000000,CDM,,,250,RC,00316023125,NDC,facility,both,1,GR,8.09,5.73,Aetna First Health,Commercial,,6.88,85,,,3.59,6.88,percent of total billed charges,
miconazole 2 % Powder 71 g Bottle,25000000,CDM,,,250,RC,00316023225,NDC,facility,both,1,GR,8.09,5.73,Aetna First Health,Commercial,,6.88,85,,,3.59,6.88,percent of total billed charges,
miconazole 2 % Powder 85 g Bottle,25000000,CDM,,,250,RC,00316022530,NDC,facility,both,1,GR,8.29,5.87,Aetna First Health,Commercial,,7.05,85,,,3.67,7.05,percent of total billed charges,
clotrimazole 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672200202,NDC,facility,both,1,GR,9.9,7.01,Aetna First Health,Commercial,,8.42,85,,,4.39,8.42,percent of total billed charges,
clotrimazole 1 % Cream 45 g Tube,25000000,CDM,,,250,RC,00536126526,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
gentamicin 0.1 % Cream 15 g Tube,25000000,CDM,,,250,RC,00168007115,NDC,facility,both,1,GR,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 28.35 g Tube,25000000,CDM,,,250,RC,00168002131,NDC,facility,both,1,GR,13.48,9.54,Aetna First Health,Commercial,,11.46,85,,,5.97,11.46,percent of total billed charges,
clotrimazole 1 % Cream 15 g Tube,25000000,CDM,,,250,RC,41100059462,NDC,facility,both,1,GR,13.75,9.74,Aetna First Health,Commercial,,11.69,85,,,6.09,11.69,percent of total billed charges,
miconazole 2 % Cream 42.5 g Tube,25000000,CDM,,,250,RC,61269073542,NDC,facility,both,1,GR,13.77,9.75,Aetna First Health,Commercial,,11.7,85,,,6.1,11.7,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 14.2 g Tube,25000000,CDM,,,250,RC,58980001205,NDC,facility,both,1,GR,13.97,9.89,Aetna First Health,Commercial,,11.87,85,,,6.19,11.87,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,76282066339,NDC,facility,both,1,GR,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 14.2 g Tube,25000000,CDM,,,250,RC,51672212001,NDC,facility,both,1,GR,17.78,12.59,Aetna First Health,Commercial,,15.11,85,,,7.88,15.11,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 28.4 g Tube,25000000,CDM,,,250,RC,68001048345,NDC,facility,both,1,GR,19.31,13.67,Aetna First Health,Commercial,,16.41,85,,,8.56,16.41,percent of total billed charges,
docosanol 10 % Cream 2 g Tube,25000000,CDM,,,250,RC,00591298135,NDC,facility,both,1,GR,20.04,14.19,Aetna First Health,Commercial,,17.03,85,,,8.88,17.03,percent of total billed charges,
docosanol 10 % Cream 2 g Tube,25000000,CDM,,,250,RC,61269098135,NDC,facility,both,1,GR,20.04,14.19,Aetna First Health,Commercial,,17.03,85,,,8.88,17.03,percent of total billed charges,
docosanol 10 % Cream 2 g Tube,25000000,CDM,,,250,RC,46122062407,NDC,facility,both,1,GR,20.99,14.86,Aetna First Health,Commercial,,17.84,85,,,9.3,17.84,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 8 g Inhaler,25000000,CDM,,,250,RC,00173068254,NDC,facility,both,1,GR,22.54,15.96,Aetna First Health,Commercial,,19.16,85,,,9.99,19.16,percent of total billed charges,
docosanol 10 % Cream 2 g Tube,25000000,CDM,,,250,RC,00135020001,NDC,facility,both,1,GR,23.19,16.42,Aetna First Health,Commercial,,19.71,85,,,10.28,19.71,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 20 g Tube,25000000,CDM,,,250,RC,67877012420,NDC,facility,both,1,GR,23.44,16.6,Aetna First Health,Commercial,,19.92,85,,,10.39,19.92,percent of total billed charges,
miconazole 2 % Powder 85 g Bottle,25000000,CDM,,,250,RC,11701003816,NDC,facility,both,1,GR,23.46,16.61,Aetna First Health,Commercial,,19.94,85,,,10.4,19.94,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 8 g Inhaler,25000000,CDM,,,250,RC,00173068221,NDC,facility,both,1,GR,26.78,18.96,Aetna First Health,Commercial,,22.76,85,,,11.87,22.76,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 8 g Inhaler,25000000,CDM,,,250,RC,00173068224,NDC,facility,both,1,GR,27.58,19.53,Aetna First Health,Commercial,,23.44,85,,,12.22,23.44,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 25 g Tube,25000000,CDM,,,250,RC,67877012425,NDC,facility,both,1,GR,29.8,21.1,Aetna First Health,Commercial,,25.33,85,,,13.21,25.33,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 25 g Tube,25000000,CDM,,,250,RC,59762013102,NDC,facility,both,1,GR,29.8,21.1,Aetna First Health,Commercial,,25.33,85,,,13.21,25.33,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 25 g Tube,25000000,CDM,,,250,RC,43598021025,NDC,facility,both,1,GR,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 25 g Tube,25000000,CDM,,,250,RC,61570013125,NDC,facility,both,1,GR,31.2,22.09,Aetna First Health,Commercial,,26.52,85,,,13.83,26.52,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 6.7 g Inhaler,25000000,CDM,,,250,RC,69097014260,NDC,facility,both,1,GR,32.48,23,Aetna First Health,Commercial,,27.61,85,,,14.4,27.61,percent of total billed charges,
mupirocin 2 % Ointment 22 g Tube,25000000,CDM,,,250,RC,45802011222,NDC,facility,both,1,GR,35.99,25.48,Aetna First Health,Commercial,,30.59,85,,,15.95,30.59,percent of total billed charges,
mupirocin 2 % Ointment 22 g Tube,25000000,CDM,,,250,RC,51672131200,NDC,facility,both,1,GR,35.99,25.48,Aetna First Health,Commercial,,30.59,85,,,15.95,30.59,percent of total billed charges,
mupirocin 2 % Ointment 22 g Tube,25000000,CDM,,,250,RC,68462018022,NDC,facility,both,1,GR,35.99,25.48,Aetna First Health,Commercial,,30.59,85,,,15.95,30.59,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 20 g Tube,25000000,CDM,,,250,RC,61570013120,NDC,facility,both,1,GR,36.4,25.77,Aetna First Health,Commercial,,30.94,85,,,16.13,30.94,percent of total billed charges,
mupirocin 2 % Ointment 22 g Tube,25000000,CDM,,,250,RC,00093101042,NDC,facility,both,1,GR,36.43,25.79,Aetna First Health,Commercial,,30.97,85,,,16.15,30.97,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,46122075252,NDC,facility,both,1,GR,38.4,27.19,Aetna First Health,Commercial,,32.64,85,,,17.02,32.64,percent of total billed charges,
clotrimazole 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,11017057136,NDC,facility,both,1,GR,39.48,27.95,Aetna First Health,Commercial,,33.56,85,,,17.5,33.56,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,57896014001,NDC,facility,both,1,GR,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 15 g Tube,25000000,CDM,,,250,RC,00472037915,NDC,facility,both,1,GR,40.5,28.67,Aetna First Health,Commercial,,34.42,85,,,17.95,34.42,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 15 g Tube,25000000,CDM,,,250,RC,68462029817,NDC,facility,both,1,GR,40.5,28.67,Aetna First Health,Commercial,,34.42,85,,,17.95,34.42,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,46122064654,NDC,facility,both,1,GR,41.2,29.17,Aetna First Health,Commercial,,35.02,85,,,18.26,35.02,percent of total billed charges,
clotrimazole 1 % Cream 15 g Tube,25000000,CDM,,,250,RC,68462018117,NDC,facility,both,1,GR,41.64,29.48,Aetna First Health,Commercial,,35.39,85,,,18.45,35.39,percent of total billed charges,
benzocaine 20 % Aerosol 57 g Can,25000000,CDM,,,250,RC,00283067902,NDC,facility,both,1,GR,44.03,31.17,Aetna First Health,Commercial,,37.43,85,,,19.51,37.43,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 6.7 g Inhaler,25000000,CDM,,,250,RC,00254100752,NDC,facility,both,1,GR,44.97,31.84,Aetna First Health,Commercial,,38.22,85,,,19.93,38.22,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 6.7 g Inhaler,25000000,CDM,,,250,RC,00781729685,NDC,facility,both,1,GR,44.97,31.84,Aetna First Health,Commercial,,38.22,85,,,19.93,38.22,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 18 g Inhaler,25000000,CDM,,,250,RC,66993001968,NDC,facility,both,1,GR,44.98,31.85,Aetna First Health,Commercial,,38.23,85,,,19.94,38.23,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 8.5 g Inhaler,25000000,CDM,,,250,RC,45802008801,NDC,facility,both,1,GR,44.98,31.85,Aetna First Health,Commercial,,38.23,85,,,19.94,38.23,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 8.5 g Inhaler,25000000,CDM,,,250,RC,68180096301,NDC,facility,both,1,GR,44.98,31.85,Aetna First Health,Commercial,,38.23,85,,,19.94,38.23,percent of total billed charges,
clotrimazole 1 % Cream 15 g Tube,25000000,CDM,,,250,RC,51672127501,NDC,facility,both,1,GR,46.8,33.13,Aetna First Health,Commercial,,39.78,85,,,20.74,39.78,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,43598097710,NDC,facility,both,1,GR,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Jar,25000000,CDM,,,250,RC,67877012450,NDC,facility,both,1,GR,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Jar,25000000,CDM,,,250,RC,59762013106,NDC,facility,both,1,GR,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Tube,25000000,CDM,,,250,RC,67877012405,NDC,facility,both,1,GR,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Tube,25000000,CDM,,,250,RC,59762013105,NDC,facility,both,1,GR,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,45802095301,NDC,facility,both,1,GR,49.2,34.83,Aetna First Health,Commercial,,41.82,85,,,21.81,41.82,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Jar,25000000,CDM,,,250,RC,00591081055,NDC,facility,both,1,GR,49.6,35.12,Aetna First Health,Commercial,,42.16,85,,,21.98,42.16,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Jar,25000000,CDM,,,250,RC,43598021055,NDC,facility,both,1,GR,49.6,35.12,Aetna First Health,Commercial,,42.16,85,,,21.98,42.16,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Tube,25000000,CDM,,,250,RC,43598021050,NDC,facility,both,1,GR,49.6,35.12,Aetna First Health,Commercial,,42.16,85,,,21.98,42.16,percent of total billed charges,
neomycin-polymyxin-dexamethasone 3.5-10000-0.1 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00574416035,NDC,facility,both,1,GR,50.53,35.78,Aetna First Health,Commercial,,42.95,85,,,22.39,42.95,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Tube,25000000,CDM,,,250,RC,61570013155,NDC,facility,both,1,GR,51.6,36.53,Aetna First Health,Commercial,,43.86,85,,,22.87,43.86,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,17478023835,NDC,facility,both,1,GR,55.59,39.36,Aetna First Health,Commercial,,47.25,85,,,24.64,47.25,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,00067815203,NDC,facility,both,1,GR,57.2,40.5,Aetna First Health,Commercial,,48.62,85,,,25.35,48.62,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 50 g Jar,25000000,CDM,,,250,RC,61570013150,NDC,facility,both,1,GR,57.6,40.78,Aetna First Health,Commercial,,48.96,85,,,25.53,48.96,percent of total billed charges,
docosanol 10 % Cream 2 g Tube,25000000,CDM,,,250,RC,07660080100,NDC,facility,both,1,GR,58.92,41.72,Aetna First Health,Commercial,,50.08,85,,,26.11,50.08,percent of total billed charges,
neomycin-bacitracin-polymyxin 5-400-10000 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,16571075453,NDC,facility,both,1,GR,59.92,42.42,Aetna First Health,Commercial,,50.93,85,,,26.56,50.93,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,65162083366,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,69097052444,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,45802016000,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
ketoconazole 2 % Cream 15 g Tube,25000000,CDM,,,250,RC,00168009915,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
neomycin-polymyxin-dexamethasone 3.5-10000-0.1 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208079535,NDC,facility,both,1,GR,63.56,45,Aetna First Health,Commercial,,54.03,85,,,28.17,54.03,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 15 g Tube,25000000,CDM,,,250,RC,00168025815,NDC,facility,both,1,GR,67.44,47.75,Aetna First Health,Commercial,,57.32,85,,,29.89,57.32,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 15 g Tube,25000000,CDM,,,250,RC,51672404801,NDC,facility,both,1,GR,67.44,47.75,Aetna First Health,Commercial,,57.32,85,,,29.89,57.32,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 18 g Inhaler,25000000,CDM,,,250,RC,00173068220,NDC,facility,both,1,GR,69.21,49,Aetna First Health,Commercial,,58.83,85,,,30.67,58.83,percent of total billed charges,
neomycin-polymyxin-dexamethasone 3.5-10000-0.1 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,61314063136,NDC,facility,both,1,GR,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
clotrimazole 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,68462018135,NDC,facility,both,1,GR,72.84,51.57,Aetna First Health,Commercial,,61.91,85,,,32.28,61.91,percent of total billed charges,
butamben-tetracaine-benzocaine 2-2-14 % Aerosol 5 g Bottle,25000000,CDM,,,250,RC,10223020104,NDC,facility,both,1,GR,76.25,53.98,Aetna First Health,Commercial,,64.81,85,,,33.79,64.81,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,21922000909,NDC,facility,both,1,GR,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 6.7 g Inhaler,25000000,CDM,,,250,RC,00085113201,NDC,facility,both,1,GR,80.94,57.31,Aetna First Health,Commercial,,68.8,85,,,35.87,68.8,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 8.5 g Inhaler,25000000,CDM,,,250,RC,59310057922,NDC,facility,both,1,GR,83.6,59.19,Aetna First Health,Commercial,,71.06,85,,,37.05,71.06,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00574402135,NDC,facility,both,1,GR,87.08,61.65,Aetna First Health,Commercial,,74.02,85,,,38.59,74.02,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 15 g Tube,25000000,CDM,,,250,RC,16714049601,NDC,facility,both,1,GR,87.66,62.06,Aetna First Health,Commercial,,74.51,85,,,38.85,74.51,percent of total billed charges,
clotrimazole 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672127502,NDC,facility,both,1,GR,88.56,62.7,Aetna First Health,Commercial,,75.28,85,,,39.25,75.28,percent of total billed charges,
levalbuterol 45 MCG/ACT Aerosol 15 g Inhaler,25000000,CDM,,,250,RC,63402051001,NDC,facility,both,1,GR,89.57,63.42,Aetna First Health,Commercial,,76.13,85,,,39.7,76.13,percent of total billed charges,
ketoconazole 2 % Cream 15 g Tube,25000000,CDM,,,250,RC,51672129801,NDC,facility,both,1,GR,90.72,64.23,Aetna First Health,Commercial,,77.11,85,,,40.21,77.11,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208055555,NDC,facility,both,1,GR,91.69,64.92,Aetna First Health,Commercial,,77.94,85,,,40.64,77.94,percent of total billed charges,
ketoconazole 2 % Cream 15 g Tube,25000000,CDM,,,250,RC,00093321915,NDC,facility,both,1,GR,98.88,70.01,Aetna First Health,Commercial,,84.05,85,,,43.82,84.05,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 15 g Tube,25000000,CDM,,,250,RC,66993089815,NDC,facility,both,1,GR,98.94,70.05,Aetna First Health,Commercial,,84.1,85,,,43.85,84.1,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 6.7 g Inhaler,25000000,CDM,,,250,RC,00085113204,NDC,facility,both,1,GR,99.66,70.56,Aetna First Health,Commercial,,84.71,85,,,44.17,84.71,percent of total billed charges,
ketoconazole 2 % Cream 30 g Tube,25000000,CDM,,,250,RC,00168009930,NDC,facility,both,1,GR,99.96,70.77,Aetna First Health,Commercial,,84.97,85,,,44.3,84.97,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 6.7 g Inhaler,25000000,CDM,,,250,RC,60687066291,NDC,facility,both,1,GR,99.99,70.79,Aetna First Health,Commercial,,84.99,85,,,44.32,84.99,percent of total billed charges,
clotrimazole 1 % Cream 45 g Tube,25000000,CDM,,,250,RC,51672127506,NDC,facility,both,1,GR,124.38,88.06,Aetna First Health,Commercial,,105.72,85,,,55.13,105.72,percent of total billed charges,
mupirocin 2 % Ointment 22 g Tube,25000000,CDM,,,250,RC,00168035222,NDC,facility,both,1,GR,129.01,91.34,Aetna First Health,Commercial,,109.66,85,,,57.18,109.66,percent of total billed charges,
clotrimazole 1 % Cream 45 g Tube,25000000,CDM,,,250,RC,00168013346,NDC,facility,both,1,GR,133.56,94.56,Aetna First Health,Commercial,,113.53,85,,,59.19,113.53,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 6.7 g Inhaler,25000000,CDM,,,250,RC,00054074287,NDC,facility,both,1,GR,143.92,101.9,Aetna First Health,Commercial,,122.33,85,,,63.79,122.33,percent of total billed charges,
albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution 8.5 g Inhaler,25000000,CDM,,,250,RC,00093317431,NDC,facility,both,1,GR,143.92,101.9,Aetna First Health,Commercial,,122.33,85,,,63.79,122.33,percent of total billed charges,
ketoconazole 2 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672129802,NDC,facility,both,1,GR,152.16,107.73,Aetna First Health,Commercial,,129.34,85,,,67.44,129.34,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,49884093547,NDC,facility,both,1,GR,154,109.03,Aetna First Health,Commercial,,130.9,85,,,68.25,130.9,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,00378875006,NDC,facility,both,1,GR,154,109.03,Aetna First Health,Commercial,,130.9,85,,,68.25,130.9,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,50383027201,NDC,facility,both,1,GR,154,109.03,Aetna First Health,Commercial,,130.9,85,,,68.25,130.9,percent of total billed charges,
gentamicin 0.1 % Cream 15 g Tube,25000000,CDM,,,250,RC,45802005635,NDC,facility,both,1,GR,157.98,111.85,Aetna First Health,Commercial,,134.28,85,,,70.02,134.28,percent of total billed charges,
gentamicin 0.1 % Cream 15 g Tube,25000000,CDM,,,250,RC,00713068315,NDC,facility,both,1,GR,157.98,111.85,Aetna First Health,Commercial,,134.28,85,,,70.02,134.28,percent of total billed charges,
gentamicin 0.1 % Cream 15 g Tube,25000000,CDM,,,250,RC,52565008515,NDC,facility,both,1,GR,157.98,111.85,Aetna First Health,Commercial,,134.28,85,,,70.02,134.28,percent of total billed charges,
gentamicin 0.1 % Ointment 15 g Tube,25000000,CDM,,,250,RC,45802004635,NDC,facility,both,1,GR,157.98,111.85,Aetna First Health,Commercial,,134.28,85,,,70.02,134.28,percent of total billed charges,
gentamicin 0.1 % Ointment 15 g Tube,25000000,CDM,,,250,RC,00713068215,NDC,facility,both,1,GR,157.98,111.85,Aetna First Health,Commercial,,134.28,85,,,70.02,134.28,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,16714097601,NDC,facility,both,1,GR,169.2,119.79,Aetna First Health,Commercial,,143.82,85,,,74.99,143.82,percent of total billed charges,
neomycin-bacitracin-polymyxin 5-400-10000 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,48102000635,NDC,facility,both,1,GR,175.13,123.99,Aetna First Health,Commercial,,148.86,85,,,77.62,148.86,percent of total billed charges,
neomycin-bacitracin-polymyxin 5-400-10000 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00574425035,NDC,facility,both,1,GR,175.13,123.99,Aetna First Health,Commercial,,148.86,85,,,77.62,148.86,percent of total billed charges,
neomycin-bacitracin-polymyxin 5-400-10000 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208078055,NDC,facility,both,1,GR,182.28,129.05,Aetna First Health,Commercial,,154.94,85,,,80.79,154.94,percent of total billed charges,
clotrimazole 1 % Cream 45 g Tube,25000000,CDM,,,250,RC,68462018147,NDC,facility,both,1,GR,194.4,137.64,Aetna First Health,Commercial,,165.24,85,,,86.16,165.24,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 400 g Jar,25000000,CDM,,,250,RC,61570013140,NDC,facility,both,1,GR,196.8,139.33,Aetna First Health,Commercial,,167.28,85,,,87.22,167.28,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 400 g Jar,25000000,CDM,,,250,RC,00591081046,NDC,facility,both,1,GR,211.2,149.53,Aetna First Health,Commercial,,179.52,85,,,93.6,179.52,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 400 g Jar,25000000,CDM,,,250,RC,67877012440,NDC,facility,both,1,GR,211.2,149.53,Aetna First Health,Commercial,,179.52,85,,,93.6,179.52,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 400 g Jar,25000000,CDM,,,250,RC,43598021040,NDC,facility,both,1,GR,211.2,149.53,Aetna First Health,Commercial,,179.52,85,,,93.6,179.52,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 400 g Jar,25000000,CDM,,,250,RC,59762013104,NDC,facility,both,1,GR,211.2,149.53,Aetna First Health,Commercial,,179.52,85,,,93.6,179.52,percent of total billed charges,
diclofenac 1 % Gel 100 g Tube,25000000,CDM,,,250,RC,63481068447,NDC,facility,both,1,GR,216,152.93,Aetna First Health,Commercial,,183.6,85,,,95.73,183.6,percent of total billed charges,
levalbuterol 45 MCG/ACT Aerosol 15 g Inhaler,25000000,CDM,,,250,RC,00591292754,NDC,facility,both,1,GR,235.86,166.99,Aetna First Health,Commercial,,200.48,85,,,104.53,200.48,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00065064835,NDC,facility,both,1,GR,285.26,201.96,Aetna First Health,Commercial,,242.47,85,,,126.43,242.47,percent of total billed charges,
mometasone - formoterol 200-5 MCG/ACT Aerosol 8.8 g Inhaler,25000000,CDM,,,250,RC,78206012602,NDC,facility,both,1,GR,289.91,205.26,Aetna First Health,Commercial,,246.42,85,,,128.49,246.42,percent of total billed charges,
tretinoin 0.025 % Cream 20 g Tube,25000000,CDM,,,250,RC,00472011720,NDC,facility,both,1,GR,334.8,237.04,Aetna First Health,Commercial,,284.58,85,,,148.38,284.58,percent of total billed charges,
tretinoin 0.025 % Cream 20 g Tube,25000000,CDM,,,250,RC,00574222520,NDC,facility,both,1,GR,334.8,237.04,Aetna First Health,Commercial,,284.58,85,,,148.38,284.58,percent of total billed charges,
tretinoin 0.025 % Cream 20 g Tube,25000000,CDM,,,250,RC,00378808220,NDC,facility,both,1,GR,334.88,237.1,Aetna First Health,Commercial,,284.65,85,,,148.42,284.65,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00078087601,NDC,facility,both,1,GR,339.05,240.05,Aetna First Health,Commercial,,288.19,85,,,150.27,288.19,percent of total billed charges,
mupirocin 2 % Ointment 22 g Tube,25000000,CDM,,,250,RC,00029152544,NDC,facility,both,1,GR,398.64,282.24,Aetna First Health,Commercial,,338.84,85,,,176.68,338.84,percent of total billed charges,
neomycin-polymyxin-dexamethasone 3.5-10000-0.1 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00065063136,NDC,facility,both,1,GR,779.56,551.93,Aetna First Health,Commercial,,662.63,85,,,345.5,662.63,percent of total billed charges,
mometasone - formoterol 100-5 MCG/ACT Aerosol 8.8 g Inhaler,25000000,CDM,,,250,RC,00085720607,NDC,facility,both,1,GR,843.04,596.87,Aetna First Health,Commercial,,716.58,85,,,373.64,716.58,percent of total billed charges,
mometasone - formoterol 200-5 MCG/ACT Aerosol 8.8 g Inhaler,25000000,CDM,,,250,RC,00085461005,NDC,facility,both,1,GR,843.04,596.87,Aetna First Health,Commercial,,716.58,85,,,373.64,716.58,percent of total billed charges,
neomycin-polymyxin-dexamethasone 3.5-10000-0.1 Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00078077101,NDC,facility,both,1,GR,899.56,636.89,Aetna First Health,Commercial,,764.63,85,,,398.68,764.63,percent of total billed charges,
mometasone - formoterol 100-5 MCG/ACT Aerosol 8.8 g Inhaler,25000000,CDM,,,250,RC,78206012702,NDC,facility,both,1,GR,927.7,656.81,Aetna First Health,Commercial,,788.54,85,,,411.16,788.54,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,49348099136,NDC,facility,both,1,ML,1.59,1.13,Aetna First Health,Commercial,,1.35,85,,,0.7,1.35,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,00904589430,NDC,facility,both,1,ML,2.79,1.98,Aetna First Health,Commercial,,2.37,85,,,1.24,2.37,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,24385032830,NDC,facility,both,1,ML,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,24385053230,NDC,facility,both,1,ML,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,00536130375,NDC,facility,both,1,ML,3.29,2.33,Aetna First Health,Commercial,,2.8,85,,,1.46,2.8,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,71399004101,NDC,facility,both,1,ML,3.29,2.33,Aetna First Health,Commercial,,2.8,85,,,1.46,2.8,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,00904630521,NDC,facility,both,1,ML,3.72,2.63,Aetna First Health,Commercial,,3.16,85,,,1.65,3.16,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,46122074976,NDC,facility,both,1,ML,3.72,2.63,Aetna First Health,Commercial,,3.16,85,,,1.65,3.16,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 0.6 mL Syringe,25000000,CDM,,,250,RC,17856589406,NDC,facility,both,1,ML,3.95,2.8,Aetna First Health,Commercial,,3.36,85,,,1.75,3.36,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 0.6 mL Syringe,25000000,CDM,,,250,RC,17856222001,NDC,facility,both,1,ML,3.95,2.8,Aetna First Health,Commercial,,3.36,85,,,1.75,3.36,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 0.6 mL Syringe,25000000,CDM,,,250,RC,17856222003,NDC,facility,both,1,ML,3.95,2.8,Aetna First Health,Commercial,,3.36,85,,,1.75,3.36,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 0.6 mL Syringe,25000000,CDM,,,250,RC,17856589402,NDC,facility,both,1,ML,3.95,2.8,Aetna First Health,Commercial,,3.36,85,,,1.75,3.36,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 0.6 mL Syringe,25000000,CDM,,,250,RC,17856130303,NDC,facility,both,1,ML,3.95,2.8,Aetna First Health,Commercial,,3.36,85,,,1.75,3.36,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,46122026530,NDC,facility,both,1,ML,3.98,2.82,Aetna First Health,Commercial,,3.38,85,,,1.76,3.38,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Spray Bottle,25000000,CDM,,,250,RC,00536122858,NDC,facility,both,1,ML,4.25,3.01,Aetna First Health,Commercial,,3.61,85,,,1.88,3.61,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,46122027830,NDC,facility,both,1,ML,4.51,3.19,Aetna First Health,Commercial,,3.83,85,,,2,3.83,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,46122005103,NDC,facility,both,1,ML,4.86,3.44,Aetna First Health,Commercial,,4.13,85,,,2.15,4.13,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,49348074027,NDC,facility,both,1,ML,5.04,3.57,Aetna First Health,Commercial,,4.28,85,,,2.23,4.28,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,50804037706,NDC,facility,both,1,ML,5.58,3.95,Aetna First Health,Commercial,,4.74,85,,,2.47,4.74,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,78112001103,NDC,facility,both,1,ML,6.64,4.7,Aetna First Health,Commercial,,5.64,85,,,2.94,5.64,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,78112001104,NDC,facility,both,1,ML,6.64,4.7,Aetna First Health,Commercial,,5.64,85,,,2.94,5.64,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,00536222075,NDC,facility,both,1,ML,6.71,4.75,Aetna First Health,Commercial,,5.7,85,,,2.97,5.7,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,46122054703,NDC,facility,both,1,ML,7.11,5.03,Aetna First Health,Commercial,,6.04,85,,,3.15,6.04,percent of total billed charges,
benzocaine 20 % Solution 0.5 mL Spray Bottle,25000000,CDM,,,250,RC,00283061043,NDC,facility,both,1,ML,7.6,5.38,Aetna First Health,Commercial,,6.46,85,,,3.37,6.46,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,56184012041,NDC,facility,both,1,ML,7.79,5.52,Aetna First Health,Commercial,,6.62,85,,,3.45,6.62,percent of total billed charges,
ketotifen 0.035 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,49348010717,NDC,facility,both,1,ML,8.24,5.83,Aetna First Health,Commercial,,7,85,,,3.65,7,percent of total billed charges,
ciprofloxacin 0.3 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,17478071425,NDC,facility,both,1,ML,9.35,6.62,Aetna First Health,Commercial,,7.95,85,,,4.14,7.95,percent of total billed charges,
sodium chloride 0.9% irrigation 0.9 % Solution 500 mL Bottle,25000000,CDM,,,250,RC,05042100883,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
phenol 1.4 % Liquid 177 mL Bottle,25000000,CDM,,,250,RC,46122074876,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
timolol 0.25 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505059701,NDC,facility,both,1,ML,10.4,7.36,Aetna First Health,Commercial,,8.84,85,,,4.61,8.84,percent of total billed charges,
ciprofloxacin 0.3 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,16571012025,NDC,facility,both,1,ML,11.25,7.96,Aetna First Health,Commercial,,9.56,85,,,4.99,9.56,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,70512052005,NDC,facility,both,1,ML,11.4,8.07,Aetna First Health,Commercial,,9.69,85,,,5.05,9.69,percent of total billed charges,
timolol 0.25 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60758080205,NDC,facility,both,1,ML,11.92,8.44,Aetna First Health,Commercial,,10.13,85,,,5.28,10.13,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 30 mL Bottle,25000000,CDM,,,250,RC,69618005951,NDC,facility,both,1,ML,12.72,9.01,Aetna First Health,Commercial,,10.81,85,,,5.64,10.81,percent of total billed charges,
ciprofloxacin 0.3 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,61314065625,NDC,facility,both,1,ML,13.13,9.3,Aetna First Health,Commercial,,11.16,85,,,5.82,11.16,percent of total billed charges,
ciprofloxacin 0.3 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,69315030802,NDC,facility,both,1,ML,13.13,9.3,Aetna First Health,Commercial,,11.16,85,,,5.82,11.16,percent of total billed charges,
ketotifen 0.035 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478071710,NDC,facility,both,1,ML,13.71,9.71,Aetna First Health,Commercial,,11.65,85,,,6.08,11.65,percent of total billed charges,
sodium chloride 0.9% irrigation 0.9 % Solution 500 mL Plas Cont,25000000,CDM,,,250,RC,00264220110,NDC,facility,both,1,ML,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
lidocaine 4 % Solution 50 mL Bottle,25000000,CDM,,,250,RC,00603139447,NDC,facility,both,1,ML,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
ketotifen 0.035 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00065401105,NDC,facility,both,1,ML,15.6,11.04,Aetna First Health,Commercial,,13.26,85,,,6.91,13.26,percent of total billed charges,
sodium hypochlorite 0.25 % Solution 473 mL Bottle,25000000,CDM,,,250,RC,00436093616,NDC,facility,both,1,ML,17.03,12.06,Aetna First Health,Commercial,,14.48,85,,,7.55,14.48,percent of total billed charges,
gentamicin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60758018805,NDC,facility,both,1,ML,17.44,12.35,Aetna First Health,Commercial,,14.82,85,,,7.73,14.82,percent of total billed charges,
lidocaine urethral/mucosal 2 % Gel 5 mL Tube,25000000,CDM,,,250,RC,17478081110,NDC,facility,both,1,ML,18.6,13.17,Aetna First Health,Commercial,,15.81,85,,,8.24,15.81,percent of total billed charges,
lidocaine urethral/mucosal 2 % Gel 5 mL Tube,25000000,CDM,,,250,RC,00591301226,NDC,facility,both,1,ML,18.6,13.17,Aetna First Health,Commercial,,15.81,85,,,8.24,15.81,percent of total billed charges,
levobunolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60758006005,NDC,facility,both,1,ML,18.6,13.17,Aetna First Health,Commercial,,15.81,85,,,8.24,15.81,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,64980051505,NDC,facility,both,1,ML,18.75,13.28,Aetna First Health,Commercial,,15.94,85,,,8.31,15.94,percent of total billed charges,
oxymetazoline 0.05% in lidocaine 4% Solution 20 mL Bottle,25000000,CDM,,,250,RC,08888800504,NDC,facility,both,1,ML,18.75,13.28,Aetna First Health,Commercial,,15.94,85,,,8.31,15.94,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,70069042101,NDC,facility,both,1,ML,19.8,14.02,Aetna First Health,Commercial,,16.83,85,,,8.78,16.83,percent of total billed charges,
tobramycin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,70069013101,NDC,facility,both,1,ML,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
gentamicin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314063305,NDC,facility,both,1,ML,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
timolol 0.25 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314022605,NDC,facility,both,1,ML,20.68,14.64,Aetna First Health,Commercial,,17.58,85,,,9.17,17.58,percent of total billed charges,
timolol 0.25 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,64980051305,NDC,facility,both,1,ML,20.8,14.73,Aetna First Health,Commercial,,17.68,85,,,9.22,17.68,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505056000,NDC,facility,both,1,ML,20.94,14.83,Aetna First Health,Commercial,,17.8,85,,,9.28,17.8,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478071310,NDC,facility,both,1,ML,20.94,14.83,Aetna First Health,Commercial,,17.8,85,,,9.28,17.8,percent of total billed charges,
timolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60758080105,NDC,facility,both,1,ML,21.88,15.49,Aetna First Health,Commercial,,18.6,85,,,9.7,18.6,percent of total billed charges,
glycerin Liquid 473 mL Bottle,25000000,CDM,,,250,RC,87701040065,NDC,facility,both,1,ML,21.99,15.57,Aetna First Health,Commercial,,18.69,85,,,9.75,18.69,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00536130840,NDC,facility,both,1,ML,22.82,16.16,Aetna First Health,Commercial,,19.4,85,,,10.11,19.4,percent of total billed charges,
brimonidine 0.2 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,70069023101,NDC,facility,both,1,ML,24.44,17.3,Aetna First Health,Commercial,,20.77,85,,,10.83,20.77,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208043405,NDC,facility,both,1,ML,25.55,18.09,Aetna First Health,Commercial,,21.72,85,,,11.32,21.72,percent of total billed charges,
ora-blend SF Suspension 473 mL Bottle,25000000,CDM,,,250,RC,00574031216,NDC,facility,both,1,ML,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
ora-blend Suspension 473 mL Bottle,25000000,CDM,,,250,RC,00574031116,NDC,facility,both,1,ML,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
lidocaine urethral/mucosal 2 % Gel 5 mL Tube,25000000,CDM,,,250,RC,17478071110,NDC,facility,both,1,ML,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
lidocaine urethral/mucosal 2 % Gel 5 mL Tube,25000000,CDM,,,250,RC,17478071131,NDC,facility,both,1,ML,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,70069042103,NDC,facility,both,1,ML,29.08,20.59,Aetna First Health,Commercial,,24.72,85,,,12.89,24.72,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,46122067264,NDC,facility,both,1,ML,30.2,21.38,Aetna First Health,Commercial,,25.67,85,,,13.38,25.67,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,70069001701,NDC,facility,both,1,ML,30.2,21.38,Aetna First Health,Commercial,,25.67,85,,,13.38,25.67,percent of total billed charges,
tropicamide 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478010112,NDC,facility,both,1,ML,31.98,22.64,Aetna First Health,Commercial,,27.18,85,,,14.17,27.18,percent of total billed charges,
tropicamide 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478010212,NDC,facility,both,1,ML,34.02,24.09,Aetna First Health,Commercial,,28.92,85,,,15.08,28.92,percent of total billed charges,
tropicamide 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,70069012101,NDC,facility,both,1,ML,34.02,24.09,Aetna First Health,Commercial,,28.92,85,,,15.08,28.92,percent of total billed charges,
timolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478028810,NDC,facility,both,1,ML,34.76,24.61,Aetna First Health,Commercial,,29.55,85,,,15.41,29.55,percent of total billed charges,
ketotifen 0.035 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,76385010617,NDC,facility,both,1,ML,35.2,24.92,Aetna First Health,Commercial,,29.92,85,,,15.6,29.92,percent of total billed charges,
sodium chloride 0.9% irrigation 0.9 % Solution 250 mL Plas Cont,25000000,CDM,,,250,RC,00338004802,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.9% irrigation 0.9 % Solution 500 mL Plas Cont,25000000,CDM,,,250,RC,00338004803,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.9% irrigation 0.9 % Solution 500 mL Plas Cont,25000000,CDM,,,250,RC,00409613803,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sterile water (preservative free) Solution 50 mL Vial,25000000,CDM,,,250,RC,00409488724,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.9% irrigation 0.9 % Solution 250 mL Plas Cont,25000000,CDM,,,250,RC,00409613822,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
timolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314022705,NDC,facility,both,1,ML,38.6,27.33,Aetna First Health,Commercial,,32.81,85,,,17.11,32.81,percent of total billed charges,
timolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,64980051405,NDC,facility,both,1,ML,38.8,27.47,Aetna First Health,Commercial,,32.98,85,,,17.2,32.98,percent of total billed charges,
brimonidine 0.2 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314014305,NDC,facility,both,1,ML,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
brimonidine 0.2 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,71921018505,NDC,facility,both,1,ML,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
tropicamide 1 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,61314035501,NDC,facility,both,1,ML,40.8,28.89,Aetna First Health,Commercial,,34.68,85,,,18.08,34.68,percent of total billed charges,
polymyxin b-trimethoprim 10000-0.1 UNIT/ML-% Solution 10 mL Bottle,25000000,CDM,,,250,RC,17478070311,NDC,facility,both,1,ML,41.2,29.17,Aetna First Health,Commercial,,35.02,85,,,18.26,35.02,percent of total billed charges,
polymyxin b-trimethoprim 10000-0.1 UNIT/ML-% Solution 10 mL Bottle,25000000,CDM,,,250,RC,61314062810,NDC,facility,both,1,ML,41.4,29.31,Aetna First Health,Commercial,,35.19,85,,,18.35,35.19,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,59762033302,NDC,facility,both,1,ML,41.56,29.42,Aetna First Health,Commercial,,35.33,85,,,18.42,35.33,percent of total billed charges,
phenylephrine 2.5 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,17478020020,NDC,facility,both,1,ML,41.76,29.57,Aetna First Health,Commercial,,35.5,85,,,18.51,35.5,percent of total billed charges,
ketotifen 0.035 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00536125240,NDC,facility,both,1,ML,42.4,30.02,Aetna First Health,Commercial,,36.04,85,,,18.79,36.04,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,61314054701,NDC,facility,both,1,ML,42.8,30.3,Aetna First Health,Commercial,,36.38,85,,,18.97,36.38,percent of total billed charges,
polymyxin b-trimethoprim 10000-0.1 UNIT/ML-% Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208031510,NDC,facility,both,1,ML,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
timolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,68682081305,NDC,facility,both,1,ML,44,31.15,Aetna First Health,Commercial,,37.4,85,,,19.5,37.4,percent of total billed charges,
tobramycin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478029010,NDC,facility,both,1,ML,46.6,32.99,Aetna First Health,Commercial,,39.61,85,,,20.65,39.61,percent of total billed charges,
tobramycin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208029005,NDC,facility,both,1,ML,47,33.28,Aetna First Health,Commercial,,39.95,85,,,20.83,39.95,percent of total billed charges,
cyclopentolate 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,17478010002,NDC,facility,both,1,ML,47.28,33.47,Aetna First Health,Commercial,,40.19,85,,,20.95,40.19,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 2.5 mL Bottle,25000000,CDM,,,250,RC,61314064725,NDC,facility,both,1,ML,47.41,33.57,Aetna First Health,Commercial,,40.3,85,,,21.01,40.3,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 2.5 mL Bottle,25000000,CDM,,,250,RC,69238137302,NDC,facility,both,1,ML,47.41,33.57,Aetna First Health,Commercial,,40.3,85,,,21.01,40.3,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 2.5 mL Bottle,25000000,CDM,,,250,RC,00574403125,NDC,facility,both,1,ML,47.41,33.57,Aetna First Health,Commercial,,40.3,85,,,21.01,40.3,percent of total billed charges,
cyclopentolate 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,61314039601,NDC,facility,both,1,ML,47.8,33.84,Aetna First Health,Commercial,,40.63,85,,,21.18,40.63,percent of total billed charges,
cyclopentolate 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,24208073501,NDC,facility,both,1,ML,48.4,34.27,Aetna First Health,Commercial,,41.14,85,,,21.45,41.14,percent of total billed charges,
balanced salt solution Solution 15 mL Bottle,25000000,CDM,,,250,RC,00065079515,NDC,facility,both,1,ML,48.66,34.45,Aetna First Health,Commercial,,41.36,85,,,21.57,41.36,percent of total billed charges,
timolol 0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,17478028811,NDC,facility,both,1,ML,49.72,35.2,Aetna First Health,Commercial,,42.26,85,,,22.04,42.26,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00065427401,NDC,facility,both,1,ML,49.72,35.2,Aetna First Health,Commercial,,42.26,85,,,22.04,42.26,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Ampule,25000000,CDM,,,250,RC,00409401101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409117101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,17478093705,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00641601301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00641601310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00641921701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00641921710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70860030105,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70860030141,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,17478093725,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,00641601501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,00641601510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,00641921901,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,00641921910,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 30 mL Vial,25000000,CDM,,,250,RC,00409427902,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 30 mL Vial,25000000,CDM,,,250,RC,63323049237,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,63323049257,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,55150016205,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 30 mL Vial,25000000,CDM,,,250,RC,55150016330,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 30 mL Vial,25000000,CDM,,,250,RC,00409427916,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,00143959501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,00143959525,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 30 mL Vial,25000000,CDM,,,250,RC,63323049207,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,63323049209,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,73293000101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,73293000102,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,67457025102,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,67457025100,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,55150020902,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,16729023993,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,16729023930,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,16729043230,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,66794023002,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,66794023042,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,66794023302,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00703115303,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Ampule,25000000,CDM,,,250,RC,00409144304,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00703115301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Ampule,25000000,CDM,,,250,RC,36000016210,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Ampule,25000000,CDM,,,250,RC,00409144325,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00409337525,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Ampule,25000000,CDM,,,250,RC,36000016201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,67457085200,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,67457085204,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00143931801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00143931810,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00781375595,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,70121157607,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00781375575,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,63323094004,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,43066099701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517096010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457019700,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457019710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517096001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,39822100001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,39822100106,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,39822100107,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,55150018810,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70860040010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,47781060191,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70860040041,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,61990061100,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,72485010701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,72485010710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,43066000801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,72611076001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,72611076010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061100,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium phosphate 15 MMOLE/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323017005,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium phosphate 15 MMOLE/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323088401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium phosphate 15 MMOLE/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323088406,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium phosphate 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,00409739172,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium phosphate 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,00409739182,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium phosphates 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,00409729501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium phosphates 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,00409729511,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Vial,25000000,CDM,,,250,RC,00517271025,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409163110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409492834,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,76329330401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Vial,25000000,CDM,,,250,RC,00517671001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Vial,25000000,CDM,,,250,RC,00517671010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,64253090030,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409163140,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409492811,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,64253090091,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride bacteriostatic 0.9 % Solution 30 mL Vial,25000000,CDM,,,250,RC,00409196607,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,43598058723,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,72485010501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 4 % Solution 50 mL Bottle,25000000,CDM,,,250,RC,60432046550,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 10 mL Vial,25000000,CDM,,,250,RC,63323020110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 50 mL Vial,25000000,CDM,,,250,RC,00409427602,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 20 mL Vial,25000000,CDM,,,250,RC,00409427601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 20 mL Vial,25000000,CDM,,,250,RC,63323048527,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 20 mL Vial,25000000,CDM,,,250,RC,00409427616,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 50 mL Vial,25000000,CDM,,,250,RC,00409427617,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 50 mL Vial,25000000,CDM,,,250,RC,00143957701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 10 mL Vial,25000000,CDM,,,250,RC,55150025110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 20 mL Vial,25000000,CDM,,,250,RC,55150025220,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 50 mL Vial,25000000,CDM,,,250,RC,63323048503,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 10 mL Vial,25000000,CDM,,,250,RC,63323020103,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2 % Solution 20 mL Vial,25000000,CDM,,,250,RC,00409427701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2 % Solution 20 mL Vial,25000000,CDM,,,250,RC,63323048627,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2 % Solution 20 mL Vial,25000000,CDM,,,250,RC,00409427716,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2 % Solution 20 mL Vial,25000000,CDM,,,250,RC,55150025520,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2 % Solution 20 mL Vial,25000000,CDM,,,250,RC,63323048602,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 20 mL Vial,25000000,CDM,,,250,RC,00517302025,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 10 mL Vial,25000000,CDM,,,250,RC,63323018510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 20 mL Vial,25000000,CDM,,,250,RC,63323018520,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 20 mL Vial,25000000,CDM,,,250,RC,00409488720,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 100 mL Vial,25000000,CDM,,,250,RC,00409488799,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 10 mL Vial,25000000,CDM,,,250,RC,00409488710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 50 mL Vial,25000000,CDM,,,250,RC,00409488750,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 10 mL Vial,25000000,CDM,,,250,RC,00409488717,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 20 mL Vial,25000000,CDM,,,250,RC,00409488723,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 100 mL Vial,25000000,CDM,,,250,RC,00409488725,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 10 mL Vial,25000000,CDM,,,250,RC,00641614710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 20 mL Vial,25000000,CDM,,,250,RC,63323018508,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00703951401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00703951403,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70069036201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,71351002105,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,71351002125,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,71351002110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409163832,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,25021031604,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,23155016631,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,25021041510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium phosphate 15 MMOLE/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00517340525,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride bacteriostatic 0.9 % Solution 30 mL Vial,25000000,CDM,,,250,RC,00409196602,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride bacteriostatic 0.9 % Solution 30 mL Vial,25000000,CDM,,,250,RC,63323092403,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70700012692,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminocaproic acid 250 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409434673,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminocaproic acid 250 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409434616,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 20 mL Vial,25000000,CDM,,,250,RC,63323048501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 30 mL Vial,25000000,CDM,,,250,RC,00517293025,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 100 mL Vial,25000000,CDM,,,250,RC,63323018500,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 50 mL Vial,25000000,CDM,,,250,RC,63323018550,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Ampule,25000000,CDM,,,250,RC,00409401161,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 25 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,55150042501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,70860030125,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,70860030143,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,55150042701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 125 MG/25ML Solution 25 mL Vial,25000000,CDM,,,250,RC,55150042710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
zinc sulfate 5 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00517810525,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70860040041,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409163802,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,42023014625,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,57664059640,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,57664059650,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70860060503,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70860060541,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,71288050502,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,43066099710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,63323056310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,47781060122,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67850004100,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67850004110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,60505616900,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,60505616901,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,69374091310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70069026101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70436002880,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminocaproic acid 250 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00517912001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 50 mL Vial,25000000,CDM,,,250,RC,63323048557,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,00409329906,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 10 mL Vial,25000000,CDM,,,250,RC,00641614701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 10 mL Vial,25000000,CDM,,,250,RC,00641614725,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 10 mL Vial,25000000,CDM,,,250,RC,63323018507,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70069036210,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,72078000200,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,63323094021,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,47335061544,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,47335061540,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061200,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,81284061210,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminocaproic acid 250 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00517912025,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminocaproic acid 250 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409434609,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminocaproic acid 250 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00517919125,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1 % Solution 50 mL Vial,25000000,CDM,,,250,RC,00143957710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,00409329925,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,00409329945,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00703951491,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,25021031066,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 30 mL Vial,25000000,CDM,,,250,RC,63323049226,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,64253090036,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00409337504,NDC,facility,both,1,ML,50.58,35.81,Aetna First Health,Commercial,,42.99,85,,,22.42,42.99,percent of total billed charges,
norepinephrine 1 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00409337514,NDC,facility,both,1,ML,50.58,35.81,Aetna First Health,Commercial,,42.99,85,,,22.42,42.99,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,51407066305,NDC,facility,both,1,ML,50.96,36.08,Aetna First Health,Commercial,,43.32,85,,,22.59,43.32,percent of total billed charges,
sodium phosphate 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,00517341525,NDC,facility,both,1,ML,52.65,37.28,Aetna First Health,Commercial,,44.75,85,,,23.33,44.75,percent of total billed charges,
tetracaine 0.5 % Solution 4 mL Plas Cont,25000000,CDM,,,250,RC,00065074114,NDC,facility,both,1,ML,52.88,37.44,Aetna First Health,Commercial,,44.95,85,,,23.44,44.95,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,59762033301,NDC,facility,both,1,ML,53.53,37.9,Aetna First Health,Commercial,,45.5,85,,,23.72,45.5,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,61314054703,NDC,facility,both,1,ML,53.6,37.95,Aetna First Health,Commercial,,45.56,85,,,23.76,45.56,percent of total billed charges,
atropine 1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208075060,NDC,facility,both,1,ML,53.84,38.12,Aetna First Health,Commercial,,45.76,85,,,23.86,45.76,percent of total billed charges,
trace minerals Cu-Mn-Se-Zn 300-55-60-3000 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00517930501,NDC,facility,both,1,ML,55.6,39.36,Aetna First Health,Commercial,,47.26,85,,,24.64,47.26,percent of total billed charges,
trace minerals Cu-Mn-Se-Zn 300-55-60-3000 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00517930525,NDC,facility,both,1,ML,55.6,39.36,Aetna First Health,Commercial,,47.26,85,,,24.64,47.26,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,69784023110,NDC,facility,both,1,ML,56.03,39.67,Aetna First Health,Commercial,,47.63,85,,,24.83,47.63,percent of total billed charges,
calcium CHLORIDE 10 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,53150069701,NDC,facility,both,1,ML,56.25,39.83,Aetna First Health,Commercial,,47.81,85,,,24.93,47.81,percent of total billed charges,
timolol 0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,61314022710,NDC,facility,both,1,ML,56.52,40.02,Aetna First Health,Commercial,,48.04,85,,,25.05,48.04,percent of total billed charges,
timolol 0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,64980051401,NDC,facility,both,1,ML,56.8,40.21,Aetna First Health,Commercial,,48.28,85,,,25.17,48.28,percent of total billed charges,
brimonidine 0.2 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208041105,NDC,facility,both,1,ML,58,41.06,Aetna First Health,Commercial,,49.3,85,,,25.71,49.3,percent of total billed charges,
brimonidine 0.2 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478071510,NDC,facility,both,1,ML,58.8,41.63,Aetna First Health,Commercial,,49.98,85,,,26.06,49.98,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,70756060730,NDC,facility,both,1,ML,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,68180042201,NDC,facility,both,1,ML,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
gentamicin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478028310,NDC,facility,both,1,ML,61.4,43.47,Aetna First Health,Commercial,,52.19,85,,,27.21,52.19,percent of total billed charges,
tobramycin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,62332051805,NDC,facility,both,1,ML,61.96,43.87,Aetna First Health,Commercial,,52.67,85,,,27.46,52.67,percent of total billed charges,
tobramycin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314064305,NDC,facility,both,1,ML,62,43.9,Aetna First Health,Commercial,,52.7,85,,,27.48,52.7,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,17478062512,NDC,facility,both,1,ML,62.2,44.04,Aetna First Health,Commercial,,52.87,85,,,27.57,52.87,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 2.5 mL Bottle,25000000,CDM,,,250,RC,24208029525,NDC,facility,both,1,ML,63.21,44.75,Aetna First Health,Commercial,,53.73,85,,,28.01,53.73,percent of total billed charges,
neomycin-polymyxin-dexameth 3.5-10000-0.1 Suspension 5 mL Bottle,25000000,CDM,,,250,RC,24208083060,NDC,facility,both,1,ML,63.56,45,Aetna First Health,Commercial,,54.03,85,,,28.17,54.03,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,71288020202,NDC,facility,both,1,ML,67.5,47.79,Aetna First Health,Commercial,,57.38,85,,,29.92,57.38,percent of total billed charges,
potassium phosphates 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,63323008615,NDC,facility,both,1,ML,68.14,48.24,Aetna First Health,Commercial,,57.92,85,,,30.2,57.92,percent of total billed charges,
povidone iodine 5 % Solution 30 mL Bottle,25000000,CDM,,,250,RC,00065041130,NDC,facility,both,1,ML,68.28,48.34,Aetna First Health,Commercial,,58.04,85,,,30.26,58.04,percent of total billed charges,
levobunolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208050505,NDC,facility,both,1,ML,71.64,50.72,Aetna First Health,Commercial,,60.89,85,,,31.75,60.89,percent of total billed charges,
neomycin-polymyxin-dexameth 3.5-10000-0.1 Suspension 5 mL Bottle,25000000,CDM,,,250,RC,61314063006,NDC,facility,both,1,ML,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
latanoprost 0.005 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,24208046325,NDC,facility,both,1,ML,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
levobunolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314022905,NDC,facility,both,1,ML,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
sodium phosphate 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,63323017015,NDC,facility,both,1,ML,74.28,52.59,Aetna First Health,Commercial,,63.14,85,,,32.92,63.14,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143978510,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143963701,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143963710,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143978501,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323049405,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323049401,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323049416,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
valproate 100 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00074156410,NDC,facility,both,1,ML,78.63,55.67,Aetna First Health,Commercial,,66.84,85,,,34.85,66.84,percent of total billed charges,
ketoconazole 2 % Shampoo 120 mL Bottle,25000000,CDM,,,250,RC,63646001004,NDC,facility,both,1,ML,78.72,55.73,Aetna First Health,Commercial,,66.91,85,,,34.89,66.91,percent of total billed charges,
tropicamide 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208059064,NDC,facility,both,1,ML,79.98,56.63,Aetna First Health,Commercial,,67.98,85,,,35.45,67.98,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,61314003002,NDC,facility,both,1,ML,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,70069005101,NDC,facility,both,1,ML,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,65862094601,NDC,facility,both,1,ML,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,62332050503,NDC,facility,both,1,ML,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
dexmedeTOMIDine 200 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,17478005502,NDC,facility,both,1,ML,80.1,56.71,Aetna First Health,Commercial,,68.08,85,,,35.5,68.08,percent of total billed charges,
tropicamide 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314035401,NDC,facility,both,1,ML,85.62,60.62,Aetna First Health,Commercial,,72.78,85,,,37.95,72.78,percent of total billed charges,
ketoconazole 2 % Shampoo 120 mL Bottle,25000000,CDM,,,250,RC,45802046564,NDC,facility,both,1,ML,88.32,62.53,Aetna First Health,Commercial,,75.07,85,,,39.14,75.07,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314001205,NDC,facility,both,1,ML,89.96,63.69,Aetna First Health,Commercial,,76.47,85,,,39.87,76.47,percent of total billed charges,
sodium phosphate 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,63323088101,NDC,facility,both,1,ML,92.71,65.64,Aetna First Health,Commercial,,78.8,85,,,41.09,78.8,percent of total billed charges,
dorzolamide 2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,61314001910,NDC,facility,both,1,ML,100,70.8,Aetna First Health,Commercial,,85,85,,,44.32,85,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,70069000701,NDC,facility,both,1,ML,100,70.8,Aetna First Health,Commercial,,85,85,,,44.32,85,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 2.5 mL Bottle,25000000,CDM,,,250,RC,00065064725,NDC,facility,both,1,ML,103.93,73.58,Aetna First Health,Commercial,,88.34,85,,,46.06,88.34,percent of total billed charges,
lidocaine 4 % Solution 50 mL Bottle,25000000,CDM,,,250,RC,70954051810,NDC,facility,both,1,ML,106.4,75.33,Aetna First Health,Commercial,,90.44,85,,,47.16,90.44,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409302401,NDC,facility,both,1,ML,107.42,76.05,Aetna First Health,Commercial,,91.31,85,,,47.61,91.31,percent of total billed charges,
potassium phosphates 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,65219005409,NDC,facility,both,1,ML,107.9,76.39,Aetna First Health,Commercial,,91.72,85,,,47.82,91.72,percent of total billed charges,
potassium phosphates 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,65219005429,NDC,facility,both,1,ML,107.9,76.39,Aetna First Health,Commercial,,91.72,85,,,47.82,91.72,percent of total billed charges,
potassium phosphates 45 MMOLE/15ML Solution 15 mL Vial,25000000,CDM,,,250,RC,00517210201,NDC,facility,both,1,ML,107.9,76.39,Aetna First Health,Commercial,,91.72,85,,,47.82,91.72,percent of total billed charges,
isoproterenol 0.2 MG/ML Solution 5 mL Ampule,25000000,CDM,,,250,RC,00409141005,NDC,facility,both,1,ML,109.15,77.28,Aetna First Health,Commercial,,92.78,85,,,48.38,92.78,percent of total billed charges,
cyclopentolate 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478010012,NDC,facility,both,1,ML,111.84,79.18,Aetna First Health,Commercial,,95.06,85,,,49.57,95.06,percent of total billed charges,
ketorolac 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314012605,NDC,facility,both,1,ML,112,79.3,Aetna First Health,Commercial,,95.2,85,,,49.64,95.2,percent of total billed charges,
lidocaine 4 % Solution 50 mL Bottle,25000000,CDM,,,250,RC,00527600480,NDC,facility,both,1,ML,112,79.3,Aetna First Health,Commercial,,95.2,85,,,49.64,95.2,percent of total billed charges,
cyclopentolate 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314039603,NDC,facility,both,1,ML,112.02,79.31,Aetna First Health,Commercial,,95.22,85,,,49.65,95.22,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,25208000305,NDC,facility,both,1,ML,112.5,79.65,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
lidocaine 1 % Solution 5 mL Vial,25000000,CDM,,,250,RC,69374052005,NDC,facility,both,1,ML,112.5,79.65,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
cyclopentolate 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208073506,NDC,facility,both,1,ML,113.4,80.29,Aetna First Health,Commercial,,96.39,85,,,50.26,96.39,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 2.5 mL Bottle,25000000,CDM,,,250,RC,00078095340,NDC,facility,both,1,ML,114.21,80.86,Aetna First Health,Commercial,,97.08,85,,,50.62,97.08,percent of total billed charges,
ketorolac 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,42571013725,NDC,facility,both,1,ML,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
tropicamide 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208058564,NDC,facility,both,1,ML,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
tropicamide 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314035502,NDC,facility,both,1,ML,122.4,86.66,Aetna First Health,Commercial,,104.04,85,,,54.25,104.04,percent of total billed charges,
lidocaine 4 % Solution 50 mL Bottle,25000000,CDM,,,250,RC,60432046551,NDC,facility,both,1,ML,128,90.62,Aetna First Health,Commercial,,108.8,85,,,56.73,108.8,percent of total billed charges,
ketorolac 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478020910,NDC,facility,both,1,ML,128.08,90.68,Aetna First Health,Commercial,,108.87,85,,,56.77,108.87,percent of total billed charges,
ketorolac 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,47335022090,NDC,facility,both,1,ML,128.2,90.77,Aetna First Health,Commercial,,108.97,85,,,56.82,108.97,percent of total billed charges,
ketorolac 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505100301,NDC,facility,both,1,ML,128.24,90.79,Aetna First Health,Commercial,,109,85,,,56.84,109,percent of total billed charges,
phenylephrine 2.5 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,17478020102,NDC,facility,both,1,ML,130,92.04,Aetna First Health,Commercial,,110.5,85,,,57.62,110.5,percent of total billed charges,
phenylephrine 2.5 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,70756062925,NDC,facility,both,1,ML,130,92.04,Aetna First Health,Commercial,,110.5,85,,,57.62,110.5,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,65862084003,NDC,facility,both,1,ML,133.88,94.79,Aetna First Health,Commercial,,113.8,85,,,59.34,113.8,percent of total billed charges,
cyclopentolate 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,00065039602,NDC,facility,both,1,ML,134.96,95.55,Aetna First Health,Commercial,,114.72,85,,,59.81,114.72,percent of total billed charges,
dorzolamide 2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208048510,NDC,facility,both,1,ML,135.96,96.26,Aetna First Health,Commercial,,115.57,85,,,60.26,115.57,percent of total billed charges,
dorzolamide 2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,42571014126,NDC,facility,both,1,ML,135.96,96.26,Aetna First Health,Commercial,,115.57,85,,,60.26,115.57,percent of total billed charges,
dorzolamide 2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,69315030410,NDC,facility,both,1,ML,135.96,96.26,Aetna First Health,Commercial,,115.57,85,,,60.26,115.57,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,00378543035,NDC,facility,both,1,ML,136,96.29,Aetna First Health,Commercial,,115.6,85,,,60.28,115.6,percent of total billed charges,
dorzolamide 2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,50383023210,NDC,facility,both,1,ML,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,00781713593,NDC,facility,both,1,ML,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
proparacaine 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208073006,NDC,facility,both,1,ML,140.34,99.36,Aetna First Health,Commercial,,119.29,85,,,62.2,119.29,percent of total billed charges,
proparacaine 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478026312,NDC,facility,both,1,ML,140.4,99.4,Aetna First Health,Commercial,,119.34,85,,,62.23,119.34,percent of total billed charges,
proparacaine 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314001601,NDC,facility,both,1,ML,140.4,99.4,Aetna First Health,Commercial,,119.34,85,,,62.23,119.34,percent of total billed charges,
ora-blend SF Suspension 473 mL Bottle,25000000,CDM,,,250,RC,38779234908,NDC,facility,both,1,ML,140.72,99.63,Aetna First Health,Commercial,,119.61,85,,,62.37,119.61,percent of total billed charges,
cyclopentolate-phenylephrine 0.2-1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,00065035902,NDC,facility,both,1,ML,141.04,99.86,Aetna First Health,Commercial,,119.88,85,,,62.51,119.88,percent of total billed charges,
gentamicin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208058060,NDC,facility,both,1,ML,142.84,101.13,Aetna First Health,Commercial,,121.41,85,,,63.31,121.41,percent of total billed charges,
atropine 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,60219174802,NDC,facility,both,1,ML,143.6,101.67,Aetna First Health,Commercial,,122.06,85,,,63.64,122.06,percent of total billed charges,
atropine 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,60505622600,NDC,facility,both,1,ML,145.48,103,Aetna First Health,Commercial,,123.66,85,,,64.48,123.66,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314027105,NDC,facility,both,1,ML,146.6,103.79,Aetna First Health,Commercial,,124.61,85,,,64.97,124.61,percent of total billed charges,
atropine 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,17478021502,NDC,facility,both,1,ML,153.16,108.44,Aetna First Health,Commercial,,130.19,85,,,67.88,130.19,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,11980077905,NDC,facility,both,1,ML,155.08,109.8,Aetna First Health,Commercial,,131.82,85,,,68.73,131.82,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505057501,NDC,facility,both,1,ML,158.16,111.98,Aetna First Health,Commercial,,134.44,85,,,70.1,134.44,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478010505,NDC,facility,both,1,ML,158.16,111.98,Aetna First Health,Commercial,,134.44,85,,,70.1,134.44,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,51293083885,NDC,facility,both,1,ML,158.16,111.98,Aetna First Health,Commercial,,134.44,85,,,70.1,134.44,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,64980051705,NDC,facility,both,1,ML,158.16,111.98,Aetna First Health,Commercial,,134.44,85,,,70.1,134.44,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,69367023305,NDC,facility,both,1,ML,158.16,111.98,Aetna First Health,Commercial,,134.44,85,,,70.1,134.44,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00378802335,NDC,facility,both,1,ML,158.16,111.98,Aetna First Health,Commercial,,134.44,85,,,70.1,134.44,percent of total billed charges,
atropine 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,00065081702,NDC,facility,both,1,ML,158.8,112.43,Aetna First Health,Commercial,,134.98,85,,,70.38,134.98,percent of total billed charges,
lidocaine 4 % Solution 50 mL Bottle,25000000,CDM,,,250,RC,00054350547,NDC,facility,both,1,ML,160,113.28,Aetna First Health,Commercial,,136,85,,,70.91,136,percent of total billed charges,
olopatadine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,65862075705,NDC,facility,both,1,ML,170,120.36,Aetna First Health,Commercial,,144.5,85,,,75.34,144.5,percent of total billed charges,
zinc sulfate 5 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00517800501,NDC,facility,both,1,ML,172.69,122.26,Aetna First Health,Commercial,,146.79,85,,,76.54,146.79,percent of total billed charges,
proparacaine 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00998001615,NDC,facility,both,1,ML,173.1,122.55,Aetna First Health,Commercial,,147.14,85,,,76.72,147.14,percent of total billed charges,
atropine 1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60219174903,NDC,facility,both,1,ML,175.16,124.01,Aetna First Health,Commercial,,148.89,85,,,77.63,148.89,percent of total billed charges,
atropine 1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,76478001505,NDC,facility,both,1,ML,175.16,124.01,Aetna First Health,Commercial,,148.89,85,,,77.63,148.89,percent of total billed charges,
prednisoLONE acetate 1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,60758011905,NDC,facility,both,1,ML,176,124.61,Aetna First Health,Commercial,,149.6,85,,,78,149.6,percent of total billed charges,
prednisoLONE acetate 1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,61314063705,NDC,facility,both,1,ML,177,125.32,Aetna First Health,Commercial,,150.45,85,,,78.45,150.45,percent of total billed charges,
atropine 1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505622601,NDC,facility,both,1,ML,177.48,125.66,Aetna First Health,Commercial,,150.86,85,,,78.66,150.86,percent of total billed charges,
sulfacetamide 10 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314070101,NDC,facility,both,1,ML,178.08,126.08,Aetna First Health,Commercial,,151.37,85,,,78.93,151.37,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,14789001202,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
sulfacetamide 10 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208067004,NDC,facility,both,1,ML,195,138.06,Aetna First Health,Commercial,,165.75,85,,,86.42,165.75,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208048610,NDC,facility,both,1,ML,199.96,141.57,Aetna First Health,Commercial,,169.97,85,,,88.62,169.97,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,50383023310,NDC,facility,both,1,ML,200,141.6,Aetna First Health,Commercial,,170,85,,,88.64,170,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,42571014726,NDC,facility,both,1,ML,200,141.6,Aetna First Health,Commercial,,170,85,,,88.64,170,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,00591248279,NDC,facility,both,1,ML,200,141.6,Aetna First Health,Commercial,,170,85,,,88.64,170,percent of total billed charges,
dorzolamide 2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,66993017520,NDC,facility,both,1,ML,200.24,141.77,Aetna First Health,Commercial,,170.2,85,,,88.75,170.2,percent of total billed charges,
trypan blue 0.06 % solution prefilled syringe 0.5 mL Syringe,25000000,CDM,,,250,RC,68803061210,NDC,facility,both,1,ML,202.2,143.16,Aetna First Health,Commercial,,171.87,85,,,89.62,171.87,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,42571026575,NDC,facility,both,1,ML,202.5,143.37,Aetna First Health,Commercial,,172.12,85,,,89.75,172.12,percent of total billed charges,
atropine 1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478021505,NDC,facility,both,1,ML,205.28,145.34,Aetna First Health,Commercial,,174.49,85,,,90.98,174.49,percent of total billed charges,
lidocaine 4 % Solution 50 mL Bottle,25000000,CDM,,,250,RC,52565000950,NDC,facility,both,1,ML,215.4,152.5,Aetna First Health,Commercial,,183.09,85,,,95.47,183.09,percent of total billed charges,
ciprofloxacin-dexAMETHasone 0.3-0.1 % Suspension 7.5 mL Bottle,25000000,CDM,,,250,RC,43598032675,NDC,facility,both,1,ML,218.75,154.88,Aetna First Health,Commercial,,185.94,85,,,96.95,185.94,percent of total billed charges,
atropine 1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00065030355,NDC,facility,both,1,ML,230.28,163.04,Aetna First Health,Commercial,,195.74,85,,,102.06,195.74,percent of total billed charges,
atropine 1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00065081701,NDC,facility,both,1,ML,230.28,163.04,Aetna First Health,Commercial,,195.74,85,,,102.06,195.74,percent of total billed charges,
timolol 0.25 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,68669052205,NDC,facility,both,1,ML,244.2,172.89,Aetna First Health,Commercial,,207.57,85,,,108.23,207.57,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,60505058204,NDC,facility,both,1,ML,267.76,189.57,Aetna First Health,Commercial,,227.6,85,,,118.67,227.6,percent of total billed charges,
ciprofloxacin-dexAMETHasone 0.3-0.1 % Suspension 7.5 mL Bottle,25000000,CDM,,,250,RC,00781618667,NDC,facility,both,1,ML,280.23,198.4,Aetna First Health,Commercial,,238.2,85,,,124.2,238.2,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,25021031002,NDC,facility,both,1,ML,292.5,207.09,Aetna First Health,Commercial,,248.62,85,,,129.64,248.62,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,67457083902,NDC,facility,both,1,ML,292.5,207.09,Aetna First Health,Commercial,,248.62,85,,,129.64,248.62,percent of total billed charges,
pilocarpine 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,70069018101,NDC,facility,both,1,ML,296.76,210.11,Aetna First Health,Commercial,,252.25,85,,,131.52,252.25,percent of total billed charges,
dorzolamide 2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,00006351936,NDC,facility,both,1,ML,303.2,214.67,Aetna First Health,Commercial,,257.72,85,,,134.38,257.72,percent of total billed charges,
pilocarpine 2 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,70069019101,NDC,facility,both,1,ML,303.54,214.91,Aetna First Health,Commercial,,258.01,85,,,134.53,258.01,percent of total billed charges,
pilocarpine 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478022312,NDC,facility,both,1,ML,305.94,216.61,Aetna First Health,Commercial,,260.05,85,,,135.59,260.05,percent of total billed charges,
fluorometholone 0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,60758088005,NDC,facility,both,1,ML,309.76,219.31,Aetna First Health,Commercial,,263.3,85,,,137.29,263.3,percent of total billed charges,
ciprofloxacin-dexAMETHasone 0.3-0.1 % Suspension 7.5 mL Bottle,25000000,CDM,,,250,RC,00065853302,NDC,facility,both,1,ML,311.36,220.44,Aetna First Health,Commercial,,264.66,85,,,137.99,264.66,percent of total billed charges,
pilocarpine 2 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478022412,NDC,facility,both,1,ML,312.9,221.53,Aetna First Health,Commercial,,265.96,85,,,138.68,265.96,percent of total billed charges,
pilocarpine 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314020315,NDC,facility,both,1,ML,315.42,223.32,Aetna First Health,Commercial,,268.11,85,,,139.79,268.11,percent of total billed charges,
polymyxin b-trimethoprim 10000-0.1 UNIT/ML-% Solution 10 mL Bottle,25000000,CDM,,,250,RC,00023782410,NDC,facility,both,1,ML,319.48,226.19,Aetna First Health,Commercial,,271.56,85,,,141.59,271.56,percent of total billed charges,
pilocarpine 2 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314020415,NDC,facility,both,1,ML,322.62,228.41,Aetna First Health,Commercial,,274.23,85,,,142.99,274.23,percent of total billed charges,
prednisoLONE acetate 1 % Suspension 10 mL Bottle,25000000,CDM,,,250,RC,60758011910,NDC,facility,both,1,ML,352,249.22,Aetna First Health,Commercial,,299.2,85,,,156.01,299.2,percent of total billed charges,
prednisoLONE acetate 1 % Suspension 10 mL Bottle,25000000,CDM,,,250,RC,61314063710,NDC,facility,both,1,ML,353.72,250.43,Aetna First Health,Commercial,,300.66,85,,,156.77,300.66,percent of total billed charges,
pilocarpine 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00998020315,NDC,facility,both,1,ML,372.18,263.5,Aetna First Health,Commercial,,316.35,85,,,164.95,316.35,percent of total billed charges,
prednisoLONE acetate 1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00065063827,NDC,facility,both,1,ML,379.52,268.7,Aetna First Health,Commercial,,322.59,85,,,168.2,322.59,percent of total billed charges,
pilocarpine 2 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00998020415,NDC,facility,both,1,ML,380.7,269.54,Aetna First Health,Commercial,,323.59,85,,,168.73,323.59,percent of total billed charges,
tobramycin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00065064305,NDC,facility,both,1,ML,408.28,289.06,Aetna First Health,Commercial,,347.04,85,,,180.95,347.04,percent of total billed charges,
timolol 0.25 % GEL FORMING SOLUTION 5 mL Bottle,25000000,CDM,,,250,RC,25010081656,NDC,facility,both,1,ML,415.96,294.5,Aetna First Health,Commercial,,353.57,85,,,184.35,353.57,percent of total billed charges,
tropicamide 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00998035515,NDC,facility,both,1,ML,424.56,300.59,Aetna First Health,Commercial,,360.88,85,,,188.16,360.88,percent of total billed charges,
neomycin-polymyxin-dexameth 3.5-10000-0.1 Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00998063006,NDC,facility,both,1,ML,452.12,320.1,Aetna First Health,Commercial,,384.3,85,,,200.38,384.3,percent of total billed charges,
ciprofloxacin-dexAMETHasone 0.3-0.1 % Suspension 7.5 mL Bottle,25000000,CDM,,,250,RC,72485062513,NDC,facility,both,1,ML,461.49,326.73,Aetna First Health,Commercial,,392.27,85,,,204.53,392.27,percent of total billed charges,
brimonidine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,82182032105,NDC,facility,both,1,ML,496.52,351.54,Aetna First Health,Commercial,,422.04,85,,,220.06,422.04,percent of total billed charges,
brimonidine-timolol 0.2-0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00832142505,NDC,facility,both,1,ML,511.96,362.47,Aetna First Health,Commercial,,435.17,85,,,226.9,435.17,percent of total billed charges,
timolol 0.25 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,76478000105,NDC,facility,both,1,ML,551.92,390.76,Aetna First Health,Commercial,,469.13,85,,,244.61,469.13,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,00006362836,NDC,facility,both,1,ML,562.96,398.58,Aetna First Health,Commercial,,478.52,85,,,249.5,478.52,percent of total billed charges,
timolol 0.25 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,82584000105,NDC,facility,both,1,ML,590.6,418.14,Aetna First Health,Commercial,,502.01,85,,,261.75,502.01,percent of total billed charges,
neomycin-polymyxin-hydrocortisone 3.5-10000-1 Suspension 7.5 mL Bottle,25000000,CDM,,,250,RC,61314064175,NDC,facility,both,1,ML,598.71,423.89,Aetna First Health,Commercial,,508.9,85,,,265.35,508.9,percent of total billed charges,
isoproterenol 0.2 MG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,69097052131,NDC,facility,both,1,ML,604.8,428.2,Aetna First Health,Commercial,,514.08,85,,,268.05,514.08,percent of total billed charges,
timolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,76478000205,NDC,facility,both,1,ML,609.44,431.48,Aetna First Health,Commercial,,518.02,85,,,270.1,518.02,percent of total billed charges,
brimonidine 0.15 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505056401,NDC,facility,both,1,ML,613.36,434.26,Aetna First Health,Commercial,,521.36,85,,,271.84,521.36,percent of total billed charges,
brimonidine 0.15 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314014405,NDC,facility,both,1,ML,613.4,434.29,Aetna First Health,Commercial,,521.39,85,,,271.86,521.39,percent of total billed charges,
timolol 0.25 % GEL FORMING SOLUTION 5 mL Bottle,25000000,CDM,,,250,RC,61314022405,NDC,facility,both,1,ML,634.4,449.16,Aetna First Health,Commercial,,539.24,85,,,281.17,539.24,percent of total billed charges,
prednisoLONE acetate 1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,11980018005,NDC,facility,both,1,ML,641.6,454.25,Aetna First Health,Commercial,,545.36,85,,,284.36,545.36,percent of total billed charges,
timolol 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,82584000205,NDC,facility,both,1,ML,652.12,461.7,Aetna First Health,Commercial,,554.3,85,,,289.02,554.3,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,17478001402,NDC,facility,both,1,ML,652.5,461.97,Aetna First Health,Commercial,,554.62,85,,,289.19,554.62,percent of total billed charges,
timolol 0.25 % GEL FORMING SOLUTION 5 mL Bottle,25000000,CDM,,,250,RC,24208081825,NDC,facility,both,1,ML,660.84,467.87,Aetna First Health,Commercial,,561.71,85,,,292.88,561.71,percent of total billed charges,
fluorometholone 0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,11980021105,NDC,facility,both,1,ML,673.68,476.97,Aetna First Health,Commercial,,572.63,85,,,298.57,572.63,percent of total billed charges,
nitroPRUSSide 25 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00187430202,NDC,facility,both,1,ML,675,477.9,Aetna First Health,Commercial,,573.75,85,,,299.16,573.75,percent of total billed charges,
timolol 0.5 % GEL FORMING SOLUTION 5 mL Bottle,25000000,CDM,,,250,RC,61314022505,NDC,facility,both,1,ML,695.24,492.23,Aetna First Health,Commercial,,590.95,85,,,308.13,590.95,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,00065401303,NDC,facility,both,1,ML,696.48,493.11,Aetna First Health,Commercial,,592.01,85,,,308.68,592.01,percent of total billed charges,
brimonidine-timolol 0.2-0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505622500,NDC,facility,both,1,ML,709.2,502.11,Aetna First Health,Commercial,,602.82,85,,,314.32,602.82,percent of total billed charges,
brimonidine-timolol 0.2-0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60505058901,NDC,facility,both,1,ML,709.2,502.11,Aetna First Health,Commercial,,602.82,85,,,314.32,602.82,percent of total billed charges,
timolol 0.5 % GEL FORMING SOLUTION 5 mL Bottle,25000000,CDM,,,250,RC,24208081905,NDC,facility,both,1,ML,725.72,513.81,Aetna First Health,Commercial,,616.86,85,,,321.64,616.86,percent of total billed charges,
timolol 0.25 % GEL FORMING SOLUTION 5 mL Bottle,25000000,CDM,,,250,RC,62332054505,NDC,facility,both,1,ML,777.04,550.14,Aetna First Health,Commercial,,660.48,85,,,344.38,660.48,percent of total billed charges,
brimonidine 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00023932105,NDC,facility,both,1,ML,777.76,550.65,Aetna First Health,Commercial,,661.1,85,,,344.7,661.1,percent of total billed charges,
moxifloxacin 0.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,00078093926,NDC,facility,both,1,ML,803.72,569.03,Aetna First Health,Commercial,,683.16,85,,,356.21,683.16,percent of total billed charges,
brimonidine-timolol 0.2-0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00023921105,NDC,facility,both,1,ML,816.52,578.1,Aetna First Health,Commercial,,694.04,85,,,361.88,694.04,percent of total billed charges,
brimonidine 0.15 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00023917705,NDC,facility,both,1,ML,829.16,587.05,Aetna First Health,Commercial,,704.79,85,,,367.48,704.79,percent of total billed charges,
dorzolamide-timolol 2-0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,17478060510,NDC,facility,both,1,ML,838.44,593.62,Aetna First Health,Commercial,,712.67,85,,,371.6,712.67,percent of total billed charges,
timolol 0.5 % GEL FORMING SOLUTION 5 mL Bottle,25000000,CDM,,,250,RC,62332054605,NDC,facility,both,1,ML,851.48,602.85,Aetna First Health,Commercial,,723.76,85,,,377.38,723.76,percent of total billed charges,
ciprofloxacin-dexAMETHasone 0.3-0.1 % Suspension 7.5 mL Bottle,25000000,CDM,,,250,RC,62756042790,NDC,facility,both,1,ML,896.73,634.88,Aetna First Health,Commercial,,762.22,85,,,397.43,762.22,percent of total billed charges,
potassium phosphates 15 MMOLE/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323008605,NDC,facility,both,5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium phosphates 15 MMOLE/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,65219005209,NDC,facility,both,5,ML,53.96,38.2,Aetna First Health,Commercial,,45.87,85,,,23.92,45.87,percent of total billed charges,
potassium phosphates 15 MMOLE/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,65219005229,NDC,facility,both,5,ML,53.96,38.2,Aetna First Health,Commercial,,45.87,85,,,23.92,45.87,percent of total billed charges,
sodium chloride (hypertonic) 5 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,17478062235,NDC,facility,inpatient,1,GR,15.7,11.12,Aetna First Health,Commercial,,13.34,85,,,6.96,13.34,percent of total billed charges,
sodium chloride (hypertonic) 5 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208038556,NDC,facility,inpatient,1,GR,18.46,13.07,Aetna First Health,Commercial,,15.69,85,,,8.18,15.69,percent of total billed charges,
sodium chloride (hypertonic) 5 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208038555,NDC,facility,inpatient,1,GR,23.97,16.97,Aetna First Health,Commercial,,20.37,85,,,10.62,20.37,percent of total billed charges,
tacrolimus 0.1 % Ointment 30 g Tube,25000000,CDM,,,250,RC,45802070000,NDC,facility,inpatient,1,GR,399.96,283.17,Aetna First Health,Commercial,,339.97,85,,,177.26,339.97,percent of total billed charges,
tacrolimus 0.1 % Ointment 30 g Tube,25000000,CDM,,,250,RC,68462053435,NDC,facility,inpatient,1,GR,399.96,283.17,Aetna First Health,Commercial,,339.97,85,,,177.26,339.97,percent of total billed charges,
tacrolimus 0.1 % Ointment 30 g Tube,25000000,CDM,,,250,RC,16729042210,NDC,facility,inpatient,1,GR,399.96,283.17,Aetna First Health,Commercial,,339.97,85,,,177.26,339.97,percent of total billed charges,
tacrolimus 0.1 % Ointment 30 g Tube,25000000,CDM,,,250,RC,00469520230,NDC,facility,inpatient,1,GR,926.04,655.64,Aetna First Health,Commercial,,787.13,85,,,410.42,787.13,percent of total billed charges,
Acetaminophen-Caffeine 500-65 MG Tablet 24 Each Bottle,25000000,CDM,,,250,RC,00067813901,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfacetamide sod-pred 10-0.23 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208031710,NDC,facility,both,0.005,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
lidocaine 2 % Solution 20 mL Bottle,25000000,CDM,,,250,RC,08888800784,NDC,facility,both,0.005,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
edrophonium 10 MG/ML Solution 15 mL Vial,25000000,CDM,,,250,RC,67457019015,NDC,facility,both,0.00667,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 144 Each Box,25000000,CDM,,,250,RC,16784011612,NDC,facility,both,0.00694,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
tropicamide-cyclopentolate-phenylephrine 1-1-2.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,71449009246,NDC,facility,both,0.01,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
hydroxypropyl methylcellulose 2 % Solution 1 mL Syringe,25000000,CDM,,,250,RC,57770005501,NDC,facility,both,0.01,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroglycerin 500 MCG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,08888800018,NDC,facility,both,0.01,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
clindamycin 1 % SWAB 60 Each Box,25000000,CDM,,,250,RC,45802026337,NDC,facility,both,0.01667,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
Vancomycin 50 MG/ML Recon Soln 150 mL Bottle,25000000,CDM,,,250,RC,65628020605,NDC,facility,both,0.01667,ML,9.53,6.75,Aetna First Health,Commercial,,8.1,85,,,4.22,8.1,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 125 mL Syringe,25000000,CDM,,,250,RC,00019118881,NDC,facility,both,0.02,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
tuberculin 5 UNIT/0.1ML Solution 5 mL Vial,25000000,CDM,,,250,RC,49281075298,NDC,facility,both,0.02,ML,13.68,9.69,Aetna First Health,Commercial,,11.63,85,,,6.06,11.63,percent of total billed charges,
tuberculin 5 UNIT/0.1ML Solution 5 mL Vial,25000000,CDM,,,250,RC,42023010405,NDC,facility,both,0.02,ML,29.76,21.07,Aetna First Health,Commercial,,25.3,85,,,13.19,25.3,percent of total billed charges,
tuberculin 5 UNIT/0.1ML Solution 5 mL Vial,25000000,CDM,,,250,RC,49281075222,NDC,facility,both,0.02,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
nitroglycerin 100 MCG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,08888800098,NDC,facility,both,0.02,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
apraclonidine 1 % Solution 24 Each Plas Cont,25000000,CDM,,,250,RC,00065066010,NDC,facility,both,0.02083,EA,55.46,39.27,Aetna First Health,Commercial,,47.14,85,,,24.58,47.14,percent of total billed charges,
pediatric electrolyte Solution 237 mL Bottle,25000000,CDM,,,250,RC,24385021634,NDC,facility,both,0.0211,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lidocaine buffered 1 % Solution 0.5 mL Syringe,25000000,CDM,,,250,RC,08888800160,NDC,facility,both,0.025,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
tropicamide 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,24208058559,NDC,facility,both,0.025,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
lactulose encephalopathy 10 GM/15ML Solution 473 mL Bottle,25000000,CDM,,,250,RC,45963043864,NDC,facility,both,0.03171,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose encephalopathy 10 GM/15ML Solution 473 mL Bottle,25000000,CDM,,,250,RC,50383079516,NDC,facility,both,0.03171,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sodium polystyrene sulfonate Powder 454 g Jar,25000000,CDM,,,250,RC,46287001216,NDC,facility,both,0.03304,GR,13.2,9.35,Aetna First Health,Commercial,,11.22,85,,,5.85,11.22,percent of total billed charges,
benzocaine 20 % Solution 25 Each Box,25000000,CDM,,,250,RC,00283061026,NDC,facility,both,0.04,EA,15.2,10.76,Aetna First Health,Commercial,,12.92,85,,,6.74,12.92,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 15 mL Bottle,25000000,CDM,,,250,RC,19903001021,NDC,facility,both,0.04,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 15 mL Bottle,25000000,CDM,,,250,RC,62372063015,NDC,facility,both,0.04,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 mg/mL 5 mL vial 0.4 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,08888800057,NDC,facility,both,0.04,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
nitroglycerin 100 MCG/ML Solution 10 mL Syringe,25000000,CDM,,,250,RC,08888800411,NDC,facility,both,0.04,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
apraclonidine 1 % Solution 24 Each Plas Cont,25000000,CDM,,,250,RC,00065066010,NDC,facility,both,0.04167,EA,110.91,78.52,Aetna First Health,Commercial,,94.27,85,,,49.16,94.27,percent of total billed charges,
apraclonidine 1 % Solution 24 Each Plas Cont,25000000,CDM,,,250,RC,82667020001,NDC,facility,both,0.04167,EA,110.91,78.52,Aetna First Health,Commercial,,94.27,85,,,49.16,94.27,percent of total billed charges,
imiquimod 5 % Cream 1 Each Box,25000000,CDM,,,250,RC,45802036800,NDC,facility,both,0.04167,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
imiquimod 5 % Cream 24 Each Box,25000000,CDM,,,250,RC,00168043224,NDC,facility,both,0.04167,EA,33.33,23.6,Aetna First Health,Commercial,,28.33,85,,,14.77,28.33,percent of total billed charges,
entecavir 0.05 MG/ML Solution 210 mL Bottle,25000000,CDM,,,250,RC,00003161412,NDC,facility,both,0.04762,ML,183,129.56,Aetna First Health,Commercial,,155.55,85,,,81.11,155.55,percent of total billed charges,
endoscopic ink marker Solution 3.38 oz Vial,25000000,CDM,,,250,RC,88887800066,NDC,facility,both,0.04931,UN,1.87,1.32,Aetna First Health,Commercial,,1.59,85,,,0.83,1.59,percent of total billed charges,
penicillin G potassium for skin test 10000 Units/mL 1 mL Syringe,25000000,CDM,,,250,RC,88888800262,NDC,facility,both,0.05,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
vitamin A 15 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70199002611,NDC,facility,both,0.05,ML,80.86,57.25,Aetna First Health,Commercial,,68.73,85,,,35.84,68.73,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 255 g Bottle,25000000,CDM,,,250,RC,62175044215,NDC,facility,both,0.06667,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ammonia Inhaler 12 Each Package,25000000,CDM,,,250,RC,39822990002,NDC,facility,both,0.08333,EA,0.66,0.47,Aetna First Health,Commercial,,0.56,85,,,0.29,0.56,percent of total billed charges,
oxymetazoline 0.05% in lidocaine 4% Solution 240 mL Bottle,25000000,CDM,,,250,RC,05446125601,NDC,facility,both,0.08333,ML,31.8,22.51,Aetna First Health,Commercial,,27.03,85,,,14.09,27.03,percent of total billed charges,
nevirapine 50 MG/5ML Suspension 240 mL Bottle,25000000,CDM,,,250,RC,65862005724,NDC,facility,both,0.08333,ML,44.17,31.27,Aetna First Health,Commercial,,37.54,85,,,19.58,37.54,percent of total billed charges,
nevirapine 50 MG/5ML Suspension 240 mL Bottle,25000000,CDM,,,250,RC,00597004724,NDC,facility,both,0.08333,ML,45.36,32.11,Aetna First Health,Commercial,,38.56,85,,,20.1,38.56,percent of total billed charges,
ammonia Inhaler 10 Each Package,25000000,CDM,,,250,RC,39822990001,NDC,facility,both,0.1,EA,0.64,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,00832030389,NDC,facility,both,0.1,EA,3.91,2.77,Aetna First Health,Commercial,,3.32,85,,,1.73,3.32,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687045211,NDC,facility,both,0.1,EA,4.55,3.22,Aetna First Health,Commercial,,3.87,85,,,2.02,3.87,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00832030300,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,69238106001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,68462086401,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00781591601,NDC,facility,both,0.1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
megestrol 40 MG/ML Suspension 10 mL Cup,25000000,CDM,,,250,RC,68094006362,NDC,facility,both,0.1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 10 mL Cup,25000000,CDM,,,250,RC,17856090703,NDC,facility,both,0.1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 10 mL Cup,25000000,CDM,,,250,RC,68094025059,NDC,facility,both,0.1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 10 mL Cup,25000000,CDM,,,250,RC,00121477610,NDC,facility,both,0.1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 10 mL Cup,25000000,CDM,,,250,RC,68094006359,NDC,facility,both,0.1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUFentanil 50 MCG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,17478005001,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,42023021601,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00781326995,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 5 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,14789025007,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 5 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,14789025010,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 5 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,42023024301,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 25% Solution 10 mL Syringe,25000000,CDM,,,250,RC,08888800747,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tuberculin 5 UNIT/0.1ML Solution 1 mL Vial,25000000,CDM,,,250,RC,49281075221,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tuberculin 5 UNIT/0.1ML Solution 1 mL Vial,25000000,CDM,,,250,RC,42023010401,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tuberculin 5 UNIT/0.1ML Solution 1 mL Vial,25000000,CDM,,,250,RC,49281075278,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00781326971,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,70121163707,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,70756061182,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,14789001401,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Trace Minerals Cr-Cu-Mn-Se-Zn 10-1000-500-60 MCG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517821025,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 0.5 mL Syringe,25000000,CDM,,,250,RC,08888800032,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,42023021625,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,51754420001,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,43598072511,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,43598072525,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 200 mL Vial,25000000,CDM,,,250,RC,63323008863,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00641623825,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine-sodium bicarbonate 1-8.4 % solution prefilled syringe 10 mL Syringe,25000000,CDM,,,250,RC,05446085010,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine-sodium bicarbonate 1-8.4 % solution prefilled syringe 10 mL Syringe,25000000,CDM,,,250,RC,70092117546,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 20 MCG/5 ML Solution 5 mL Syringe,25000000,CDM,,,250,RC,08888800789,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,17478051701,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00641623801,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,70700024925,NDC,facility,both,0.1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
candida albicans extract Solution 1 mL Vial,25000000,CDM,,,250,RC,59584013801,NDC,facility,both,0.1,ML,66.6,47.15,Aetna First Health,Commercial,,56.61,85,,,29.52,56.61,percent of total billed charges,
methohexital 0.5 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,42023010501,NDC,facility,both,0.12,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ALPRAZolam 2 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,59762372201,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 2 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,67253090310,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 50 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,64679090401,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 119 g Bottle,25000000,CDM,,,250,RC,45802086801,NDC,facility,both,0.14286,GM,0.87,0.62,Aetna First Health,Commercial,,0.74,85,,,0.39,0.74,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 119 g Bottle,25000000,CDM,,,250,RC,41100082076,NDC,facility,both,0.14286,GM,1.48,1.05,Aetna First Health,Commercial,,1.26,85,,,0.66,1.26,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 119 g Bottle,25000000,CDM,,,250,RC,11523723402,NDC,facility,both,0.14286,GM,1.48,1.05,Aetna First Health,Commercial,,1.26,85,,,0.66,1.26,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 119 g Bottle,25000000,CDM,,,250,RC,87701040585,NDC,facility,both,0.14286,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 119 g Bottle,25000000,CDM,,,250,RC,46122001431,NDC,facility,both,0.14286,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
lurasidone HCl 120 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,63402031230,NDC,facility,both,0.16667,EA,41.18,29.16,Aetna First Health,Commercial,,35,85,,,18.25,35,percent of total billed charges,
timolol PF 0.25 % Solution 60 Each Plas Cont,25000000,CDM,,,250,RC,00187149825,NDC,facility,both,0.16667,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 5 mL Syringe,25000000,CDM,,,250,RC,88888800338,NDC,facility,both,0.16667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cycloSPORINE 0.05 % Emulsion 1 Each Plas Cont,25000000,CDM,,,250,RC,54569625600,NDC,facility,both,0.2,EA,7.13,5.05,Aetna First Health,Commercial,,6.06,85,,,3.16,6.06,percent of total billed charges,
cycloSPORINE 0.05 % Emulsion 30 Each Plas Cont,25000000,CDM,,,250,RC,60505620201,NDC,facility,both,0.2,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
cycloSPORINE 0.05 % Emulsion 30 Each Plas Cont,25000000,CDM,,,250,RC,10702080803,NDC,facility,both,0.2,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
leucovorin 25 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687022711,NDC,facility,both,0.2,EA,7.49,5.3,Aetna First Health,Commercial,,6.37,85,,,3.32,6.37,percent of total billed charges,
leucovorin 25 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079058201,NDC,facility,both,0.2,EA,7.7,5.45,Aetna First Health,Commercial,,6.54,85,,,3.41,6.54,percent of total billed charges,
leucovorin 25 MG Tablet 20 Each Box,25000000,CDM,,,250,RC,60687022794,NDC,facility,both,0.2,EA,7.49,5.3,Aetna First Health,Commercial,,6.37,85,,,3.32,6.37,percent of total billed charges,
leucovorin 25 MG Tablet 20 Each Box,25000000,CDM,,,250,RC,51079058205,NDC,facility,both,0.2,EA,7.7,5.45,Aetna First Health,Commercial,,6.54,85,,,3.41,6.54,percent of total billed charges,
leucovorin 25 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,00555048527,NDC,facility,both,0.2,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
leucovorin 25 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,69315018725,NDC,facility,both,0.2,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
leucovorin 25 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,00054449911,NDC,facility,both,0.2,EA,7.91,5.6,Aetna First Health,Commercial,,6.72,85,,,3.51,6.72,percent of total billed charges,
venetoclax 100 MG Tablet 1 Each Box,25000000,CDM,,,250,RC,00074057611,NDC,facility,both,0.2,EA,89.05,63.05,Aetna First Health,Commercial,,75.69,85,,,39.47,75.69,percent of total billed charges,
venetoclax 100 MG Tablet 120 Each Bottle,25000000,CDM,,,250,RC,00074057622,NDC,facility,both,0.2,EA,89.06,63.05,Aetna First Health,Commercial,,75.7,85,,,39.47,75.7,percent of total billed charges,
venetoclax 100 MG Tablet 180 Each Bottle,25000000,CDM,,,250,RC,00074057634,NDC,facility,both,0.2,EA,89.06,63.05,Aetna First Health,Commercial,,75.7,85,,,39.47,75.7,percent of total billed charges,
venetoclax 100 MG Tablet 28 Each Bottle,25000000,CDM,,,250,RC,00074057630,NDC,facility,both,0.2,EA,89.05,63.05,Aetna First Health,Commercial,,75.69,85,,,39.47,75.69,percent of total billed charges,
xylose Powder 25 g Bottle,25000000,CDM,,,250,RC,51552084304,NDC,facility,both,0.2,GR,5.7,4.04,Aetna First Health,Commercial,,4.84,85,,,2.53,4.84,percent of total billed charges,
ePHEDrine 25-0.9 MG/5ML-% solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,66647600325,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine 25-0.9 MG/5ML-% solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,71286600301,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 1 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143968301,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 1 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,63323042410,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 1 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143978310,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 1 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143978301,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine 25-0.9 MG/5ML-% solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,70092147844,NDC,facility,both,0.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine 40 MCG/10 ML Solution 10 mL Syringe,25000000,CDM,,,250,RC,08888-8004-,NDC,facility,both,0.2,ML,51.2,36.25,Aetna First Health,Commercial,,43.52,85,,,22.69,43.52,percent of total billed charges,
isoproterenol 0.2 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,69918073501,NDC,facility,both,0.2,ML,108,76.46,Aetna First Health,Commercial,,91.8,85,,,47.87,91.8,percent of total billed charges,
dantrolene 100 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,00115443301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imatinib 400 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687020395,NDC,facility,both,0.25,EA,13.08,9.26,Aetna First Health,Commercial,,11.12,85,,,5.8,11.12,percent of total billed charges,
imatinib 400 MG Tablet 15 Each Bottle,25000000,CDM,,,250,RC,54868542701,NDC,facility,both,0.25,EA,163.82,115.98,Aetna First Health,Commercial,,139.25,85,,,72.61,139.25,percent of total billed charges,
imatinib 400 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00093763056,NDC,facility,both,0.25,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
imatinib 400 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00378224693,NDC,facility,both,0.25,EA,10.24,7.25,Aetna First Health,Commercial,,8.7,85,,,4.54,8.7,percent of total billed charges,
imatinib 400 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,43598034530,NDC,facility,both,0.25,EA,11.94,8.45,Aetna First Health,Commercial,,10.15,85,,,5.29,10.15,percent of total billed charges,
imatinib 400 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,60687020325,NDC,facility,both,0.25,EA,13.08,9.26,Aetna First Health,Commercial,,11.12,85,,,5.8,11.12,percent of total billed charges,
imatinib 400 MG Tablet 30 Each Disp Pack,25000000,CDM,,,250,RC,00078064930,NDC,facility,both,0.25,EA,268.64,190.2,Aetna First Health,Commercial,,228.34,85,,,119.06,228.34,percent of total billed charges,
lurasidone 80 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687078011,NDC,facility,both,0.25,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
lurasidone 80 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,62332049730,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lurasidone 80 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,63402030830,NDC,facility,both,0.25,EA,41.38,29.3,Aetna First Health,Commercial,,35.17,85,,,18.34,35.17,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00409163401,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,41616093244,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,25021065820,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,47335093240,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,47335093244,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378827055,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204020025,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,63807010075,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,64253011130,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,63807010211,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,08881570121,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,08290306553,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,08290306547,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,63807010001,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,08290306500,NDC,facility,both,0.25,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204020030,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204020001,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378827031,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,60687039583,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,60687039579,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204020060,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487950100,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378827093,NDC,facility,both,0.25,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00409114402,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,70069027201,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,72485010901,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,70710164401,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
labetalol 20 MG/4ML solution prefilled syringe 4 mL Syringe,25000000,CDM,,,250,RC,08888800419,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Ampule,25000000,CDM,,,250,RC,00409228505,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143966001,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143987325,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70860030005,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,47781058717,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,72611074001,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409201605,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409201610,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Syringe,25000000,CDM,,,250,RC,00409963305,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,00409114462,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,43066003501,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 4 mL Vial,25000000,CDM,,,250,RC,43066003505,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
labetalol 20 MG/4ML solution prefilled syringe 4 mL Syringe,25000000,CDM,,,250,RC,65302050304,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143987301,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 0.9% flush 0.9% Solution 10 mL Syringe,25000000,CDM,,,250,RC,63807010075,NDC,facility,both,0.3,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% flush 0.9% Solution 10 mL Syringe,25000000,CDM,,,250,RC,08290306553,NDC,facility,both,0.3,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% flush 0.9% Solution 10 mL Syringe,25000000,CDM,,,250,RC,08290306547,NDC,facility,both,0.3,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% flush 0.9% Solution 10 mL Syringe,25000000,CDM,,,250,RC,08881570121,NDC,facility,both,0.3,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
iodine 2.5 % Solution 30 mL Bottle,25000000,CDM,,,250,RC,08888800456,NDC,facility,both,0.3,ML,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
cloNIDine 0.3 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00228212910,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
eltrombopag 75 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00007464213,NDC,facility,both,0.33333,EA,330.72,234.15,Aetna First Health,Commercial,,281.11,85,,,146.58,281.11,percent of total billed charges,
lurasidone 60 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687076911,NDC,facility,both,0.33333,EA,4.97,3.52,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
lurasidone 60 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,63402030630,NDC,facility,both,0.33333,EA,55.17,39.06,Aetna First Health,Commercial,,46.89,85,,,24.45,46.89,percent of total billed charges,
QUEtiapine XR 150 MG Tablet Extended Release 24 Hour 100 Each Box,25000000,CDM,,,250,RC,00904680261,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 150 MG Tablet Extended Release 24 Hour 60 Each Bottle,25000000,CDM,,,250,RC,16729010912,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 150 MG Tablet Extended Release 24 Hour 60 Each Bottle,25000000,CDM,,,250,RC,68001051206,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 150 MG Tablet Extended Release 24 Hour 60 Each Bottle,25000000,CDM,,,250,RC,00310828160,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 150 MG Tablet Extended Release 24 Hour 60 Each Bottle,25000000,CDM,,,250,RC,49884080602,NDC,facility,both,0.33333,EA,13.76,9.74,Aetna First Health,Commercial,,11.7,85,,,6.1,11.7,percent of total billed charges,
QUEtiapine XR 150 MG Tablet Extended Release 24 Hour 60 Each Bottle,25000000,CDM,,,250,RC,00310028160,NDC,facility,both,0.33333,EA,15.93,11.28,Aetna First Health,Commercial,,13.54,85,,,7.06,13.54,percent of total billed charges,
rivastigmine 4.5 MG capsule 60 Each Bottle,25000000,CDM,,,250,RC,55111035460,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
theophylline SR (12 hour) 300 MG Tablet Extended Release 12 Hour 100 Each Bottle,25000000,CDM,,,250,RC,68462072101,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
theophylline SR (12 hour) 300 MG Tablet Extended Release 12 Hour 100 Each Bottle,25000000,CDM,,,250,RC,50111045901,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
theophylline SR (12 hour) 300 MG Tablet Extended Release 12 Hour 100 Each Bottle,25000000,CDM,,,250,RC,62332002531,NDC,facility,both,0.33333,EA,4.01,2.84,Aetna First Health,Commercial,,3.41,85,,,1.78,3.41,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,50268016311,NDC,facility,both,0.4,EA,3.14,2.22,Aetna First Health,Commercial,,2.67,85,,,1.39,2.67,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,00832030189,NDC,facility,both,0.4,EA,7.67,5.43,Aetna First Health,Commercial,,6.52,85,,,3.4,6.52,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687043011,NDC,facility,both,0.4,EA,8.3,5.88,Aetna First Health,Commercial,,7.06,85,,,3.68,7.06,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079051901,NDC,facility,both,0.4,EA,8.92,6.32,Aetna First Health,Commercial,,7.58,85,,,3.95,7.58,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,69238105601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00832601800,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00781171601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00781591401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,68462086201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00832030100,NDC,facility,both,0.4,EA,5.29,3.75,Aetna First Health,Commercial,,4.5,85,,,2.34,4.5,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,16714004801,NDC,facility,both,0.4,EA,5.46,3.87,Aetna First Health,Commercial,,4.64,85,,,2.42,4.64,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,60687043001,NDC,facility,both,0.4,EA,8.3,5.88,Aetna First Health,Commercial,,7.06,85,,,3.68,7.06,percent of total billed charges,
fluPHENAZine 2.5 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079048601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 2.5 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00378600901,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 2.5 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,69238167901,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 2.5 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00527178901,NDC,facility,both,0.4,EA,3.25,2.3,Aetna First Health,Commercial,,2.76,85,,,1.44,2.76,percent of total billed charges,
fluPHENAZine 2.5 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,51079048620,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 2.5 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,00904715861,NDC,facility,both,0.4,EA,10.37,7.34,Aetna First Health,Commercial,,8.81,85,,,4.6,8.81,percent of total billed charges,
venetoclax 50 MG Tablet 7 Each Box,25000000,CDM,,,250,RC,00074056607,NDC,facility,both,0.4,EA,89.06,63.05,Aetna First Health,Commercial,,75.7,85,,,39.47,75.7,percent of total billed charges,
fat emulsion 20 % Emulsion 500 mL Flex Cont,25000000,CDM,,,250,RC,00264446010,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143978410,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143968410,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143978401,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,67457044700,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,36000014801,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,36000014810,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,67457044753,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781300392,NDC,facility,both,0.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
arginine 500 MG Tablet 50 Each Bottle,25000000,CDM,,,250,RC,00904421551,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
belladonna alkaloids-opium 16.2-30 MG Suppository 1 Each Packet,25000000,CDM,,,250,RC,00574704501,NDC,facility,both,0.5,EA,38.52,27.27,Aetna First Health,Commercial,,32.74,85,,,17.07,32.74,percent of total billed charges,
benzocaine 20 % Solution 2 Each Box,25000000,CDM,,,250,RC,00283061011,NDC,facility,both,0.5,EA,16.21,11.48,Aetna First Health,Commercial,,13.78,85,,,7.18,13.78,percent of total billed charges,
eltrombopag 50 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00007464113,NDC,facility,both,0.5,EA,330.72,234.15,Aetna First Health,Commercial,,281.11,85,,,146.58,281.11,percent of total billed charges,
eltrombopag 50 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00078068615,NDC,facility,both,0.5,EA,764.99,541.61,Aetna First Health,Commercial,,650.24,85,,,339.04,650.24,percent of total billed charges,
megestrol 40 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00555060702,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,49884029001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,64380015901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,63739016510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mercaptopurine 50 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,69076091302,NDC,facility,both,0.5,EA,3.48,2.46,Aetna First Health,Commercial,,2.96,85,,,1.54,2.96,percent of total billed charges,
mercaptopurine 50 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,00054458111,NDC,facility,both,0.5,EA,5.55,3.93,Aetna First Health,Commercial,,4.72,85,,,2.46,4.72,percent of total billed charges,
mercaptopurine 50 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,00378354752,NDC,facility,both,0.5,EA,5.55,3.93,Aetna First Health,Commercial,,4.72,85,,,2.46,4.72,percent of total billed charges,
mercaptopurine 50 MG Tablet 250 Each Bottle,25000000,CDM,,,250,RC,00054458127,NDC,facility,both,0.5,EA,4.99,3.53,Aetna First Health,Commercial,,4.24,85,,,2.21,4.24,percent of total billed charges,
neomycin 500 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,39822031007,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
neomycin 500 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079001501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
neomycin 500 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,50383056510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
neomycin 500 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00093117701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
neomycin 500 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,39822031005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
neomycin 500 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,51079001520,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 10 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,50268068511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,59746011506,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00378511001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00093965201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00781502101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 10 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,51079054220,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
racEPINEPHrine 2.25 % Nebulization Solution 1 Each Plas Cont,25000000,CDM,,,250,RC,00487590102,NDC,facility,both,0.5,EA,0.98,0.69,Aetna First Health,Commercial,,0.83,85,,,0.43,0.83,percent of total billed charges,
racEPINEPHrine 2.25 % Nebulization Solution 1 Each Plas Cont,25000000,CDM,,,250,RC,00487590110,NDC,facility,both,0.5,EA,1.46,1.03,Aetna First Health,Commercial,,1.24,85,,,0.65,1.24,percent of total billed charges,
tamoxifen 10 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,63739026910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,63739014310,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 180 Each Bottle,25000000,CDM,,,250,RC,00093078486,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,00093078406,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,00378014491,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,00591247260,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,51862064260,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,59651029960,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,51862044760,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,68382082614,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 10 MG Tablet 60 Each Bottle,25000000,CDM,,,250,RC,63739026942,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
theophylline SR (12 hour) 200 MG Tablet Extended Release 12 Hour 100 Each Bottle,25000000,CDM,,,250,RC,50111048201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00703291403,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00409163201,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00703291401,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457043800,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457043810,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,47335093140,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,47335093144,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323078110,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150023501,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323078121,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00143923401,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00409163221,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150023502,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 5 mL Syringe,25000000,CDM,,,250,RC,64253011135,NDC,facility,both,0.5,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
charcoal activated-sorbitol 50 GM/240ML Suspension 240 mL Bottle,25000000,CDM,90675,CPT,250,RC,66689020308,NDC,facility,both,0.5,ML,22.5,15.93,Aetna First Health,Commercial,,19.12,85,,,9.97,19.12,percent of total billed charges,
charcoal activated-sorbitol 50 GM/240ML Suspension 240 mL Bottle,25000000,CDM,90675,CPT,250,RC,00574052008,NDC,facility,both,0.5,ML,33.18,23.49,Aetna First Health,Commercial,,28.2,85,,,14.71,28.2,percent of total billed charges,
budesonide 1 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00186199004,NDC,facility,both,0.5,ML,41.03,29.05,Aetna First Health,Commercial,,34.88,85,,,18.18,34.88,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70069027105,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409114465,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,72485010805,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70710164305,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70710164301,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 1 mL Vial,25000000,CDM,,,250,RC,43598007811,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 1 mL Vial,25000000,CDM,,,250,RC,43598007858,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409669502,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,42023017010,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00143950701,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00143950710,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,55150022220,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00143931101,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00143931110,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,65219044702,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,00409490264,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,76329330201,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70069027125,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70069027101,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,67850007100,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,08888800643,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fentaNYL 1.25-0.9 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,08888800027,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,25021067420,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,23155016032,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,23155016042,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409669512,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409114410,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409114411,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,43066003101,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,70710164307,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Syringe,25000000,CDM,,,250,RC,00409806029,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,67457090300,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 5 MG/5 ML Solution 5 mL Syringe,25000000,CDM,,,250,RC,08888800031,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 1 mL Vial,25000000,CDM,,,250,RC,00703840101,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tetracaine 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,54288012701,NDC,facility,both,0.5,ML,95.63,67.71,Aetna First Health,Commercial,,81.29,85,,,42.38,81.29,percent of total billed charges,
tetracaine 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,54288012710,NDC,facility,both,0.5,ML,95.63,67.71,Aetna First Health,Commercial,,81.29,85,,,42.38,81.29,percent of total billed charges,
fibrinogen human and thrombin human Solution 2 mL Syringe,25000000,CDM,,,250,RC,00338956001,NDC,facility,both,0.5,ML,185.32,131.21,Aetna First Health,Commercial,,157.52,85,,,82.13,157.52,percent of total billed charges,
fibrinogen human and thrombin human Solution 2 mL Syringe,25000000,CDM,,,250,RC,00338840202,NDC,facility,both,0.5,ML,316.88,224.35,Aetna First Health,Commercial,,269.35,85,,,140.44,269.35,percent of total billed charges,
erlotinib 150 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,50242006401,NDC,facility,both,0.66667,EA,521.81,369.44,Aetna First Health,Commercial,,443.54,85,,,231.27,443.54,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 1 Each Blister,25000000,CDM,,,250,RC,60687050411,NDC,facility,both,0.66667,EA,3.52,2.49,Aetna First Health,Commercial,,2.99,85,,,1.56,2.99,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 100 Each Bottle,25000000,CDM,,,250,RC,68462029301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 100 Each Bottle,25000000,CDM,,,250,RC,00093304401,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 100 Each Bottle,25000000,CDM,,,250,RC,75834015801,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 100 Each Bottle,25000000,CDM,,,250,RC,00172428660,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 100 Each Box,25000000,CDM,,,250,RC,60687050401,NDC,facility,both,0.66667,EA,3.52,2.49,Aetna First Health,Commercial,,2.99,85,,,1.56,2.99,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 100 Each Box,25000000,CDM,,,250,RC,51079089920,NDC,facility,both,0.66667,EA,4.85,3.43,Aetna First Health,Commercial,,4.12,85,,,2.15,4.12,percent of total billed charges,
DASAtinib 140 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00003085722,NDC,facility,both,0.71429,EA,863.08,611.06,Aetna First Health,Commercial,,733.62,85,,,382.52,733.62,percent of total billed charges,
CRIZotinib 250 MG capsule 60 Each Bottle,25000000,CDM,,,250,RC,00069814020,NDC,facility,both,0.8,EA,598.47,423.72,Aetna First Health,Commercial,,508.7,85,,,265.24,508.7,percent of total billed charges,
lidocaine-phenylephrine 1-1.5 % Solution 1 mL Vial,25000000,CDM,,,250,RC,71449009042,NDC,facility,both,0.8,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fat emulsion 20 % Emulsion 250 mL Flex Cont,25000000,CDM,,,250,RC,00264446030,NDC,facility,both,0.8,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fat emulsion 20 % Emulsion 250 mL Flex Cont,25000000,CDM,,,250,RC,65219053301,NDC,facility,both,0.8,ML,79.2,56.07,Aetna First Health,Commercial,,67.32,85,,,35.1,67.32,percent of total billed charges,
fat emuls plant base(soy/oliv) 20 % Emulsion 250 mL Flex Cont,25000000,CDM,,,250,RC,00338954002,NDC,facility,both,0.8,ML,84.6,59.9,Aetna First Health,Commercial,,71.91,85,,,37.49,71.91,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 3 mL Syringe,25000000,CDM,,,250,RC,63807016031,NDC,facility,both,0.83333,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 3 mL Syringe,25000000,CDM,,,250,RC,08881570123,NDC,facility,both,0.83333,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 3 mL Syringe,25000000,CDM,,,250,RC,08290306544,NDC,facility,both,0.83333,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
ethyl chloride Aerosol 116 mL Glass Cont,25000000,CDM,,,250,RC,00386000103,NDC,facility,both,0.89224,ML,130,92.04,Aetna First Health,Commercial,,110.5,85,,,57.62,110.5,percent of total billed charges,
Abacavir-Dolutegravir-Lamivud 600-50-300 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,49702023113,NDC,facility,both,1,EA,437.21,309.54,Aetna First Health,Commercial,,371.63,85,,,193.77,371.63,percent of total billed charges,
abiraterone 250 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687045511,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
abiraterone 250 MG Tablet 120 Each Bottle,25000000,CDM,,,250,RC,72205003092,NDC,facility,both,1,EA,6.56,4.64,Aetna First Health,Commercial,,5.58,85,,,2.91,5.58,percent of total billed charges,
abiraterone 250 MG Tablet 120 Each Bottle,25000000,CDM,,,250,RC,72606056601,NDC,facility,both,1,EA,12.4,8.78,Aetna First Health,Commercial,,10.54,85,,,5.5,10.54,percent of total billed charges,
abiraterone 250 MG Tablet 120 Each Bottle,25000000,CDM,,,250,RC,57894015012,NDC,facility,both,1,EA,317.54,224.82,Aetna First Health,Commercial,,269.91,85,,,140.73,269.91,percent of total billed charges,
abiraterone 250 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,00904694804,NDC,facility,both,1,EA,15.65,11.08,Aetna First Health,Commercial,,13.3,85,,,6.94,13.3,percent of total billed charges,
abiraterone 250 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,60687045521,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
acetylcholine chloride 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00078047461,NDC,facility,both,1,EA,155.75,110.27,Aetna First Health,Commercial,,132.39,85,,,69.03,132.39,percent of total billed charges,
acetylcholine chloride 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,24208053920,NDC,facility,both,1,EA,289.44,204.92,Aetna First Health,Commercial,,246.02,85,,,128.28,246.02,percent of total billed charges,
acetylcysteine 600 MG capsule 60 Each Bottle,25000000,CDM,,,250,RC,40093010084,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
amiodarone 100 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,00245014489,NDC,facility,both,1,EA,9.77,6.92,Aetna First Health,Commercial,,8.3,85,,,4.33,8.3,percent of total billed charges,
amiodarone 100 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,50268009711,NDC,facility,both,1,EA,12.32,8.72,Aetna First Health,Commercial,,10.47,85,,,5.46,10.47,percent of total billed charges,
amiodarone 100 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,51862024030,NDC,facility,both,1,EA,9.75,6.9,Aetna First Health,Commercial,,8.29,85,,,4.32,8.29,percent of total billed charges,
ammonia for inhalation Misc 1 Each Packet,25000000,CDM,,,250,RC,08888800781,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amOXApine 25 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00591571301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amyl nitrite .3 ML Solution 1 Each Ampule,25000000,CDM,,,250,RC,46414222201,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
amyl nitrite .3 ML Solution 1 Each Ampule,25000000,CDM,,,250,RC,46414222208,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
amyl nitrite .3 ML Solution 1 Each Box,25000000,CDM,,,250,RC,00741507698,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
anastrozole 1 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,68084044811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687011211,NDC,facility,both,1,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,16729003510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00904619546,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,68001015504,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,51991062033,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00093753656,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,68382020906,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00310020130,NDC,facility,both,1,EA,55.69,39.43,Aetna First Health,Commercial,,47.34,85,,,24.68,47.34,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,68084044821,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
anastrozole 1 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,60687011221,NDC,facility,both,1,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
anastrozole 1 MG Tablet 90 Each Bottle,25000000,CDM,,,250,RC,16729003515,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ascorbic acid 500 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00904052360,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ascorbic acid 500 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,10135014201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ascorbic acid 500 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00536329201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ascorbic acid 500 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,00904052361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ascorbic acid 500 MG Tablet 300 Each Bottle,25000000,CDM,,,250,RC,00904052372,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Avacopan 10 MG capsule 30 Each Bottle,25000000,CDM,,,250,RC,73556016802,NDC,facility,both,1,EA,312.38,221.17,Aetna First Health,Commercial,,265.52,85,,,138.45,265.52,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 1 Each Packet,25000000,CDM,,,250,RC,00168002109,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
belladonna alkaloids-opium 16.2-60 MG Suppository 1 Each Packet,25000000,CDM,,,250,RC,00574704001,NDC,facility,both,1,EA,93.67,66.32,Aetna First Health,Commercial,,79.62,85,,,41.51,79.62,percent of total billed charges,
belladonna alkaloids-opium 16.2-60 MG Suppository 12 Each Box,25000000,CDM,,,250,RC,00574704012,NDC,facility,both,1,EA,93.67,66.32,Aetna First Health,Commercial,,79.62,85,,,41.51,79.62,percent of total billed charges,
belladonna alkaloids-opium 16.2-60 MG Suppository 4 Each Box,25000000,CDM,,,250,RC,00574704004,NDC,facility,both,1,EA,146.35,103.62,Aetna First Health,Commercial,,124.4,85,,,64.86,124.4,percent of total billed charges,
benzocaine 20 % SWAB 72 Each Box,25000000,CDM,,,250,RC,00283056972,NDC,facility,both,1,EA,0.55,0.39,Aetna First Health,Commercial,,0.47,85,,,0.24,0.47,percent of total billed charges,
bicalutamide 50 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,68084061211,NDC,facility,both,1,EA,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
bicalutamide 50 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,16729002301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bicalutamide 50 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00093022001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bicalutamide 50 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00093022056,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bicalutamide 50 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00904601946,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bicalutamide 50 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,16729002310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bicalutamide 50 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,16714081601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bicalutamide 50 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,16714057101,NDC,facility,both,1,EA,13.41,9.49,Aetna First Health,Commercial,,11.4,85,,,5.94,11.4,percent of total billed charges,
bicalutamide 50 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,68084061221,NDC,facility,both,1,EA,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
capreomycin 1 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,17478008050,NDC,facility,both,1,EA,384.95,272.54,Aetna First Health,Commercial,,327.21,85,,,170.61,327.21,percent of total billed charges,
cardioplegic high K+/low K+ Solution 1 Each Flex Cont,25000000,CDM,,,250,RC,88888800055,NDC,facility,both,1,EA,305.5,216.29,Aetna First Health,Commercial,,259.68,85,,,135.4,259.68,percent of total billed charges,
chloroquine 500 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,64980017802,NDC,facility,both,1,EA,11.76,8.33,Aetna First Health,Commercial,,10,85,,,5.21,10,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687041911,NDC,facility,both,1,EA,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079051801,NDC,facility,both,1,EA,15.47,10.95,Aetna First Health,Commercial,,13.15,85,,,6.86,13.15,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,68462086101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,62332073531,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,69238105401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00832030000,NDC,facility,both,1,EA,9.26,6.56,Aetna First Health,Commercial,,7.87,85,,,4.1,7.87,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00781591301,NDC,facility,both,1,EA,12.04,8.52,Aetna First Health,Commercial,,10.23,85,,,5.34,10.23,percent of total billed charges,
chlorproMAZINE 10 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,51079051820,NDC,facility,both,1,EA,15.47,10.95,Aetna First Health,Commercial,,13.15,85,,,6.86,13.15,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079051601,NDC,facility,both,1,EA,51.87,36.72,Aetna First Health,Commercial,,44.09,85,,,22.99,44.09,percent of total billed charges,
chlorproMAZINE 100 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,51079051620,NDC,facility,both,1,EA,51.88,36.73,Aetna First Health,Commercial,,44.1,85,,,22.99,44.1,percent of total billed charges,
chlorproMAZINE 25 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,51079051920,NDC,facility,both,1,EA,22.31,15.8,Aetna First Health,Commercial,,18.96,85,,,9.89,18.96,percent of total billed charges,
clog-zapper 1 Each Package,25000000,CDM,,,250,RC,08922000020,NDC,facility,both,1,EA,25,17.7,Aetna First Health,Commercial,,21.25,85,,,11.08,21.25,percent of total billed charges,
CRIZotinib 200 MG capsule 60 Each Bottle,25000000,CDM,,,250,RC,00069814120,NDC,facility,both,1,EA,748.09,529.65,Aetna First Health,Commercial,,635.88,85,,,331.55,635.88,percent of total billed charges,
cycloSPORINE 0.05 % Emulsion 30 Each Plas Cont,25000000,CDM,,,250,RC,00023916330,NDC,facility,both,1,EA,43.04,30.47,Aetna First Health,Commercial,,36.58,85,,,19.08,36.58,percent of total billed charges,
cycloSPORINE 0.05 % Emulsion 60 Each Plas Cont,25000000,CDM,,,250,RC,60505620202,NDC,facility,both,1,EA,16.8,11.89,Aetna First Health,Commercial,,14.28,85,,,7.45,14.28,percent of total billed charges,
dantrolene 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,27505000367,NDC,facility,both,1,EA,157.5,111.51,Aetna First Health,Commercial,,133.88,85,,,69.8,133.88,percent of total billed charges,
dantrolene 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,27505000166,NDC,facility,both,1,EA,182.25,129.03,Aetna First Health,Commercial,,154.91,85,,,80.77,154.91,percent of total billed charges,
dantrolene 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,27505000368,NDC,facility,both,1,EA,182.25,129.03,Aetna First Health,Commercial,,154.91,85,,,80.77,154.91,percent of total billed charges,
dantrolene 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,42023012306,NDC,facility,both,1,EA,199.44,141.2,Aetna First Health,Commercial,,169.52,85,,,88.39,169.52,percent of total billed charges,
dilTIAZem 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00409435003,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dilTIAZem 100 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00409435013,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
eltrombopag 25 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00007464013,NDC,facility,both,1,EA,338.59,239.72,Aetna First Health,Commercial,,287.8,85,,,150.06,287.8,percent of total billed charges,
Emtricitabine-Tenofovir AF 200-25 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,61958200201,NDC,facility,both,1,EA,256.94,181.91,Aetna First Health,Commercial,,218.4,85,,,113.88,218.4,percent of total billed charges,
Emtricitabine-Tenofovir AF 200-25 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,61958200202,NDC,facility,both,1,EA,256.94,181.91,Aetna First Health,Commercial,,218.4,85,,,113.88,218.4,percent of total billed charges,
erlotinib 100 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,50242006301,NDC,facility,both,1,EA,871.73,617.18,Aetna First Health,Commercial,,740.97,85,,,386.35,740.97,percent of total billed charges,
esomeprazole 40 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00186604001,NDC,facility,both,1,EA,100.46,71.13,Aetna First Health,Commercial,,85.39,85,,,44.52,85.39,percent of total billed charges,
ethosuximide 250 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,59762225002,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
ethosuximide 250 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,23155053201,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
ethosuximide 250 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,50111090101,NDC,facility,both,1,EA,6.25,4.42,Aetna First Health,Commercial,,5.31,85,,,2.77,5.31,percent of total billed charges,
etodolac XL 400 MG Tablet Extended Release 24 Hour 100 Each Bottle,25000000,CDM,,,250,RC,00093112201,NDC,facility,both,1,EA,8.12,5.75,Aetna First Health,Commercial,,6.9,85,,,3.6,6.9,percent of total billed charges,
exemestane 25 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00832059530,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
exemestane 25 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00054008013,NDC,facility,both,1,EA,38.01,26.91,Aetna First Health,Commercial,,32.31,85,,,16.85,32.31,percent of total billed charges,
exemestane 25 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,59762285801,NDC,facility,both,1,EA,47.25,33.45,Aetna First Health,Commercial,,40.16,85,,,20.94,40.16,percent of total billed charges,
exemestane 25 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00009766304,NDC,facility,both,1,EA,134.31,95.09,Aetna First Health,Commercial,,114.16,85,,,59.53,114.16,percent of total billed charges,
Eye Tray (for charging only) 1 Each Box,25000000,CDM,,,250,RC,88886800283,NDC,facility,both,1,EA,38.3,27.12,Aetna First Health,Commercial,,32.56,85,,,16.97,32.56,percent of total billed charges,
fidaxomicin 200 MG Tablet 20 Each Bottle,25000000,CDM,,,250,RC,52015008001,NDC,facility,both,1,EA,871.64,617.12,Aetna First Health,Commercial,,740.89,85,,,386.31,740.89,percent of total billed charges,
fluorescein sodium 1 MG Strip 1 Each Packet,25000000,CDM,,,250,RC,17238090099,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluorescein sodium 1 MG Strip 100 Each Box,25000000,CDM,,,250,RC,17238090011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluorescein sodium 1 MG Strip 100 Each Box,25000000,CDM,,,250,RC,17478040401,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
fluorescein sodium 1 MG Strip 300 Each Box,25000000,CDM,,,250,RC,17238090030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flutamide 125 MG capsule 180 Each Bottle,25000000,CDM,,,250,RC,49884075313,NDC,facility,both,1,EA,5.49,3.89,Aetna First Health,Commercial,,4.67,85,,,2.43,4.67,percent of total billed charges,
fosfomycin 3 g Packet 1 Each Box,25000000,CDM,,,250,RC,69097057967,NDC,facility,both,1,EA,210,148.68,Aetna First Health,Commercial,,178.5,85,,,93.07,178.5,percent of total billed charges,
fosfomycin 3 g Packet 1 Each Box,25000000,CDM,,,250,RC,67877074957,NDC,facility,both,1,EA,244.3,172.96,Aetna First Health,Commercial,,207.66,85,,,108.27,207.66,percent of total billed charges,
fosfomycin 3 g Packet 1 Each Box,25000000,CDM,,,250,RC,70700026894,NDC,facility,both,1,EA,281.12,199.03,Aetna First Health,Commercial,,238.95,85,,,124.59,238.95,percent of total billed charges,
fosfomycin 3 g Packet 1 Each Sachet,25000000,CDM,,,250,RC,00456430008,NDC,facility,both,1,EA,211.77,149.93,Aetna First Health,Commercial,,180,85,,,93.86,180,percent of total billed charges,
fosfomycin 3 g Packet 1 Each Sachet,25000000,CDM,,,250,RC,70700026899,NDC,facility,both,1,EA,281.12,199.03,Aetna First Health,Commercial,,238.95,85,,,124.59,238.95,percent of total billed charges,
fosfomycin 3 g Packet 1 Each Sachet,25000000,CDM,,,250,RC,00456430001,NDC,facility,both,1,EA,319.45,226.17,Aetna First Health,Commercial,,271.53,85,,,141.58,271.53,percent of total billed charges,
gelatin absorbable 50 Misc 4 Each Box,25000000,CDM,,,250,RC,00009032301,NDC,facility,both,1,EA,102.93,72.87,Aetna First Health,Commercial,,87.49,85,,,45.62,87.49,percent of total billed charges,
gelatin absorbable FILM 1 Each Package,25000000,CDM,,,250,RC,30009029701,NDC,facility,both,1,EA,681.59,482.57,Aetna First Health,Commercial,,579.35,85,,,302.08,579.35,percent of total billed charges,
gelatin absorbable FILM 6 Each Box,25000000,CDM,,,250,RC,00009029703,NDC,facility,both,1,EA,944.57,668.76,Aetna First Health,Commercial,,802.88,85,,,418.63,802.88,percent of total billed charges,
gelatin adsorbable 100 Misc 6 Each Box,25000000,CDM,,,250,RC,63713001974,NDC,facility,both,1,EA,95.96,67.94,Aetna First Health,Commercial,,81.57,85,,,42.53,81.57,percent of total billed charges,
gelatin adsorbable 100 Misc 6 Each Box,25000000,CDM,,,250,RC,00009034201,NDC,facility,both,1,EA,175.83,124.49,Aetna First Health,Commercial,,149.46,85,,,77.93,149.46,percent of total billed charges,
gelatin adsorbable 4 Misc 2 Each Box,25000000,CDM,,,250,RC,00009039605,NDC,facility,both,1,EA,31.56,22.34,Aetna First Health,Commercial,,26.83,85,,,13.99,26.83,percent of total billed charges,
glyBURIDE-metformin 5-500 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,57237002501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hot shot Solution 1 Each Flex Cont,25000000,CDM,,,250,RC,88888800056,NDC,facility,both,1,EA,99.5,70.45,Aetna First Health,Commercial,,84.58,85,,,44.1,84.58,percent of total billed charges,
hydroxyurea 500 MG capsule 1 Each Blister,25000000,CDM,,,250,RC,68084028411,NDC,facility,both,1,EA,3.22,2.28,Aetna First Health,Commercial,,2.74,85,,,1.43,2.74,percent of total billed charges,
hydroxyurea 500 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,49884072401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxyurea 500 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,00555088202,NDC,facility,both,1,EA,4.13,2.92,Aetna First Health,Commercial,,3.51,85,,,1.83,3.51,percent of total billed charges,
hydroxyurea 500 MG capsule 100 Each Box,25000000,CDM,,,250,RC,68084028401,NDC,facility,both,1,EA,3.22,2.28,Aetna First Health,Commercial,,2.74,85,,,1.43,2.74,percent of total billed charges,
hydroxyurea 500 MG capsule 100 Each Box,25000000,CDM,,,250,RC,00904693961,NDC,facility,both,1,EA,3.38,2.39,Aetna First Health,Commercial,,2.87,85,,,1.5,2.87,percent of total billed charges,
imatinib 100 MG Tablet 10 Each Bottle,25000000,CDM,,,250,RC,54868528901,NDC,facility,both,1,EA,182.6,129.28,Aetna First Health,Commercial,,155.21,85,,,80.93,155.21,percent of total billed charges,
imatinib 100 MG Tablet 90 Each Bottle,25000000,CDM,,,250,RC,00093762998,NDC,facility,both,1,EA,4.25,3.01,Aetna First Health,Commercial,,3.61,85,,,1.88,3.61,percent of total billed charges,
imatinib 100 MG Tablet 90 Each Bottle,25000000,CDM,,,250,RC,00378224577,NDC,facility,both,1,EA,10.38,7.35,Aetna First Health,Commercial,,8.82,85,,,4.6,8.82,percent of total billed charges,
imatinib 100 MG Tablet 90 Each Bottle,25000000,CDM,,,250,RC,43598034490,NDC,facility,both,1,EA,13.26,9.39,Aetna First Health,Commercial,,11.27,85,,,5.88,11.27,percent of total billed charges,
imatinib 100 MG Tablet 90 Each Bottle,25000000,CDM,,,250,RC,00078040134,NDC,facility,both,1,EA,298.21,211.13,Aetna First Health,Commercial,,253.48,85,,,132.17,253.48,percent of total billed charges,
imiquimod 5 % Cream 1 Each Packet,25000000,CDM,,,250,RC,00168043227,NDC,facility,both,1,EA,25,17.7,Aetna First Health,Commercial,,21.25,85,,,11.08,21.25,percent of total billed charges,
indomethacin 50 MG Suppository 30 Each Box,25000000,CDM,,,250,RC,42211010243,NDC,facility,both,1,EA,718.64,508.8,Aetna First Health,Commercial,,610.84,85,,,318.5,610.84,percent of total billed charges,
indomethacin sodium 1 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323065909,NDC,facility,both,1,EA,891,630.83,Aetna First Health,Commercial,,757.35,85,,,394.89,757.35,percent of total billed charges,
inhalation anesth 1st hour 1 Each Package,25000000,CDM,,,250,RC,88888800023,NDC,facility,both,1,EA,34.5,24.43,Aetna First Health,Commercial,,29.32,85,,,15.29,29.32,percent of total billed charges,
inhalation anesth next hour 1 Each Package,25000000,CDM,,,250,RC,88888800024,NDC,facility,both,1,EA,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
insulin pen needle 30G X 8 MM Misc 100 Each Box,25000000,CDM,,,250,RC,00169185275,NDC,facility,both,1,EA,1.22,0.86,Aetna First Health,Commercial,,1.04,85,,,0.54,1.04,percent of total billed charges,
isosorbide mononitrate 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00228263111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate 10 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,62175010601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine XR 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,68382098006,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
lamoTRIgine XR 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,00228143503,NDC,facility,both,1,EA,33.95,24.04,Aetna First Health,Commercial,,28.86,85,,,15.05,28.86,percent of total billed charges,
lamoTRIgine XR 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,16714062401,NDC,facility,both,1,EA,35.11,24.86,Aetna First Health,Commercial,,29.84,85,,,15.56,29.84,percent of total billed charges,
lamoTRIgine XR 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,55111071830,NDC,facility,both,1,EA,36.66,25.96,Aetna First Health,Commercial,,31.16,85,,,16.25,31.16,percent of total billed charges,
letrozole 2.5 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,50268047611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,68084080311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00378207193,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00093762056,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,62756051183,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,16729003410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,51991075933,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,59651018030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,60505325503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00078024915,NDC,facility,both,1,EA,78.01,55.23,Aetna First Health,Commercial,,66.31,85,,,34.57,66.31,percent of total billed charges,
letrozole 2.5 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,68084080321,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
letrozole 2.5 MG Tablet 50 Each Box,25000000,CDM,,,250,RC,50268047615,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
leucovorin 5 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079058101,NDC,facility,both,1,EA,9.17,6.49,Aetna First Health,Commercial,,7.79,85,,,4.06,7.79,percent of total billed charges,
leucovorin 5 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00054449625,NDC,facility,both,1,EA,3.81,2.7,Aetna First Health,Commercial,,3.24,85,,,1.69,3.24,percent of total billed charges,
leucovorin 5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00054449613,NDC,facility,both,1,EA,3.91,2.77,Aetna First Health,Commercial,,3.32,85,,,1.73,3.32,percent of total billed charges,
leucovorin 5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00555048401,NDC,facility,both,1,EA,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
leucovorin 5 MG Tablet 50 Each Box,25000000,CDM,,,250,RC,00054849619,NDC,facility,both,1,EA,5.51,3.9,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,25000000,CDM,,,250,RC,00378655053,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,25000000,CDM,,,250,RC,69238155406,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,25000000,CDM,,,250,RC,68180084473,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,25000000,CDM,,,250,RC,00378655085,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lidocaine 1% 9.5 mL -epinephrine 1:1000 0.5 mL Solution 1 Each Vial,25000000,CDM,,,250,RC,88887800050,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% 5 mL-bupivacaine 0.75 % 5 mL-Amphadase 75 units 1 Each Syringe,25000000,CDM,,,250,RC,88888800347,NDC,facility,both,1,EA,156,110.45,Aetna First Health,Commercial,,132.6,85,,,69.14,132.6,percent of total billed charges,
lidocaine 4 % Patch 1 Each Package,25000000,CDM,,,250,RC,41167005847,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
lidocaine 4 % Patch 1 Each Packet,25000000,CDM,,,250,RC,71399445601,NDC,facility,both,1,EA,1.53,1.08,Aetna First Health,Commercial,,1.3,85,,,0.68,1.3,percent of total billed charges,
lidocaine 4 % Patch 3 Each Box,25000000,CDM,,,250,RC,41167005842,NDC,facility,both,1,EA,8.69,6.15,Aetna First Health,Commercial,,7.39,85,,,3.85,7.39,percent of total billed charges,
lidocaine 4 % Patch 30 Each Box,25000000,CDM,,,250,RC,00536120207,NDC,facility,both,1,EA,3.81,2.7,Aetna First Health,Commercial,,3.24,85,,,1.69,3.24,percent of total billed charges,
lidocaine 4 % Patch 5 Each Box,25000000,CDM,,,250,RC,46122045021,NDC,facility,both,1,EA,1.34,0.95,Aetna First Health,Commercial,,1.14,85,,,0.59,1.14,percent of total billed charges,
lidocaine 4 % Patch 5 Each Box,25000000,CDM,,,250,RC,71399445605,NDC,facility,both,1,EA,1.53,1.08,Aetna First Health,Commercial,,1.3,85,,,0.68,1.3,percent of total billed charges,
lidocaine 4 % Patch 5 Each Box,25000000,CDM,,,250,RC,00536120215,NDC,facility,both,1,EA,4.39,3.11,Aetna First Health,Commercial,,3.73,85,,,1.95,3.73,percent of total billed charges,
lidocaine 4 % Patch 5 Each Box,25000000,CDM,,,250,RC,41167005840,NDC,facility,both,1,EA,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
lidocaine 4 % Patch 6 Each Box,25000000,CDM,,,250,RC,46581083006,NDC,facility,both,1,EA,4.33,3.07,Aetna First Health,Commercial,,3.68,85,,,1.92,3.68,percent of total billed charges,
lidocaine 4 % Patch 7 Each Box,25000000,CDM,,,250,RC,46581084007,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
lomustine 10 MG capsule 5 Each Bottle,25000000,CDM,,,250,RC,58181304005,NDC,facility,both,1,EA,92.72,65.65,Aetna First Health,Commercial,,78.81,85,,,41.09,78.81,percent of total billed charges,
lurasidone 20 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,60687074711,NDC,facility,both,1,EA,14.9,10.55,Aetna First Health,Commercial,,12.66,85,,,6.6,12.66,percent of total billed charges,
lurasidone 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,16729034610,NDC,facility,both,1,EA,4.25,3.01,Aetna First Health,Commercial,,3.61,85,,,1.88,3.61,percent of total billed charges,
lurasidone 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,62332049430,NDC,facility,both,1,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
lurasidone 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,63402030230,NDC,facility,both,1,EA,165.52,117.19,Aetna First Health,Commercial,,140.69,85,,,73.36,140.69,percent of total billed charges,
lurasidone 20 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,60687074721,NDC,facility,both,1,EA,14.9,10.55,Aetna First Health,Commercial,,12.66,85,,,6.6,12.66,percent of total billed charges,
mafenide acetate 5 % Packet 1 Each Packet,25000000,CDM,,,250,RC,50742031050,NDC,facility,both,1,EA,385,272.58,Aetna First Health,Commercial,,327.25,85,,,170.63,327.25,percent of total billed charges,
mafenide acetate 5 % Packet 1 Each Packet,25000000,CDM,,,250,RC,51079062484,NDC,facility,both,1,EA,699.78,495.44,Aetna First Health,Commercial,,594.81,85,,,310.14,594.81,percent of total billed charges,
mafenide acetate 5 % Packet 5 Each Box,25000000,CDM,,,250,RC,50742031025,NDC,facility,both,1,EA,385,272.58,Aetna First Health,Commercial,,327.25,85,,,170.63,327.25,percent of total billed charges,
mafenide acetate 5 % Packet 5 Each Box,25000000,CDM,,,250,RC,51079062485,NDC,facility,both,1,EA,912.87,646.31,Aetna First Health,Commercial,,775.94,85,,,404.58,775.94,percent of total billed charges,
megestrol 40 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,00904357161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mesna 400 MG Tablet 10 Each Disp Pack,25000000,CDM,,,250,RC,67108356509,NDC,facility,both,1,EA,275.07,194.75,Aetna First Health,Commercial,,233.81,85,,,121.91,233.81,percent of total billed charges,
microfibrillar coll hemostat 1X2 Pad 1 Each Box,25000000,CDM,,,250,RC,08137001961,NDC,facility,both,1,EA,128.4,90.91,Aetna First Health,Commercial,,109.14,85,,,56.91,109.14,percent of total billed charges,
microfibrillar coll hemostat 2X4 Pad 1 Each Box,25000000,CDM,,,250,RC,08137001961,NDC,facility,both,1,EA,128.4,90.91,Aetna First Health,Commercial,,109.14,85,,,56.91,109.14,percent of total billed charges,
microfibrillar coll hemostat 35X35 Pad 1 Each Box,25000000,CDM,,,250,RC,53276101008,NDC,facility,both,1,EA,189,133.81,Aetna First Health,Commercial,,160.65,85,,,83.76,160.65,percent of total billed charges,
microfibrillar coll hemostat Pad 1 Each Box,25000000,CDM,,,250,RC,53276101009,NDC,facility,both,1,EA,346.68,245.45,Aetna First Health,Commercial,,294.68,85,,,153.65,294.68,percent of total billed charges,
microfibrillar coll hemostat Pad 1 Each Box,25000000,CDM,,,250,RC,00998101009,NDC,facility,both,1,EA,722.37,511.44,Aetna First Health,Commercial,,614.01,85,,,320.15,614.01,percent of total billed charges,
microfibrillar collagen Powder 1 Each Packet,25000000,CDM,,,250,RC,08137001984,NDC,facility,both,1,EA,383.25,271.34,Aetna First Health,Commercial,,325.76,85,,,169.86,325.76,percent of total billed charges,
mitotane 500 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00015308060,NDC,facility,both,1,EA,16.8,11.89,Aetna First Health,Commercial,,14.28,85,,,7.45,14.28,percent of total billed charges,
Nafcillin Sodium 10 g Recon Soln 1 Each Bottle,25000000,CDM,,,250,RC,70860011999,NDC,facility,both,1,EA,225,159.3,Aetna First Health,Commercial,,191.25,85,,,99.72,191.25,percent of total billed charges,
Nafcillin Sodium 10 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781312646,NDC,facility,both,1,EA,249.8,176.86,Aetna First Health,Commercial,,212.33,85,,,110.71,212.33,percent of total billed charges,
Nafcillin Sodium 10 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150012499,NDC,facility,both,1,EA,250.88,177.62,Aetna First Health,Commercial,,213.25,85,,,111.19,213.25,percent of total billed charges,
Nafcillin Sodium 10 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150012409,NDC,facility,both,1,EA,250.88,177.62,Aetna First Health,Commercial,,213.25,85,,,111.19,213.25,percent of total billed charges,
Nafcillin Sodium 10 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323033060,NDC,facility,both,1,EA,318.49,225.49,Aetna First Health,Commercial,,270.72,85,,,141.15,270.72,percent of total billed charges,
Nafcillin Sodium 10 g Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,44567022301,NDC,facility,both,1,EA,326.25,230.98,Aetna First Health,Commercial,,277.31,85,,,144.59,277.31,percent of total billed charges,
OptiHaler Device 1 Each Box,25000000,CDM,,,250,RC,08373076500,NDC,facility,both,1,EA,37.45,26.51,Aetna First Health,Commercial,,31.83,85,,,16.6,31.83,percent of total billed charges,
OptiHaler Device 1 Each Box,25000000,CDM,,,250,RC,08373747800,NDC,facility,both,1,EA,56.56,40.04,Aetna First Health,Commercial,,48.08,85,,,25.07,48.08,percent of total billed charges,
oxidized cellulose 6X9 Pad 1 Each Box,25000000,CDM,,,250,RC,08137001946,NDC,facility,both,1,EA,233.12,165.05,Aetna First Health,Commercial,,198.15,85,,,103.32,198.15,percent of total billed charges,
oxidized cellulose 6X9 Pad 10 Each Box,25000000,CDM,,,250,RC,63713001946,NDC,facility,both,1,EA,599.71,424.59,Aetna First Health,Commercial,,509.75,85,,,265.79,509.75,percent of total billed charges,
Oxidized Cellulose Pad 1 Each Box,25000000,CDM,,,250,RC,63713001962,NDC,facility,both,1,EA,526.22,372.56,Aetna First Health,Commercial,,447.29,85,,,233.22,447.29,percent of total billed charges,
Oxidized Cellulose Pad 10 Each Box,25000000,CDM,,,250,RC,63713001961,NDC,facility,both,1,EA,285.92,202.43,Aetna First Health,Commercial,,243.03,85,,,126.72,243.03,percent of total billed charges,
Oxidized Cellulose Pad 12 Each Box,25000000,CDM,,,250,RC,63713001953,NDC,facility,both,1,EA,168.12,119.03,Aetna First Health,Commercial,,142.9,85,,,74.51,142.9,percent of total billed charges,
penicillin G sodium 5000000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00781615394,NDC,facility,both,1,EA,103.68,73.41,Aetna First Health,Commercial,,88.13,85,,,45.95,88.13,percent of total billed charges,
Phenol 89 % SWAB 30 Each Package,25000000,CDM,,,250,RC,00884629730,NDC,facility,both,1,EA,6.82,4.83,Aetna First Health,Commercial,,5.8,85,,,3.02,5.8,percent of total billed charges,
PHENOL SAFETY APPLICATOR 1 Each Package,25000000,CDM,,,250,RC,08888800604,NDC,facility,both,1,EA,60.4,42.76,Aetna First Health,Commercial,,51.34,85,,,26.77,51.34,percent of total billed charges,
phentermine 37.5 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,11534016001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,39822016605,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,39822016607,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,25021011710,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,39822017001,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,39822017107,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,39822017106,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,70860010310,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150023410,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,70594004901,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,70860010341,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55390013910,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,39822017002,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323036711,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
polymyxin B 500000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323036701,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium iodide (antidote) 130 MG Tablet 14 Each Box,25000000,CDM,,,250,RC,51803000101,NDC,facility,both,1,EA,1.97,1.39,Aetna First Health,Commercial,,1.67,85,,,0.87,1.67,percent of total billed charges,
prime solution - bypass Solution 1 Each Flex Cont,25000000,CDM,,,250,RC,88888800054,NDC,facility,both,1,EA,34.5,24.43,Aetna First Health,Commercial,,29.32,85,,,15.29,29.32,percent of total billed charges,
procarbazine 50 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,54482005301,NDC,facility,both,1,EA,197.07,139.53,Aetna First Health,Commercial,,167.51,85,,,87.34,167.51,percent of total billed charges,
prochlorperazine 10 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079054201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
quiniDINE sulfate 200 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00185434601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
quiniDINE sulfate 200 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,42806051330,NDC,facility,both,1,EA,42.25,29.91,Aetna First Health,Commercial,,35.91,85,,,18.73,35.91,percent of total billed charges,
racEPINEPHrine 2.25 % Nebulization Solution 1 Each Box,25000000,CDM,,,250,RC,00487278401,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
racEPINEPHrine 2.25 % Nebulization Solution 1 Each Plas Cont,25000000,CDM,,,250,RC,00487590199,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
remifentanil 2 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457019805,NDC,facility,both,1,EA,275.81,195.27,Aetna First Health,Commercial,,234.44,85,,,122.24,234.44,percent of total billed charges,
remifentanil 2 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457019899,NDC,facility,both,1,EA,275.81,195.27,Aetna First Health,Commercial,,234.44,85,,,122.24,234.44,percent of total billed charges,
remifentanil 2 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,72078003500,NDC,facility,both,1,EA,275.81,195.27,Aetna First Health,Commercial,,234.44,85,,,122.24,234.44,percent of total billed charges,
remifentanil 2 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,72078003502,NDC,facility,both,1,EA,275.81,195.27,Aetna First Health,Commercial,,234.44,85,,,122.24,234.44,percent of total billed charges,
remifentanil 2 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457091302,NDC,facility,both,1,EA,275.81,195.27,Aetna First Health,Commercial,,234.44,85,,,122.24,234.44,percent of total billed charges,
remifentanil 2 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323072401,NDC,facility,both,1,EA,289.4,204.9,Aetna First Health,Commercial,,245.99,85,,,128.26,245.99,percent of total billed charges,
remifentanil 2 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323072405,NDC,facility,both,1,EA,289.4,204.9,Aetna First Health,Commercial,,245.99,85,,,128.26,245.99,percent of total billed charges,
rOPINIRole SR 2 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,13811063930,NDC,facility,both,1,EA,5.13,3.63,Aetna First Health,Commercial,,4.36,85,,,2.27,4.36,percent of total billed charges,
rOPINIRole SR 2 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,00781578031,NDC,facility,both,1,EA,7.52,5.32,Aetna First Health,Commercial,,6.39,85,,,3.33,6.39,percent of total billed charges,
rOPINIRole SR 2 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,00228365803,NDC,facility,both,1,EA,7.54,5.34,Aetna First Health,Commercial,,6.41,85,,,3.34,6.41,percent of total billed charges,
rOPINIRole SR 2 MG Tablet Extended Release 24 Hour 30 Each Bottle,25000000,CDM,,,250,RC,55111065930,NDC,facility,both,1,EA,7.54,5.34,Aetna First Health,Commercial,,6.41,85,,,3.34,6.41,percent of total billed charges,
rOPINIRole SR 2 MG Tablet Extended Release 24 Hour 90 Each Bottle,25000000,CDM,,,250,RC,00228365809,NDC,facility,both,1,EA,7.54,5.34,Aetna First Health,Commercial,,6.41,85,,,3.34,6.41,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 1 Each Box,25000000,CDM,,,250,RC,00067434509,NDC,facility,both,1,EA,53.28,37.72,Aetna First Health,Commercial,,45.29,85,,,23.61,45.29,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 1 Each Box,25000000,CDM,,,250,RC,00378647016,NDC,facility,both,1,EA,64.33,45.55,Aetna First Health,Commercial,,54.68,85,,,28.51,54.68,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 1 Each Box,25000000,CDM,,,250,RC,10019055388,NDC,facility,both,1,EA,74.55,52.78,Aetna First Health,Commercial,,63.37,85,,,33.04,63.37,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 1 Each Package,25000000,CDM,,,250,RC,45802058001,NDC,facility,both,1,EA,56.18,39.78,Aetna First Health,Commercial,,47.75,85,,,24.9,47.75,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 1 Each Package,25000000,CDM,,,250,RC,66758020858,NDC,facility,both,1,EA,62.42,44.19,Aetna First Health,Commercial,,53.06,85,,,27.66,53.06,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 1 Each Package,25000000,CDM,,,250,RC,10019055390,NDC,facility,both,1,EA,74.54,52.77,Aetna First Health,Commercial,,63.36,85,,,33.04,63.36,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 10 Each Box,25000000,CDM,,,250,RC,00378647097,NDC,facility,both,1,EA,64.33,45.55,Aetna First Health,Commercial,,54.68,85,,,28.51,54.68,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 10 Each Box,25000000,CDM,,,250,RC,45802058046,NDC,facility,both,1,EA,67.08,47.49,Aetna First Health,Commercial,,57.02,85,,,29.73,57.02,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 10 Each Box,25000000,CDM,,,250,RC,10019055301,NDC,facility,both,1,EA,68.38,48.41,Aetna First Health,Commercial,,58.12,85,,,30.31,58.12,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 10 Each Box,25000000,CDM,,,250,RC,10019055303,NDC,facility,both,1,EA,74.54,52.77,Aetna First Health,Commercial,,63.36,85,,,33.04,63.36,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 24 Each Box,25000000,CDM,,,250,RC,00378647044,NDC,facility,both,1,EA,64.33,45.55,Aetna First Health,Commercial,,54.68,85,,,28.51,54.68,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 24 Each Box,25000000,CDM,,,250,RC,45802058062,NDC,facility,both,1,EA,67.08,47.49,Aetna First Health,Commercial,,57.02,85,,,29.73,57.02,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 24 Each Box,25000000,CDM,,,250,RC,10019055302,NDC,facility,both,1,EA,68.38,48.41,Aetna First Health,Commercial,,58.12,85,,,30.31,58.12,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 24 Each Box,25000000,CDM,,,250,RC,10019055304,NDC,facility,both,1,EA,74.54,52.77,Aetna First Health,Commercial,,63.36,85,,,33.04,63.36,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 4 Each Box,25000000,CDM,,,250,RC,45802058084,NDC,facility,both,1,EA,56.18,39.78,Aetna First Health,Commercial,,47.75,85,,,24.9,47.75,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 4 Each Box,25000000,CDM,,,250,RC,00378647099,NDC,facility,both,1,EA,56.56,40.04,Aetna First Health,Commercial,,48.08,85,,,25.07,48.08,percent of total billed charges,
scopolamine 1 MG/3DAYS Patch 72 Hour 4 Each Box,25000000,CDM,,,250,RC,00067434504,NDC,facility,both,1,EA,62.42,44.19,Aetna First Health,Commercial,,53.06,85,,,27.66,53.06,percent of total billed charges,
selegiline 5 MG capsule 60 Each Bottle,25000000,CDM,,,250,RC,60505005501,NDC,facility,both,1,EA,5.86,4.15,Aetna First Health,Commercial,,4.98,85,,,2.6,4.98,percent of total billed charges,
selegiline 5 MG capsule 60 Each Bottle,25000000,CDM,,,250,RC,67253070006,NDC,facility,both,1,EA,5.86,4.15,Aetna First Health,Commercial,,4.98,85,,,2.6,4.98,percent of total billed charges,
selegiline 6 MG/24HR Patch 24 Hour 1 Each Packet,25000000,CDM,,,250,RC,49502090001,NDC,facility,both,1,EA,250.25,177.18,Aetna First Health,Commercial,,212.71,85,,,110.91,212.71,percent of total billed charges,
selegiline 6 MG/24HR Patch 24 Hour 30 Each Box,25000000,CDM,,,250,RC,49502090030,NDC,facility,both,1,EA,250.25,177.18,Aetna First Health,Commercial,,212.71,85,,,110.91,212.71,percent of total billed charges,
selegiline 9 MG/24HR Patch 24 Hour 1 Each Box,25000000,CDM,,,250,RC,49502090101,NDC,facility,both,1,EA,250.25,177.18,Aetna First Health,Commercial,,212.71,85,,,110.91,212.71,percent of total billed charges,
streitz #3 Solution 1 Each,25000000,CDM,,,250,RC,88888800080,NDC,facility,both,1,EA,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
tadalafil 20 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,50268073911,NDC,facility,both,1,EA,11.31,8.01,Aetna First Health,Commercial,,9.61,85,,,5.01,9.61,percent of total billed charges,
tadalafil 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,27241011403,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tadalafil 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,43598057330,NDC,facility,both,1,EA,4.68,3.31,Aetna First Health,Commercial,,3.98,85,,,2.07,3.98,percent of total billed charges,
tadalafil 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,60505468603,NDC,facility,both,1,EA,5.68,4.02,Aetna First Health,Commercial,,4.83,85,,,2.52,4.83,percent of total billed charges,
tadalafil 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00002446430,NDC,facility,both,1,EA,132.83,94.04,Aetna First Health,Commercial,,112.91,85,,,58.87,112.91,percent of total billed charges,
tadalafil 20 MG Tablet 30 Each Box,25000000,CDM,,,250,RC,50268073913,NDC,facility,both,1,EA,11.31,8.01,Aetna First Health,Commercial,,9.61,85,,,5.01,9.61,percent of total billed charges,
talc 2 g Powder 1 Each Vial,25000000,CDM,,,250,RC,62327022242,NDC,facility,both,1,EA,267.19,189.17,Aetna First Health,Commercial,,227.11,85,,,118.42,227.11,percent of total billed charges,
talc 2 g Powder 1 Each Vial,25000000,CDM,,,250,RC,62327022202,NDC,facility,both,1,EA,267.19,189.17,Aetna First Health,Commercial,,227.11,85,,,118.42,227.11,percent of total billed charges,
talc 4 g Powder 1 Each Vial,25000000,CDM,,,250,RC,62327044444,NDC,facility,both,1,EA,382.5,270.81,Aetna First Health,Commercial,,325.12,85,,,169.52,325.12,percent of total billed charges,
talc 4 g Powder 1 Each Vial,25000000,CDM,,,250,RC,62327044404,NDC,facility,both,1,EA,382.5,270.81,Aetna First Health,Commercial,,325.12,85,,,169.52,325.12,percent of total billed charges,
tamoxifen 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00378027493,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00591247330,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,68382082706,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamoxifen 20 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,59651030030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temozolomide 100 MG capsule 1 Each Box,25000000,CDM,J8700,CPT,250,RC,00085136605,NDC,facility,both,1,EA,650.87,460.82,Aetna First Health,Commercial,,553.24,85,,,288.47,553.24,percent of total billed charges,
temozolomide 100 MG capsule 14 Each Bottle,25000000,CDM,J8700,CPT,250,RC,16729005054,NDC,facility,both,1,EA,87.45,61.91,Aetna First Health,Commercial,,74.33,85,,,38.76,74.33,percent of total billed charges,
temozolomide 250 MG capsule 5 Each Bottle,25000000,CDM,J8700,CPT,250,RC,16729005153,NDC,facility,both,1,EA,179,126.73,Aetna First Health,Commercial,,152.15,85,,,79.33,152.15,percent of total billed charges,
temozolomide 250 MG capsule 5 Each Bottle,25000000,CDM,J8700,CPT,250,RC,43975025705,NDC,facility,both,1,EA,703.86,498.33,Aetna First Health,Commercial,,598.28,85,,,311.95,598.28,percent of total billed charges,
temozolomide 5 MG capsule 1 Each Blister,25000000,CDM,,,250,RC,00085300405,NDC,facility,both,1,EA,39.01,27.62,Aetna First Health,Commercial,,33.16,85,,,17.29,33.16,percent of total billed charges,
temozolomide 5 MG capsule 5 Each Bottle,25000000,CDM,,,250,RC,16729004853,NDC,facility,both,1,EA,9.29,6.58,Aetna First Health,Commercial,,7.9,85,,,4.12,7.9,percent of total billed charges,
temozolomide 5 MG capsule 5 Each Bottle,25000000,CDM,,,250,RC,00781269175,NDC,facility,both,1,EA,15.47,10.95,Aetna First Health,Commercial,,13.15,85,,,6.86,13.15,percent of total billed charges,
temozolomide 5 MG capsule 5 Each Box,25000000,CDM,,,250,RC,00085300403,NDC,facility,both,1,EA,50.53,35.78,Aetna First Health,Commercial,,42.95,85,,,22.39,42.95,percent of total billed charges,
Tetrabenazine 12.5 MG Tablet 112 Each Bottle,25000000,CDM,,,250,RC,43598039467,NDC,facility,both,1,EA,27.47,19.45,Aetna First Health,Commercial,,23.35,85,,,12.17,23.35,percent of total billed charges,
thalidomide 100 MG capsule 28 Each Disp Pack,25000000,CDM,,,250,RC,59572021095,NDC,facility,both,1,EA,970.92,687.41,Aetna First Health,Commercial,,825.28,85,,,430.31,825.28,percent of total billed charges,
theophylline ER (12 hour) 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,25000000,CDM,,,250,RC,50111048301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
theophylline SR (12 hour) 200 MG Tablet Extended Release 12 Hour 100 Each Box,25000000,CDM,,,250,RC,00904588861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thrombin (recombinant) 5000 units Recon Soln 1 Each Box,25000000,CDM,,,250,RC,28400010541,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thrombin (recombinant) 5000 units Recon Soln 1 Each Box,25000000,CDM,,,250,RC,65293000641,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thrombin (recombinant) 5000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,65293000601,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thrombin (recombinant) 5000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,43825060641,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thrombin (recombinant) 5000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00338032201,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thrombin (recombinant) 5000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00338032401,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thrombin (recombinant) 5000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,43825000641,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thrombin 1000 units Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,56091003801,NDC,facility,both,1,EA,13.99,9.9,Aetna First Health,Commercial,,11.89,85,,,6.2,11.89,percent of total billed charges,
thrombin 10000 units Kit 1 Each Box,25000000,CDM,,,250,RC,56091004010,NDC,facility,both,1,EA,133.56,94.56,Aetna First Health,Commercial,,113.53,85,,,59.19,113.53,percent of total billed charges,
THROMBIN 5000 UNITS IN SURGIFLO HEMOSTATIC MATRIX 1 Each Vial,25000000,CDM,,,250,RC,43825060641,NDC,facility,both,1,EA,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
thyroid 15 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00456045701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tretinoin 10 MG capsule 1 Each Blister,25000000,CDM,,,250,RC,68084007511,NDC,facility,both,1,EA,86.47,61.22,Aetna First Health,Commercial,,73.5,85,,,38.32,73.5,percent of total billed charges,
tretinoin 10 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,00555080802,NDC,facility,both,1,EA,75.3,53.31,Aetna First Health,Commercial,,64,85,,,33.37,64,percent of total billed charges,
tretinoin 10 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,10370026801,NDC,facility,both,1,EA,94.13,66.64,Aetna First Health,Commercial,,80.01,85,,,41.72,80.01,percent of total billed charges,
tretinoin 10 MG capsule 30 Each Box,25000000,CDM,,,250,RC,68084007521,NDC,facility,both,1,EA,86.47,61.22,Aetna First Health,Commercial,,73.5,85,,,38.32,73.5,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 1 Each Packet,25000000,CDM,,,250,RC,45802014370,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 1 Each Packet,25000000,CDM,,,250,RC,00168001209,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Triple Dye SWAB 100 Each Box,25000000,CDM,,,250,RC,66689071006,NDC,facility,both,1,EA,7.01,4.96,Aetna First Health,Commercial,,5.96,85,,,3.11,5.96,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,41616093144,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,41616093140,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457057100,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457057110,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 10 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00409163249,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457047500,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,67457047520,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,47335093240,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,47335093244,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323078220,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150023601,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,55150023620,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,00409163485,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vecuronium 20 MG Recon Soln 1 Each Vial,25000000,CDM,,,250,RC,63323078223,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil CR 120 MG Capsule Extended Release 24 Hour 1 Each Blister,25000000,CDM,,,250,RC,51079091701,NDC,facility,both,1,EA,15.65,11.08,Aetna First Health,Commercial,,13.3,85,,,6.94,13.3,percent of total billed charges,
verapamil CR 120 MG Capsule Extended Release 24 Hour 100 Each Bottle,25000000,CDM,,,250,RC,00378632001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 120 MG Capsule Extended Release 24 Hour 100 Each Box,25000000,CDM,,,250,RC,51079091720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 180 MG Tablet Extended Release 1 Each Blister,25000000,CDM,,,250,RC,51079089901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SURGIFLO HEMOSTATIC MATRIX KIT WITH THROMBIN 1 Kit Syringe,25000000,CDM,,,250,RC,63713002993,NDC,facility,both,1,EA,487,344.8,Aetna First Health,Commercial,,413.95,85,,,215.84,413.95,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 15 g Tube,25000000,CDM,,,250,RC,54162001715,NDC,facility,both,1,GM,2.43,1.72,Aetna First Health,Commercial,,2.07,85,,,1.08,2.07,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 14.2 g Tube,25000000,CDM,,,250,RC,68001047746,NDC,facility,both,1,GM,2.56,1.81,Aetna First Health,Commercial,,2.18,85,,,1.13,2.18,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,00713028031,NDC,facility,both,1,GM,3.32,2.35,Aetna First Health,Commercial,,2.82,85,,,1.47,2.82,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,68001047747,NDC,facility,both,1,GM,3.32,2.35,Aetna First Health,Commercial,,2.82,85,,,1.47,2.82,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 14 g Tube,25000000,CDM,,,250,RC,00472110534,NDC,facility,both,1,GM,4.1,2.9,Aetna First Health,Commercial,,3.48,85,,,1.82,3.48,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 14.2 g Tube,25000000,CDM,,,250,RC,51672207501,NDC,facility,both,1,GM,4.77,3.38,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
bacitracin zinc 500 UNIT/GM Ointment 14.2 g Tube,25000000,CDM,,,250,RC,68001053145,NDC,facility,both,1,GM,4.77,3.38,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
bacitracin 500 UNIT/GM Ointment 14 g Tube,25000000,CDM,,,250,RC,45802006001,NDC,facility,both,1,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 510 g Bottle,25000000,CDM,,,250,RC,68001050569,NDC,facility,both,1,GM,36.72,26,Aetna First Health,Commercial,,31.21,85,,,16.27,31.21,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 255 g Bottle,25000000,CDM,,,250,RC,62175044215,NDC,facility,both,1,GM,46.92,33.22,Aetna First Health,Commercial,,39.88,85,,,20.79,39.88,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 15 g Tube,25000000,CDM,,,250,RC,68462079917,NDC,facility,both,1,GM,50.28,35.6,Aetna First Health,Commercial,,42.74,85,,,22.28,42.74,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 255 g Bottle,25000000,CDM,,,250,RC,00574041202,NDC,facility,both,1,GM,57.12,40.44,Aetna First Health,Commercial,,48.55,85,,,25.32,48.55,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 510 g Bottle,25000000,CDM,,,250,RC,45802086803,NDC,facility,both,1,GM,57.12,40.44,Aetna First Health,Commercial,,48.55,85,,,25.32,48.55,percent of total billed charges,
polyethylene glycol 3350 17 g Powder 255 g Bottle,25000000,CDM,,,250,RC,51991045758,NDC,facility,both,1,GM,58.14,41.16,Aetna First Health,Commercial,,49.42,85,,,25.77,49.42,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 15 g Tube,25000000,CDM,,,250,RC,45802024414,NDC,facility,both,1,GM,62.4,44.18,Aetna First Health,Commercial,,53.04,85,,,27.66,53.04,percent of total billed charges,
ferric subsulfate 259 MG/GM Solution 8 g Bottle,25000000,CDM,,,250,RC,59365606500,NDC,facility,both,1,GM,65.47,46.35,Aetna First Health,Commercial,,55.65,85,,,29.02,55.65,percent of total billed charges,
ferric subsulfate 259 MG/GM Solution 8 g Bottle,25000000,CDM,,,250,RC,59365606501,NDC,facility,both,1,GM,65.5,46.37,Aetna First Health,Commercial,,55.68,85,,,29.03,55.68,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 30 g Tube,25000000,CDM,,,250,RC,68462079935,NDC,facility,both,1,GM,70.56,49.96,Aetna First Health,Commercial,,59.98,85,,,31.27,59.98,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 30 g Tube,25000000,CDM,,,250,RC,72578008904,NDC,facility,both,1,GM,75.96,53.78,Aetna First Health,Commercial,,64.57,85,,,33.67,64.57,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 15 g Tube,25000000,CDM,,,250,RC,62332058515,NDC,facility,both,1,GM,82.98,58.75,Aetna First Health,Commercial,,70.53,85,,,36.78,70.53,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 30 g Tube,25000000,CDM,,,250,RC,00472016630,NDC,facility,both,1,GM,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 30 g Tube,25000000,CDM,,,250,RC,45802004811,NDC,facility,both,1,GM,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
nystatin 100000 UNIT/GM Ointment 30 g Tube,25000000,CDM,,,250,RC,00168000730,NDC,facility,both,1,GM,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 30 g Tube,25000000,CDM,,,250,RC,62332058530,NDC,facility,both,1,GM,116.4,82.41,Aetna First Health,Commercial,,98.94,85,,,51.59,98.94,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 30 g Tube,25000000,CDM,,,250,RC,68462031435,NDC,facility,both,1,GM,117.72,83.35,Aetna First Health,Commercial,,100.06,85,,,52.17,100.06,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 30 g Tube,25000000,CDM,,,250,RC,45802088094,NDC,facility,both,1,GM,117.72,83.35,Aetna First Health,Commercial,,100.06,85,,,52.17,100.06,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 30 g Tube,25000000,CDM,,,250,RC,68180054502,NDC,facility,both,1,GM,117.72,83.35,Aetna First Health,Commercial,,100.06,85,,,52.17,100.06,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 60 g Tube,25000000,CDM,,,250,RC,68462031465,NDC,facility,both,1,GM,174.72,123.7,Aetna First Health,Commercial,,148.51,85,,,77.44,148.51,percent of total billed charges,
mafenide 85 MG/GM Cream 56.7 g Tube,25000000,CDM,,,250,RC,51079062381,NDC,facility,both,1,GM,201.63,142.75,Aetna First Health,Commercial,,171.39,85,,,89.36,171.39,percent of total billed charges,
mafenide 85 MG/GM Cream 56.7 g Tube,25000000,CDM,,,250,RC,16571072360,NDC,facility,both,1,GM,289.62,205.05,Aetna First Health,Commercial,,246.18,85,,,128.36,246.18,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 15 g Tube,25000000,CDM,,,250,RC,51672127201,NDC,facility,both,1,GM,358.2,253.61,Aetna First Health,Commercial,,304.47,85,,,158.75,304.47,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 15 g Tube,25000000,CDM,,,250,RC,00168008915,NDC,facility,both,1,GM,358.2,253.61,Aetna First Health,Commercial,,304.47,85,,,158.75,304.47,percent of total billed charges,
mafenide 85 MG/GM Cream 113.4 g Tube,25000000,CDM,,,250,RC,51079062382,NDC,facility,both,1,GM,465.39,329.5,Aetna First Health,Commercial,,395.58,85,,,206.26,395.58,percent of total billed charges,
talc sterile 4 g Aerosol Powder 30 g Can,25000000,CDM,,,250,RC,63256010030,NDC,facility,both,1,GM,504,356.83,Aetna First Health,Commercial,,428.4,85,,,223.37,428.4,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 30 g Tube,25000000,CDM,,,250,RC,00168008130,NDC,facility,both,1,GM,510.48,361.42,Aetna First Health,Commercial,,433.91,85,,,226.24,433.91,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 30 g Tube,25000000,CDM,,,250,RC,00472015030,NDC,facility,both,1,GM,510.48,361.42,Aetna First Health,Commercial,,433.91,85,,,226.24,433.91,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 30 g Tube,25000000,CDM,,,250,RC,51672126302,NDC,facility,both,1,GM,510.48,361.42,Aetna First Health,Commercial,,433.91,85,,,226.24,433.91,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 30 g Tube,25000000,CDM,,,250,RC,00168008930,NDC,facility,both,1,GM,510.48,361.42,Aetna First Health,Commercial,,433.91,85,,,226.24,433.91,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 30 g Tube,25000000,CDM,,,250,RC,00472015530,NDC,facility,both,1,GM,510.48,361.42,Aetna First Health,Commercial,,433.91,85,,,226.24,433.91,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Ointment 30 g Tube,25000000,CDM,,,250,RC,51672127202,NDC,facility,both,1,GM,510.48,361.42,Aetna First Health,Commercial,,433.91,85,,,226.24,433.91,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 60 g Tube,25000000,CDM,,,250,RC,00168008160,NDC,facility,both,1,GM,727.44,515.03,Aetna First Health,Commercial,,618.32,85,,,322.4,618.32,percent of total billed charges,
nystatin-triamcinolone 100000-0.1 UNIT/GM-% Cream 60 g Tube,25000000,CDM,,,250,RC,51672126303,NDC,facility,both,1,GM,727.44,515.03,Aetna First Health,Commercial,,618.32,85,,,322.4,618.32,percent of total billed charges,
clotrimazole 1 % Cream 14.17 g Tube,25000000,CDM,,,250,RC,00904782236,NDC,facility,both,1,GR,1.85,1.31,Aetna First Health,Commercial,,1.57,85,,,0.82,1.57,percent of total billed charges,
clotrimazole 1 % Cream 28.35 g Tube,25000000,CDM,,,250,RC,00904782231,NDC,facility,both,1,GR,2.59,1.83,Aetna First Health,Commercial,,2.2,85,,,1.15,2.2,percent of total billed charges,
miconazole 2 % Cream 28.4 g Tube,25000000,CDM,,,250,RC,68001048145,NDC,facility,both,1,GR,3.58,2.53,Aetna First Health,Commercial,,3.04,85,,,1.59,3.04,percent of total billed charges,
miconazole 2 % Cream 30 g Tube,25000000,CDM,,,250,RC,49348068972,NDC,facility,both,1,GR,3.69,2.61,Aetna First Health,Commercial,,3.14,85,,,1.64,3.14,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 28.4 g Tube,25000000,CDM,,,250,RC,00713026831,NDC,facility,both,1,GR,4.13,2.92,Aetna First Health,Commercial,,3.51,85,,,1.83,3.51,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 28.4 g Tube,25000000,CDM,,,250,RC,00603064450,NDC,facility,both,1,GR,4.26,3.02,Aetna First Health,Commercial,,3.62,85,,,1.89,3.62,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 28 g Tube,25000000,CDM,,,250,RC,45802014303,NDC,facility,both,1,GR,4.28,3.03,Aetna First Health,Commercial,,3.64,85,,,1.9,3.64,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 28 g Tube,25000000,CDM,,,250,RC,45802014303,NDC,facility,both,1,GR,4.28,3.03,Aetna First Health,Commercial,,3.64,85,,,1.9,3.64,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 28 g Tube,25000000,CDM,,,250,RC,45802006103,NDC,facility,both,1,GR,4.28,3.03,Aetna First Health,Commercial,,3.64,85,,,1.9,3.64,percent of total billed charges,
clotrimazole 1 % Cream 14.2 g Tube,25000000,CDM,,,250,RC,68001047545,NDC,facility,both,1,GR,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 14 g Tube,25000000,CDM,,,250,RC,00472017934,NDC,facility,both,1,GR,5.12,3.62,Aetna First Health,Commercial,,4.35,85,,,2.27,4.35,percent of total billed charges,
miconazole 2 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672200102,NDC,facility,both,1,GR,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
miconazole 2 % Powder 90 g Bottle,25000000,CDM,,,250,RC,11523091901,NDC,facility,both,1,GR,7.16,5.07,Aetna First Health,Commercial,,6.09,85,,,3.17,6.09,percent of total billed charges,
Eucerin Cream 57 g Tube,25000000,CDM,,,250,RC,72140003868,NDC,facility,both,1,GR,7.27,5.15,Aetna First Health,Commercial,,6.18,85,,,3.22,6.18,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 28 g Tube,25000000,CDM,,,250,RC,00472017956,NDC,facility,both,1,GR,7.27,5.15,Aetna First Health,Commercial,,6.18,85,,,3.22,6.18,percent of total billed charges,
Eucerin Cream 99 g Tube,25000000,CDM,,,250,RC,53329007681,NDC,facility,both,1,GR,8.02,5.68,Aetna First Health,Commercial,,6.82,85,,,3.55,6.82,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 14.17 g Tube,25000000,CDM,,,250,RC,00168002135,NDC,facility,both,1,GR,8.99,6.36,Aetna First Health,Commercial,,7.64,85,,,3.98,7.64,percent of total billed charges,
bacitracin-polymyxin b 500-10000 UNIT/GM Ointment 28.4 g Tube,25000000,CDM,,,250,RC,49348027472,NDC,facility,both,1,GR,8.99,6.36,Aetna First Health,Commercial,,7.64,85,,,3.98,7.64,percent of total billed charges,
terbinafine 1 % Cream 15 g Tube,25000000,CDM,,,250,RC,51672208001,NDC,facility,both,1,GR,9.65,6.83,Aetna First Health,Commercial,,8.2,85,,,4.28,8.2,percent of total billed charges,
neomycin-bacitracin-polymyxin 3.5-400-5000 Ointment 14 g Tube,25000000,CDM,,,250,RC,45802014301,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 14 g Tube,25000000,CDM,,,250,RC,45802014301,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
triple antibiotic 5-400-5000 Ointment 28 g Tube,25000000,CDM,,,250,RC,00904073431,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
terbinafine 1 % Cream 15 g Tube,25000000,CDM,,,250,RC,24385052405,NDC,facility,both,1,GR,10.06,7.12,Aetna First Health,Commercial,,8.55,85,,,4.46,8.55,percent of total billed charges,
sodium metabisulfite Granules 0.075 g Bottle,25000000,CDM,,,250,RC,51552006909,NDC,facility,both,1,GR,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
terbinafine 1 % Cream 12 g Tube,25000000,CDM,,,250,RC,00067399842,NDC,facility,both,1,GR,10.73,7.6,Aetna First Health,Commercial,,9.12,85,,,4.76,9.12,percent of total billed charges,
Eucerin Cream 113 g Jar,25000000,CDM,,,250,RC,72140000022,NDC,facility,both,1,GR,11.02,7.8,Aetna First Health,Commercial,,9.37,85,,,4.88,9.37,percent of total billed charges,
cellulose Powder 240 g Bottle,25000000,CDM,,,250,RC,46017004408,NDC,facility,both,1,GR,12.24,8.67,Aetna First Health,Commercial,,10.4,85,,,5.42,10.4,percent of total billed charges,
benzoyl peroxide 5 % Gel 42.5 g Tube,25000000,CDM,,,250,RC,00536105556,NDC,facility,both,1,GR,14.45,10.23,Aetna First Health,Commercial,,12.28,85,,,6.4,12.28,percent of total billed charges,
terbinafine 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672208002,NDC,facility,both,1,GR,14.45,10.23,Aetna First Health,Commercial,,12.28,85,,,6.4,12.28,percent of total billed charges,
potassium sorbate Crystals 100 g Bottle,25000000,CDM,,,250,RC,51552021404,NDC,facility,both,1,GR,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
starch Powder 500 g Bottle,25000000,CDM,,,250,RC,51552043906,NDC,facility,both,1,GR,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
terbinafine 1 % Cream 28.4 g Tube,25000000,CDM,,,250,RC,24385052403,NDC,facility,both,1,GR,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
intrasite gel Misc 15 g Box,25000000,CDM,,,250,RC,08888800155,NDC,facility,both,1,GR,16.2,11.47,Aetna First Health,Commercial,,13.77,85,,,7.18,13.77,percent of total billed charges,
benzoyl peroxide 5 % Liquid 237 g Bottle,25000000,CDM,,,250,RC,67405082508,NDC,facility,both,1,GR,16.71,11.83,Aetna First Health,Commercial,,14.2,85,,,7.41,14.2,percent of total billed charges,
benzoyl peroxide 5 % Liquid 237 g Bottle,25000000,CDM,,,250,RC,35573045308,NDC,facility,both,1,GR,16.71,11.83,Aetna First Health,Commercial,,14.2,85,,,7.41,14.2,percent of total billed charges,
mupirocin 2 % Ointment 1 g Box,25000000,CDM,,,250,RC,50268057211,NDC,facility,both,1,GR,17.09,12.1,Aetna First Health,Commercial,,14.53,85,,,7.57,14.53,percent of total billed charges,
terbinafine 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,00067399830,NDC,facility,both,1,GR,18.23,12.91,Aetna First Health,Commercial,,15.5,85,,,8.08,15.5,percent of total billed charges,
Eucerin Cream 454 g Jar,25000000,CDM,,,250,RC,72140000021,NDC,facility,both,1,GR,19.07,13.5,Aetna First Health,Commercial,,16.21,85,,,8.45,16.21,percent of total billed charges,
benzoyl peroxide 5 % Gel 60 g Tube,25000000,CDM,,,250,RC,45802021696,NDC,facility,both,1,GR,20.7,14.66,Aetna First Health,Commercial,,17.6,85,,,9.17,17.6,percent of total billed charges,
diclofenac 1 % Gel 50 g Tube,25000000,CDM,,,250,RC,46122075237,NDC,facility,both,1,GR,23.8,16.85,Aetna First Health,Commercial,,20.23,85,,,10.55,20.23,percent of total billed charges,
l-glutamine Powder 100 g Bottle,25000000,CDM,,,250,RC,51552028505,NDC,facility,both,1,GR,29.25,20.71,Aetna First Health,Commercial,,24.86,85,,,12.96,24.86,percent of total billed charges,
Tetracaine HCl Powder 0.5 g Bottle,25000000,CDM,,,250,RC,51552026909,NDC,facility,both,1,GR,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
sodium metabisulfite Granules 500 g Bottle,25000000,CDM,,,250,RC,51552006906,NDC,facility,both,1,GR,33,23.36,Aetna First Health,Commercial,,28.05,85,,,14.63,28.05,percent of total billed charges,
mupirocin 2 % Ointment 15 g Tube,25000000,CDM,,,250,RC,51672131201,NDC,facility,both,1,GR,34.02,24.09,Aetna First Health,Commercial,,28.92,85,,,15.08,28.92,percent of total billed charges,
terbinafine 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,87701040472,NDC,facility,both,1,GR,34.56,24.47,Aetna First Health,Commercial,,29.38,85,,,15.32,29.38,percent of total billed charges,
diclofenac 1 % Gel 50 g Tube,25000000,CDM,,,250,RC,00536129434,NDC,facility,both,1,GR,35.4,25.06,Aetna First Health,Commercial,,30.09,85,,,15.69,30.09,percent of total billed charges,
Citric Acid Monohydrate Granules 100 g Bottle,25000000,CDM,,,250,RC,51552007604,NDC,facility,both,1,GR,35.7,25.28,Aetna First Health,Commercial,,30.35,85,,,15.82,30.35,percent of total billed charges,
diclofenac 1 % Gel 50 g Tube,25000000,CDM,,,250,RC,00067815202,NDC,facility,both,1,GR,35.8,25.35,Aetna First Health,Commercial,,30.43,85,,,15.87,30.43,percent of total billed charges,
butenafine 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672210002,NDC,facility,both,1,GR,38.52,27.27,Aetna First Health,Commercial,,32.74,85,,,17.07,32.74,percent of total billed charges,
lidocaine Powder 4 g Bottle,25000000,CDM,,,250,RC,51552010609,NDC,facility,both,1,GR,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
bacitracin-polymyxin-neomycin-hydrocortisone 1 % Ointment 15 g Tube,25000000,CDM,,,250,RC,61570003150,NDC,facility,both,1,GR,42.38,30.01,Aetna First Health,Commercial,,36.02,85,,,18.78,36.02,percent of total billed charges,
desoximetasone 0.25 % Ointment 15 g Tube,25000000,CDM,,,250,RC,52565003015,NDC,facility,both,1,GR,49.98,35.39,Aetna First Health,Commercial,,42.48,85,,,22.15,42.48,percent of total billed charges,
sodium polystyrene sulfonate Powder 15 g Bottle,25000000,CDM,,,250,RC,10702003615,NDC,facility,both,1,GR,49.98,35.39,Aetna First Health,Commercial,,42.48,85,,,22.15,42.48,percent of total billed charges,
sodium polystyrene sulfonate Powder 15 g Bottle,25000000,CDM,,,250,RC,11534016616,NDC,facility,both,1,GR,49.98,35.39,Aetna First Health,Commercial,,42.48,85,,,22.15,42.48,percent of total billed charges,
diclofenac 1 % Gel 150 g Tube,25000000,CDM,,,250,RC,46122075253,NDC,facility,both,1,GR,51.6,36.53,Aetna First Health,Commercial,,43.86,85,,,22.87,43.86,percent of total billed charges,
benzoyl peroxide 10 % Gel 60 g Tube,25000000,CDM,,,250,RC,45802030896,NDC,facility,both,1,GR,56.4,39.93,Aetna First Health,Commercial,,47.94,85,,,25,47.94,percent of total billed charges,
silver sulfADIAZINE 1 % Cream 85 g Tube,25000000,CDM,,,250,RC,67877012485,NDC,facility,both,1,GR,59.5,42.13,Aetna First Health,Commercial,,50.58,85,,,26.37,50.58,percent of total billed charges,
desoximetasone 0.25 % Ointment 15 g Tube,25000000,CDM,,,250,RC,45802049614,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
EPINEPHrine Bitartrate Powder 0.18 g Bottle,25000000,CDM,,,250,RC,51552045409,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
lidocaine Powder 25 g Bottle,25000000,CDM,,,250,RC,51552010604,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
polyethylene glycol 3350 238 G/ 64 OZ Solution 238 g Bottle,25000000,CDM,,,250,RC,88887800003,NDC,facility,both,1,GR,60.93,43.14,Aetna First Health,Commercial,,51.79,85,,,27,51.79,percent of total billed charges,
butamben-tetracaine-benzocaine 2-2-14 % Aerosol 56 g Bottle,25000000,CDM,,,250,RC,10223020101,NDC,facility,both,1,GR,64.19,45.45,Aetna First Health,Commercial,,54.56,85,,,28.45,54.56,percent of total billed charges,
gentamicin 0.3 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00574410235,NDC,facility,both,1,GR,66.6,47.15,Aetna First Health,Commercial,,56.61,85,,,29.52,56.61,percent of total billed charges,
econazole nitrate 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,52565002230,NDC,facility,both,1,GR,69.96,49.53,Aetna First Health,Commercial,,59.47,85,,,31.01,59.47,percent of total billed charges,
atropine 1 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208082555,NDC,facility,both,1,GR,70.04,49.59,Aetna First Health,Commercial,,59.53,85,,,31.04,59.53,percent of total billed charges,
benzoyl peroxide 5 % Liquid 113 g Bottle,25000000,CDM,,,250,RC,24470090004,NDC,facility,both,1,GR,75.94,53.77,Aetna First Health,Commercial,,64.55,85,,,33.66,64.55,percent of total billed charges,
iodoform Powder 100 g Bottle,25000000,CDM,,,250,RC,51552023009,NDC,facility,both,1,GR,77.55,54.91,Aetna First Health,Commercial,,65.92,85,,,34.37,65.92,percent of total billed charges,
clindamycin 1 % Gel 30 g Tube,25000000,CDM,,,250,RC,21922002705,NDC,facility,both,1,GR,80.04,56.67,Aetna First Health,Commercial,,68.03,85,,,35.47,68.03,percent of total billed charges,
peruvian balsam Liquid 113 g Bottle,25000000,CDM,,,250,RC,00395225594,NDC,facility,both,1,GR,82.55,58.45,Aetna First Health,Commercial,,70.17,85,,,36.59,70.17,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 45 g Tube,25000000,CDM,,,250,RC,68462029855,NDC,facility,both,1,GR,87.12,61.68,Aetna First Health,Commercial,,74.05,85,,,38.61,74.05,percent of total billed charges,
calcium gluconate 2.5 % Gel 25 g Tube,25000000,CDM,,,250,RC,77683006306,NDC,facility,both,1,GR,108,76.46,Aetna First Health,Commercial,,91.8,85,,,47.87,91.8,percent of total billed charges,
ciclopirox 0.77 % Cream 30 g Tube,25000000,CDM,,,250,RC,45802013811,NDC,facility,both,1,GR,108.36,76.72,Aetna First Health,Commercial,,92.11,85,,,48.03,92.11,percent of total billed charges,
chlorproMAZINE HCl powder Powder 25 g Bottle,25000000,CDM,,,250,RC,51552013904,NDC,facility,both,1,GR,130.4,92.32,Aetna First Health,Commercial,,110.84,85,,,57.79,110.84,percent of total billed charges,
ciclopirox 0.77 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672131802,NDC,facility,both,1,GR,132.84,94.05,Aetna First Health,Commercial,,112.91,85,,,58.87,112.91,percent of total billed charges,
salicylic acid Powder 454 g Bottle,25000000,CDM,,,250,RC,00395262501,NDC,facility,both,1,GR,143.46,101.57,Aetna First Health,Commercial,,121.94,85,,,63.58,121.94,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 45 g Tube,25000000,CDM,,,250,RC,00168025846,NDC,facility,both,1,GR,145.26,102.84,Aetna First Health,Commercial,,123.47,85,,,64.38,123.47,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 45 g Tube,25000000,CDM,,,250,RC,51672404806,NDC,facility,both,1,GR,145.26,102.84,Aetna First Health,Commercial,,123.47,85,,,64.38,123.47,percent of total billed charges,
butamben-tetracaine-benzocaine 2-2-14 % Aerosol 20 g Bottle,25000000,CDM,,,250,RC,10223020103,NDC,facility,both,1,GR,148.75,105.32,Aetna First Health,Commercial,,126.44,85,,,65.93,126.44,percent of total billed charges,
ketoconazole 2 % Cream 60 g Tube,25000000,CDM,,,250,RC,00168009960,NDC,facility,both,1,GR,150,106.2,Aetna First Health,Commercial,,127.5,85,,,66.48,127.5,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 45 g Tube,25000000,CDM,,,250,RC,16714049602,NDC,facility,both,1,GR,158.58,112.27,Aetna First Health,Commercial,,134.79,85,,,70.28,134.79,percent of total billed charges,
clindamycin-benzoyl peroxide 1-5 % Gel 25 g Jar,25000000,CDM,,,250,RC,68462048619,NDC,facility,both,1,GR,160,113.28,Aetna First Health,Commercial,,136,85,,,70.91,136,percent of total billed charges,
clindamycin-benzoyl peroxide 1-5 % Gel 25 g Jar,25000000,CDM,,,250,RC,45802050901,NDC,facility,both,1,GR,160,113.28,Aetna First Health,Commercial,,136,85,,,70.91,136,percent of total billed charges,
bacitracin-neomycin-polymyxin-hydrocortisone 1 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,17478071935,NDC,facility,both,1,GR,197.4,139.76,Aetna First Health,Commercial,,167.79,85,,,87.49,167.79,percent of total billed charges,
bacitracin-neomycin-polymyxin-hydrocortisone 1 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00574414435,NDC,facility,both,1,GR,199.92,141.54,Aetna First Health,Commercial,,169.93,85,,,88.6,169.93,percent of total billed charges,
econazole nitrate 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672130302,NDC,facility,both,1,GR,200.28,141.8,Aetna First Health,Commercial,,170.24,85,,,88.76,170.24,percent of total billed charges,
econazole nitrate 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,45802046611,NDC,facility,both,1,GR,200.28,141.8,Aetna First Health,Commercial,,170.24,85,,,88.76,170.24,percent of total billed charges,
erythromycin 2 % Gel 30 g Tube,25000000,CDM,,,250,RC,45802096694,NDC,facility,both,1,GR,201.6,142.73,Aetna First Health,Commercial,,171.36,85,,,89.35,171.36,percent of total billed charges,
bacitracin-neomycin-polymyxin-hydrocortisone 1 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,24208078555,NDC,facility,both,1,GR,208.17,147.38,Aetna First Health,Commercial,,176.94,85,,,92.26,176.94,percent of total billed charges,
gentamicin 0.1 % Cream 30 g Tube,25000000,CDM,,,250,RC,45802005611,NDC,facility,both,1,GR,210.72,149.19,Aetna First Health,Commercial,,179.11,85,,,93.39,179.11,percent of total billed charges,
ketoconazole 2 % Cream 60 g Tube,25000000,CDM,,,250,RC,51672129803,NDC,facility,both,1,GR,228.24,161.59,Aetna First Health,Commercial,,194,85,,,101.16,194,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Cream 45 g Tube,25000000,CDM,,,250,RC,00472037945,NDC,facility,both,1,GR,232.02,164.27,Aetna First Health,Commercial,,197.22,85,,,102.83,197.22,percent of total billed charges,
fluorouracil 5 % Cream 40 g Tube,25000000,CDM,,,250,RC,00187320447,NDC,facility,both,1,GR,240,169.92,Aetna First Health,Commercial,,204,85,,,106.37,204,percent of total billed charges,
ciclopirox 0.77 % Gel 30 g Tube,25000000,CDM,,,250,RC,68462045535,NDC,facility,both,1,GR,259.44,183.68,Aetna First Health,Commercial,,220.52,85,,,114.98,220.52,percent of total billed charges,
ciclopirox 0.77 % Cream 90 g Tube,25000000,CDM,,,250,RC,51672131808,NDC,facility,both,1,GR,259.56,183.77,Aetna First Health,Commercial,,220.63,85,,,115.04,220.63,percent of total billed charges,
ciclopirox 0.77 % Cream 90 g Tube,25000000,CDM,,,250,RC,45802013818,NDC,facility,both,1,GR,259.56,183.77,Aetna First Health,Commercial,,220.63,85,,,115.04,220.63,percent of total billed charges,
ciclopirox 0.77 % Cream 90 g Tube,25000000,CDM,,,250,RC,00713063818,NDC,facility,both,1,GR,259.56,183.77,Aetna First Health,Commercial,,220.63,85,,,115.04,220.63,percent of total billed charges,
tretinoin 0.01 % Gel 15 g Tube,25000000,CDM,,,250,RC,66530025615,NDC,facility,both,1,GR,265.92,188.27,Aetna First Health,Commercial,,226.03,85,,,117.86,226.03,percent of total billed charges,
tretinoin 0.01 % Gel 15 g Tube,25000000,CDM,,,250,RC,00378808515,NDC,facility,both,1,GR,265.92,188.27,Aetna First Health,Commercial,,226.03,85,,,117.86,226.03,percent of total billed charges,
adapalene 0.3 % Gel 45 g Tube,25000000,CDM,,,250,RC,51672137706,NDC,facility,both,1,GR,266.04,188.36,Aetna First Health,Commercial,,226.13,85,,,117.91,226.13,percent of total billed charges,
adapalene 0.3 % Gel 45 g Tube,25000000,CDM,,,250,RC,21922005106,NDC,facility,both,1,GR,266.04,188.36,Aetna First Health,Commercial,,226.13,85,,,117.91,226.13,percent of total billed charges,
clindamycin 1 % Gel 30 g Tube,25000000,CDM,,,250,RC,59762374301,NDC,facility,both,1,GR,276.36,195.66,Aetna First Health,Commercial,,234.91,85,,,122.48,234.91,percent of total billed charges,
erythromycin 2 % Gel 60 g Tube,25000000,CDM,,,250,RC,45802096696,NDC,facility,both,1,GR,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
tetracaine Powder 5 g Bottle,25000000,CDM,,,250,RC,49452767501,NDC,facility,both,1,GR,296.8,210.13,Aetna First Health,Commercial,,252.28,85,,,131.54,252.28,percent of total billed charges,
acyclovir 5 % Ointment 15 g Tube,25000000,CDM,,,250,RC,00378870006,NDC,facility,both,1,GR,300,212.4,Aetna First Health,Commercial,,255,85,,,132.96,255,percent of total billed charges,
mupirocin calcium 2 % Cream 15 g Tube,25000000,CDM,,,250,RC,51672137001,NDC,facility,both,1,GR,300,212.4,Aetna First Health,Commercial,,255,85,,,132.96,255,percent of total billed charges,
gelatin adsorbable Powder 1 g Packet,25000000,CDM,,,250,RC,00009043304,NDC,facility,both,1,GR,302.89,214.45,Aetna First Health,Commercial,,257.46,85,,,134.24,257.46,percent of total billed charges,
gentamicin 0.1 % Ointment 30 g Tube,25000000,CDM,,,250,RC,45802004611,NDC,facility,both,1,GR,315.96,223.7,Aetna First Health,Commercial,,268.57,85,,,140.03,268.57,percent of total billed charges,
gentamicin 0.1 % Ointment 30 g Tube,25000000,CDM,,,250,RC,00713068231,NDC,facility,both,1,GR,315.96,223.7,Aetna First Health,Commercial,,268.57,85,,,140.03,268.57,percent of total billed charges,
mupirocin calcium 2 % Cream 15 g Tube,25000000,CDM,,,250,RC,00029152722,NDC,facility,both,1,GR,329.22,233.09,Aetna First Health,Commercial,,279.84,85,,,145.91,279.84,percent of total billed charges,
clindamycin 1 % Gel 30 g Tube,25000000,CDM,,,250,RC,00168020230,NDC,facility,both,1,GR,331.68,234.83,Aetna First Health,Commercial,,281.93,85,,,147,281.93,percent of total billed charges,
tretinoin 0.05 % Cream 20 g Tube,25000000,CDM,,,250,RC,66530025420,NDC,facility,both,1,GR,375.52,265.87,Aetna First Health,Commercial,,319.19,85,,,166.43,319.19,percent of total billed charges,
tretinoin 0.05 % Cream 20 g Tube,25000000,CDM,,,250,RC,00574220520,NDC,facility,both,1,GR,375.52,265.87,Aetna First Health,Commercial,,319.19,85,,,166.43,319.19,percent of total billed charges,
tretinoin 0.05 % Cream 20 g Tube,25000000,CDM,,,250,RC,51672139400,NDC,facility,both,1,GR,375.52,265.87,Aetna First Health,Commercial,,319.19,85,,,166.43,319.19,percent of total billed charges,
gelatin adsorbable Powder 1 g Packet,25000000,CDM,,,250,RC,63713001978,NDC,facility,both,1,GR,388.97,275.39,Aetna First Health,Commercial,,330.62,85,,,172.39,330.62,percent of total billed charges,
econazole nitrate 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,00168031230,NDC,facility,both,1,GR,389.52,275.78,Aetna First Health,Commercial,,331.09,85,,,172.64,331.09,percent of total billed charges,
fluorouracil 5 % Cream 40 g Tube,25000000,CDM,,,250,RC,51862036240,NDC,facility,both,1,GR,411.84,291.58,Aetna First Health,Commercial,,350.06,85,,,182.53,350.06,percent of total billed charges,
chlorproMAZINE HCl powder Powder 10 g Bottle,25000000,CDM,,,250,RC,38779042301,NDC,facility,both,1,GR,432.16,305.97,Aetna First Health,Commercial,,367.34,85,,,191.53,367.34,percent of total billed charges,
erythromycin 2 % Gel 30 g Tube,25000000,CDM,,,250,RC,52565003330,NDC,facility,both,1,GR,480,339.84,Aetna First Health,Commercial,,408,85,,,212.74,408,percent of total billed charges,
pimecrolimus 1 % Cream 30 g Tube,25000000,CDM,,,250,RC,00078037546,NDC,facility,both,1,GR,486.12,344.17,Aetna First Health,Commercial,,413.2,85,,,215.45,413.2,percent of total billed charges,
erythromycin 2 % Gel 30 g Tube,25000000,CDM,,,250,RC,00168021630,NDC,facility,both,1,GR,497.4,352.16,Aetna First Health,Commercial,,422.79,85,,,220.45,422.79,percent of total billed charges,
clindamycin 1 % Gel 60 g Tube,25000000,CDM,,,250,RC,59762374302,NDC,facility,both,1,GR,498,352.58,Aetna First Health,Commercial,,423.3,85,,,220.71,423.3,percent of total billed charges,
HYDROmorphone HCl Powder 1 g Bottle,25000000,CDM,,,250,RC,00406324552,NDC,facility,both,1,GR,508.64,360.12,Aetna First Health,Commercial,,432.34,85,,,225.43,432.34,percent of total billed charges,
urea Powder 500 g Bottle,25000000,CDM,,,250,RC,38779010108,NDC,facility,both,1,GR,534,378.07,Aetna First Health,Commercial,,453.9,85,,,236.67,453.9,percent of total billed charges,
mupirocin calcium 2 % Cream 30 g Tube,25000000,CDM,,,250,RC,00029152725,NDC,facility,both,1,GR,557.88,394.98,Aetna First Health,Commercial,,474.2,85,,,247.25,474.2,percent of total billed charges,
clindamycin 1 % Gel 60 g Tube,25000000,CDM,,,250,RC,00168020260,NDC,facility,both,1,GR,597.36,422.93,Aetna First Health,Commercial,,507.76,85,,,264.75,507.76,percent of total billed charges,
clindamycin-benzoyl peroxide 1-5 % Gel 50 g Jar,25000000,CDM,,,250,RC,00378868854,NDC,facility,both,1,GR,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
mupirocin calcium 2 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672137002,NDC,facility,both,1,GR,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
tretinoin 0.025 % Cream 45 g Tube,25000000,CDM,,,250,RC,00574222545,NDC,facility,both,1,GR,633.96,448.84,Aetna First Health,Commercial,,538.87,85,,,280.97,538.87,percent of total billed charges,
fluorometholone 0.1 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00023031604,NDC,facility,both,1,GR,641.61,454.26,Aetna First Health,Commercial,,545.37,85,,,284.36,545.37,percent of total billed charges,
dexAMETHasone Powder 5 g Bottle,25000000,CDM,,,250,RC,49452246502,NDC,facility,both,1,GR,674.98,477.89,Aetna First Health,Commercial,,573.73,85,,,299.15,573.73,percent of total billed charges,
microfibrillar collagen Powder 1 g Jar,25000000,CDM,,,250,RC,53276101002,NDC,facility,both,1,GR,680.35,481.69,Aetna First Health,Commercial,,578.3,85,,,301.53,578.3,percent of total billed charges,
erythromycin 2 % Gel 30 g Tube,25000000,CDM,,,250,RC,40076041530,NDC,facility,both,1,GR,699,494.89,Aetna First Health,Commercial,,594.15,85,,,309.8,594.15,percent of total billed charges,
mupirocin calcium 2 % Cream 15 g Tube,25000000,CDM,,,250,RC,68462056417,NDC,facility,both,1,GR,784.5,555.43,Aetna First Health,Commercial,,666.82,85,,,347.69,666.82,percent of total billed charges,
adapalene 0.1 % Cream 45 g Tube,25000000,CDM,,,250,RC,00168042446,NDC,facility,both,1,GR,786.24,556.66,Aetna First Health,Commercial,,668.3,85,,,348.46,668.3,percent of total billed charges,
tacrolimus 0.1 % Ointment 60 g Tube,25000000,CDM,,,250,RC,68462053465,NDC,facility,both,1,GR,799.92,566.34,Aetna First Health,Commercial,,679.93,85,,,354.52,679.93,percent of total billed charges,
fluorouracil 5 % Cream 40 g Tube,25000000,CDM,,,250,RC,66530024940,NDC,facility,both,1,GR,823.68,583.17,Aetna First Health,Commercial,,700.13,85,,,365.05,700.13,percent of total billed charges,
calcipotriene 0.005 % Cream 60 g Tube,25000000,CDM,,,250,RC,66993087761,NDC,facility,both,1,GR,840.24,594.89,Aetna First Health,Commercial,,714.2,85,,,372.39,714.2,percent of total billed charges,
ciprofloxacin 0.3 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00065065435,NDC,facility,both,1,GR,857.44,607.07,Aetna First Health,Commercial,,728.82,85,,,380.02,728.82,percent of total billed charges,
tobramycin 0.3 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,00065064435,NDC,facility,both,1,GR,857.44,607.07,Aetna First Health,Commercial,,728.82,85,,,380.02,728.82,percent of total billed charges,
tazarotene 0.1 % Cream 30 g Tube,25000000,CDM,,,250,RC,51672137302,NDC,facility,both,1,GR,867.24,614.01,Aetna First Health,Commercial,,737.15,85,,,384.36,737.15,percent of total billed charges,
calcipotriene 0.005 % Cream 60 g Tube,25000000,CDM,,,250,RC,68462050165,NDC,facility,both,1,GR,882.24,624.63,Aetna First Health,Commercial,,749.9,85,,,391.01,749.9,percent of total billed charges,
ketoprofen Powder 25 g Bottle,25000000,CDM,,,250,RC,38779007804,NDC,facility,both,1,GR,888.2,628.85,Aetna First Health,Commercial,,754.97,85,,,393.65,754.97,percent of total billed charges,
adapalene 0.1 % Cream 45 g Tube,25000000,CDM,,,250,RC,45802045384,NDC,facility,both,1,GR,903.96,640,Aetna First Health,Commercial,,768.37,85,,,400.64,768.37,percent of total billed charges,
fluorouracil 5 % Cream 40 g Tube,25000000,CDM,,,250,RC,00378479106,NDC,facility,both,1,GR,947.2,670.62,Aetna First Health,Commercial,,805.12,85,,,419.8,805.12,percent of total billed charges,
adapalene 0.3 % Gel 45 g Tube,25000000,CDM,,,250,RC,00781714219,NDC,facility,both,1,GR,991.08,701.68,Aetna First Health,Commercial,,842.42,85,,,439.25,842.42,percent of total billed charges,
chlorhexidine 4 % Solution 15 mL Package,25000000,CDM,,,250,RC,00234057517,NDC,facility,both,1,ML,1.64,1.16,Aetna First Health,Commercial,,1.39,85,,,0.73,1.39,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378967131,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 240 mL Bottle,25000000,CDM,,,250,RC,49884090738,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,47335075648,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 240 mL Bottle,25000000,CDM,,,250,RC,60432012608,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 240 mL Bottle,25000000,CDM,,,250,RC,00054354258,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 40 MG/ML Suspension 240 mL Bottle,25000000,CDM,,,250,RC,64380016001,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gentian violet 1 % Solution 59 mL Bottle,25000000,CDM,,,250,RC,87701040073,NDC,facility,both,1,ML,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
isopropyl alcohol 99 % Solution 473 mL Bottle,25000000,CDM,,,250,RC,00574006616,NDC,facility,both,1,ML,3.55,2.51,Aetna First Health,Commercial,,3.02,85,,,1.57,3.02,percent of total billed charges,
tetrahydrozoline 0.05 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24385007505,NDC,facility,both,1,ML,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
selenium sulfide 1 % Lotion 207 mL Bottle,25000000,CDM,,,250,RC,00536199553,NDC,facility,both,1,ML,4.35,3.08,Aetna First Health,Commercial,,3.7,85,,,1.93,3.7,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 5 mL Syringe,25000000,CDM,,,250,RC,08290306545,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% IV FLUSH 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,08290306546,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% flush 0.9% Solution 5 mL Syringe,25000000,CDM,,,250,RC,08290306545,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% flush 0.9% Solution 10 mL Syringe,25000000,CDM,,,250,RC,08290306546,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
Saline Flush 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,63807010075,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
Saline Flush 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,64253011130,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
Saline Flush 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,08881571121,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
Saline Flush 0.9 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,63807010001,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
sodium chloride 0.9% flush 0.9% Solution 3 mL Syringe,25000000,CDM,,,250,RC,08290306544,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
polyvinyl alcohol-povidone 5-6 MG/ML Solution 15 mL Bottle,25000000,CDM,,,250,RC,24385000605,NDC,facility,both,1,ML,5.11,3.62,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
gentian violet 1 % Solution 59 mL Bottle,25000000,CDM,,,250,RC,24385000346,NDC,facility,both,1,ML,5.13,3.63,Aetna First Health,Commercial,,4.36,85,,,2.27,4.36,percent of total billed charges,
glycerin Liquid 177 mL Bottle,25000000,CDM,,,250,RC,24385003330,NDC,facility,both,1,ML,5.31,3.76,Aetna First Health,Commercial,,4.51,85,,,2.35,4.51,percent of total billed charges,
castor oil Oil 59 mL Bottle,25000000,CDM,,,250,RC,00395051592,NDC,facility,both,1,ML,5.49,3.89,Aetna First Health,Commercial,,4.67,85,,,2.43,4.67,percent of total billed charges,
chlorhexidine 4 % Solution 118 mL Bottle,25000000,CDM,,,250,RC,00234057504,NDC,facility,both,1,ML,5.84,4.13,Aetna First Health,Commercial,,4.96,85,,,2.59,4.96,percent of total billed charges,
sodium chloride 5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00904649035,NDC,facility,both,1,ML,6.12,4.33,Aetna First Health,Commercial,,5.2,85,,,2.71,5.2,percent of total billed charges,
lidocaine 2% in mouthwash Solution 6 mL Vial,25000000,CDM,,,250,RC,98886800160,NDC,facility,both,1,ML,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
chlorhexidine 4 % Solution 118 mL Bottle,25000000,CDM,,,250,RC,52380127204,NDC,facility,both,1,ML,8.32,5.89,Aetna First Health,Commercial,,7.07,85,,,3.69,7.07,percent of total billed charges,
pramoxine 1 % Lotion 222 mL Pump Btl,25000000,CDM,,,250,RC,00145063005,NDC,facility,both,1,ML,9.66,6.84,Aetna First Health,Commercial,,8.21,85,,,4.28,8.21,percent of total billed charges,
chlorhexidine 4 % Solution 118 mL Bottle,25000000,CDM,,,250,RC,67618020004,NDC,facility,both,1,ML,9.91,7.02,Aetna First Health,Commercial,,8.42,85,,,4.39,8.42,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,00487980101,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,00487980125,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,76204010025,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,76204010030,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,76204010001,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Vial,25000000,CDM,,,250,RC,00378797031,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,60687039483,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,60687039479,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487950101,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487950103,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487950125,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol (2.5 MG/3ML) 0.083% Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487950160,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,69097031887,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,69097031987,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,69097031986,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,68180098430,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00185732230,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487020101,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487020160,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487020103,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204060001,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204060005,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204060012,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378967193,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00781714629,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204060030,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,76204060060,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,60687040583,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,60687040579,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487990401,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00487990425,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378705852,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
gentian violet 1 % Solution 59 mL Bottle,25000000,CDM,,,250,RC,00395100392,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
tetrahydrozoline 0.05 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00536121794,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.9% irrigation 0.9 % Solution 250 mL Bottle,25000000,CDM,,,250,RC,05042100882,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium 0.02 % Solution 2.5 mL Plas Cont,25000000,CDM,,,250,RC,00487980160,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Ampule,25000000,CDM,,,250,RC,68180098405,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00185732286,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,47335075649,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
albuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378699252,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00781751514,NDC,facility,both,1,ML,11.34,8.03,Aetna First Health,Commercial,,9.64,85,,,5.03,9.64,percent of total billed charges,
pramoxine 1 % Lotion 222 mL Bottle,25000000,CDM,,,250,RC,00316023075,NDC,facility,both,1,ML,11.66,8.26,Aetna First Health,Commercial,,9.91,85,,,5.17,9.91,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00781751687,NDC,facility,both,1,ML,11.94,8.45,Aetna First Health,Commercial,,10.15,85,,,5.29,10.15,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00781751614,NDC,facility,both,1,ML,11.94,8.45,Aetna First Health,Commercial,,10.15,85,,,5.29,10.15,percent of total billed charges,
ketotifen 0.035 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208060110,NDC,facility,both,1,ML,12.95,9.17,Aetna First Health,Commercial,,11.01,85,,,5.74,11.01,percent of total billed charges,
chlorhexidine 4 % Solution 237 mL Bottle,25000000,CDM,,,250,RC,46122013734,NDC,facility,both,1,ML,13.86,9.81,Aetna First Health,Commercial,,11.78,85,,,6.14,11.78,percent of total billed charges,
diphenhydrAMINE-lidocaine viscous-alum-mag hydroxide-simeth equal parts Solution 5 mL Cup,25000000,CDM,,,250,RC,08887800045,NDC,facility,both,1,ML,14.88,10.54,Aetna First Health,Commercial,,12.65,85,,,6.59,12.65,percent of total billed charges,
norepinephrine Injectable 10 mL Vial,25000000,CDM,,,250,RC,88888800348,NDC,facility,both,1,ML,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 15 mL Bottle,25000000,CDM,,,250,RC,19903001021,NDC,facility,both,1,ML,15.23,10.78,Aetna First Health,Commercial,,12.95,85,,,6.75,12.95,percent of total billed charges,
simethicone 40 MG/0.6ML Suspension 15 mL Bottle,25000000,CDM,,,250,RC,62372063015,NDC,facility,both,1,ML,15.23,10.78,Aetna First Health,Commercial,,12.95,85,,,6.75,12.95,percent of total billed charges,
benzoin Tincture 59 mL Bottle,25000000,CDM,,,250,RC,00395024792,NDC,facility,both,1,ML,16.11,11.41,Aetna First Health,Commercial,,13.69,85,,,7.14,13.69,percent of total billed charges,
lidocaine 1.4% - phenylephrine 0.28% sterile topical Solution 7 mL Syringe,25000000,CDM,,,250,RC,99700100342,NDC,facility,both,1,ML,17,12.04,Aetna First Health,Commercial,,14.45,85,,,7.53,14.45,percent of total billed charges,
sodium chloride 5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00536125494,NDC,facility,both,1,ML,17.52,12.4,Aetna First Health,Commercial,,14.89,85,,,7.76,14.89,percent of total billed charges,
sodium chloride 5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478062312,NDC,facility,both,1,ML,17.69,12.52,Aetna First Health,Commercial,,15.04,85,,,7.84,15.04,percent of total billed charges,
tetracaine 0.5 % Solution 0.6 mL Plas Cont,25000000,CDM,,,250,RC,54799050501,NDC,facility,both,1,ML,18.46,13.07,Aetna First Health,Commercial,,15.69,85,,,8.18,15.69,percent of total billed charges,
tetracaine 0.5 % Solution 0.6 mL Plas Cont,25000000,CDM,,,250,RC,54799050501,NDC,facility,both,1,ML,19.92,14.1,Aetna First Health,Commercial,,16.93,85,,,8.83,16.93,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00487970130,NDC,facility,both,1,ML,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
ferric subsulfate Solution 100 mL Bottle,25000000,CDM,,,250,RC,51552035703,NDC,facility,both,1,ML,20.25,14.34,Aetna First Health,Commercial,,17.21,85,,,8.97,17.21,percent of total billed charges,
sodium chloride (hypertonic) 2 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208027615,NDC,facility,both,1,ML,22.77,16.12,Aetna First Health,Commercial,,19.35,85,,,10.09,19.35,percent of total billed charges,
lidocaine urethral/mucosal 2 % Prefilled Syringe 5 mL Syringe,25000000,CDM,,,250,RC,76329301205,NDC,facility,both,1,ML,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
lidocaine urethral/mucosal 2 % Prefilled Syringe 6 mL Syringe,25000000,CDM,,,250,RC,25021067376,NDC,facility,both,1,ML,23.81,16.86,Aetna First Health,Commercial,,20.24,85,,,10.55,20.24,percent of total billed charges,
lidocaine urethral/mucosal 2 % Prefilled Syringe 5 mL Syringe,25000000,CDM,,,250,RC,76329301105,NDC,facility,both,1,ML,24,16.99,Aetna First Health,Commercial,,20.4,85,,,10.64,20.4,percent of total billed charges,
timolol 0.25 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,60758080210,NDC,facility,both,1,ML,24.8,17.56,Aetna First Health,Commercial,,21.08,85,,,10.99,21.08,percent of total billed charges,
lidocaine urethral/mucosal 2 % Prefilled Syringe 11 mL Syringe,25000000,CDM,,,250,RC,25021067377,NDC,facility,both,1,ML,25.39,17.98,Aetna First Health,Commercial,,21.58,85,,,11.25,21.58,percent of total billed charges,
chlorhexidine 4 % Solution 946 mL Bottle,25000000,CDM,,,250,RC,67618020030,NDC,facility,both,1,ML,25.54,18.08,Aetna First Health,Commercial,,21.71,85,,,11.32,21.71,percent of total billed charges,
lidocaine urethral/mucosal 2 % Prefilled Syringe 10 mL Uro-Jet,25000000,CDM,,,250,RC,76329301305,NDC,facility,both,1,ML,25.64,18.15,Aetna First Health,Commercial,,21.79,85,,,11.36,21.79,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00093681545,NDC,facility,both,1,ML,26.36,18.66,Aetna First Health,Commercial,,22.41,85,,,11.68,22.41,percent of total billed charges,
brimonidine 0.2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,70069023201,NDC,facility,both,1,ML,26.8,18.97,Aetna First Health,Commercial,,22.78,85,,,11.88,22.78,percent of total billed charges,
povidone iodine 10% 17.5 mL in 0.9% sodium chloride 500 mL 500 mL Bag,25000000,CDM,,,250,RC,88888800315,NDC,facility,both,1,ML,27,19.12,Aetna First Health,Commercial,,22.95,85,,,11.97,22.95,percent of total billed charges,
ciprofloxacin 0.3 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,61314065610,NDC,facility,both,1,ML,27.5,19.47,Aetna First Health,Commercial,,23.38,85,,,12.19,23.38,percent of total billed charges,
charcoal activated-sorbitol 50 GM/240ML Suspension 240 mL Bottle,25000000,CDM,90675,CPT,250,RC,00574012008,NDC,facility,both,1,ML,28.44,20.14,Aetna First Health,Commercial,,24.17,85,,,12.6,24.17,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00093681573,NDC,facility,both,1,ML,30.13,21.33,Aetna First Health,Commercial,,25.61,85,,,13.35,25.61,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00591376730,NDC,facility,both,1,ML,30.13,21.33,Aetna First Health,Commercial,,25.61,85,,,13.35,25.61,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00093681519,NDC,facility,both,1,ML,30.13,21.33,Aetna First Health,Commercial,,25.61,85,,,13.35,25.61,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00487960101,NDC,facility,both,1,ML,31.62,22.39,Aetna First Health,Commercial,,26.88,85,,,14.01,26.88,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,69097031832,NDC,facility,both,1,ML,31.62,22.39,Aetna First Health,Commercial,,26.88,85,,,14.01,26.88,percent of total billed charges,
tropicamide 1 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,24208058559,NDC,facility,both,1,ML,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
benzoin Tincture 118 mL Bottle,25000000,CDM,,,250,RC,40565011182,NDC,facility,both,1,ML,32.39,22.93,Aetna First Health,Commercial,,27.53,85,,,14.36,27.53,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,69097031953,NDC,facility,both,1,ML,32.56,23.05,Aetna First Health,Commercial,,27.68,85,,,14.43,27.68,percent of total billed charges,
budesonide 0.25 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00186198804,NDC,facility,both,1,ML,34.86,24.68,Aetna First Health,Commercial,,29.63,85,,,15.45,29.63,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00093681673,NDC,facility,both,1,ML,35.46,25.11,Aetna First Health,Commercial,,30.14,85,,,15.72,30.14,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00093681645,NDC,facility,both,1,ML,35.46,25.11,Aetna First Health,Commercial,,30.14,85,,,15.72,30.14,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00591376830,NDC,facility,both,1,ML,35.46,25.11,Aetna First Health,Commercial,,30.14,85,,,15.72,30.14,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00093681619,NDC,facility,both,1,ML,35.46,25.11,Aetna First Health,Commercial,,30.14,85,,,15.72,30.14,percent of total billed charges,
ciprofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478071410,NDC,facility,both,1,ML,35.48,25.12,Aetna First Health,Commercial,,30.16,85,,,15.72,30.16,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00338002303,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,00990793002,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00990793003,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,69374095350,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,70092147550,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 5% electrolyte #48 Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00338014303,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.9% IV LINE FLUSH 0.9% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409798303,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.9% IV LINE FLUSH 0.9% Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,00409710167,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.45 % 0.45 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409798503,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,00338002302,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409793003,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,00409793002,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 5% 5% Solution 50 mL Flex Cont,25000000,CDM,,,250,RC,00409792313,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409793819,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 40% 40 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409793719,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 70 % Solution 500 mL Plas Cont,25000000,CDM,,,250,RC,00409791819,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
morphine dilution 0.1 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,88888800043,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.45 % 0.45 % Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,63323062603,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00264752010,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,63323082475,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.45 % 0.45 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00338004303,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.45 % 0.45 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,63323062604,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 20 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409793519,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 20 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00990793519,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
sodium chloride 0.9% IV LINE FLUSH 0.9% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00338004903,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
tetracaine 0.5 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,00065074112,NDC,facility,both,1,ML,36.76,26.03,Aetna First Health,Commercial,,31.25,85,,,16.29,31.25,percent of total billed charges,
lidocaine urethral/mucosal 2 % Prefilled Syringe 20 mL Syringe,25000000,CDM,,,250,RC,76329301505,NDC,facility,both,1,ML,37.04,26.22,Aetna First Health,Commercial,,31.48,85,,,16.42,31.48,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00487970101,NDC,facility,both,1,ML,37.22,26.35,Aetna First Health,Commercial,,31.64,85,,,16.5,31.64,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Ampule,25000000,CDM,,,250,RC,69097031932,NDC,facility,both,1,ML,37.22,26.35,Aetna First Health,Commercial,,31.64,85,,,16.5,31.64,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,60687052479,NDC,facility,both,1,ML,37.34,26.44,Aetna First Health,Commercial,,31.74,85,,,16.55,31.74,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,60687052483,NDC,facility,both,1,ML,37.34,26.44,Aetna First Health,Commercial,,31.74,85,,,16.55,31.74,percent of total billed charges,
phenol Liquid 500 mL Bottle,25000000,CDM,,,250,RC,51552011805,NDC,facility,both,1,ML,39,27.61,Aetna First Health,Commercial,,33.15,85,,,17.28,33.15,percent of total billed charges,
budesonide 0.5 MG/2ML Suspension 2 mL Plas Cont,25000000,CDM,,,250,RC,00186198904,NDC,facility,both,1,ML,41.03,29.05,Aetna First Health,Commercial,,34.88,85,,,18.18,34.88,percent of total billed charges,
lidocaine urethral/mucosal 2 % Gel 30 mL Tube,25000000,CDM,,,250,RC,17478081130,NDC,facility,both,1,ML,41.64,29.48,Aetna First Health,Commercial,,35.39,85,,,18.45,35.39,percent of total billed charges,
diclofenac 0.1 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,61314001425,NDC,facility,both,1,ML,42,29.74,Aetna First Health,Commercial,,35.7,85,,,18.61,35.7,percent of total billed charges,
caffeine citrate 20 MG/ML Solution 3 mL Vial,25000000,CDM,,,250,RC,51754050103,NDC,facility,both,1,ML,42,29.74,Aetna First Health,Commercial,,35.7,85,,,18.61,35.7,percent of total billed charges,
castellani paint Liquid 29.57 mL Bottle,25000000,CDM,,,250,RC,00884299301,NDC,facility,both,1,ML,42.18,29.86,Aetna First Health,Commercial,,35.85,85,,,18.69,35.85,percent of total billed charges,
tetrahydrozoline 0.05 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,49348003729,NDC,facility,both,1,ML,42.75,30.27,Aetna First Health,Commercial,,36.34,85,,,18.95,36.34,percent of total billed charges,
diclofenac 0.1 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,17478089225,NDC,facility,both,1,ML,43.4,30.73,Aetna First Health,Commercial,,36.89,85,,,19.23,36.89,percent of total billed charges,
neomycin-polymyxin B GU 40-200000 Solution 1 mL Ampule,25000000,CDM,,,250,RC,39822120102,NDC,facility,both,1,ML,43.7,30.94,Aetna First Health,Commercial,,37.15,85,,,19.37,37.15,percent of total billed charges,
neomycin-polymyxin B GU 40-200000 Solution 1 mL Ampule,25000000,CDM,,,250,RC,39822120101,NDC,facility,both,1,ML,43.7,30.94,Aetna First Health,Commercial,,37.15,85,,,19.37,37.15,percent of total billed charges,
EPINEPHrine 0.5 mg in 0.9% sodium chloride 150 mL 150 mL Bag,25000000,CDM,,,250,RC,88888800303,NDC,facility,both,1,ML,44,31.15,Aetna First Health,Commercial,,37.4,85,,,19.5,37.4,percent of total billed charges,
ferric subsulfate Solution 60 mL Bottle,25000000,CDM,,,250,RC,10481011202,NDC,facility,both,1,ML,44.4,31.44,Aetna First Health,Commercial,,37.74,85,,,19.68,37.74,percent of total billed charges,
balanced salt solution Solution 118 mL Bottle,25000000,CDM,,,250,RC,00065053004,NDC,facility,both,1,ML,46.02,32.58,Aetna First Health,Commercial,,39.12,85,,,20.4,39.12,percent of total billed charges,
ciprofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,16571012050,NDC,facility,both,1,ML,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
brimonidine 0.2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,61314014310,NDC,facility,both,1,ML,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
lidocaine 1% PF 1 % Solution 10 mL Ampule,25000000,CDM,,,250,RC,63323049297,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,63323049227,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,55150016102,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,63323049204,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 10 mL Ampule,25000000,CDM,,,250,RC,63323049697,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 2 mL Vial,25000000,CDM,,,250,RC,63323049527,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 2 mL Vial,25000000,CDM,,,250,RC,55150016402,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 2 mL Vial,25000000,CDM,,,250,RC,63323049509,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
moxifloxacin 1 MG/ML Solution 0.8 mL Syringe,25000000,CDM,,,250,RC,05446105001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 1 mL Vial,25000000,CDM,,,250,RC,00409212213,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 2 mL Vial,25000000,CDM,,,250,RC,00409212288,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 2 mL Vial,25000000,CDM,,,250,RC,00409212202,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 1 mL Vial,25000000,CDM,,,250,RC,00409212201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 2 mL Vial,25000000,CDM,,,250,RC,00143978610,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 1 mL Vial,25000000,CDM,,,250,RC,00143978710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 1 mL Vial,25000000,CDM,,,250,RC,00143978701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
enalaprilat 1.25 MG/ML Injectable 2 mL Vial,25000000,CDM,,,250,RC,00143978601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
indigotindisulfonate 8 MG/ML Solution 5 mL Ampule,25000000,CDM,,,250,RC,00517037510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
indigotindisulfonate 8 MG/ML Solution 5 mL Ampule,25000000,CDM,,,250,RC,17478050801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
indigotindisulfonate 8 MG/ML Solution 5 mL Ampule,25000000,CDM,,,250,RC,17478080801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781903795,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323041605,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,71288071206,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323041601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,63323041710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,63323041701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine 25-0.9 MG/5ML-% solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,71030000301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,69374094905,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium bromide 50 MG/5ML solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,69374092405,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium bromide 50 MG/5ML solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,65302051005,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
norepinephrine 4-0.9 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,69374052825,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
labetalol 20 MG/4ML solution prefilled syringe 4 mL Syringe,25000000,CDM,,,250,RC,69374094604,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
labetalol 20 MG/4ML solution prefilled syringe 4 mL Syringe,25000000,CDM,,,250,RC,70092100944,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine-phenylephrine 1-1.5 % Solution 0.8 mL Syringe,25000000,CDM,,,250,RC,05446111801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 mg in 100 mL 0.7% sodium chloride (premix) 1000-0.7 MG/100ML-% Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,51754010801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 mg in 100 mL 0.7% sodium chloride (premix) 1000-0.7 MG/100ML-% Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,51754010803,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ePHEDrine 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,14789001401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium chloride bacteriostatic 0.9 % Solution 10 mL Vial,25000000,CDM,,,250,RC,00409196612,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Trace Minerals Cr-Cu-Mn-Se-Zn 10-1000-500-60 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00517820125,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409669501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517078010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00069000602,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,25021067410,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,42023016910,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457047700,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457047710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,68382054507,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143950601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143950610,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,55150022110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409669511,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143931001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143931010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,72266014601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,72266014610,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 25% Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409177510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 25% Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409177540,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,00409490234,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,00409751716,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,76329330101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,00409751766,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ipratropium-albuterol 0.5-2.5 (3) MG/3ML Solution 3 mL Plas Cont,25000000,CDM,,,250,RC,00378698831,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 g/100 mL Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,08888800084,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
midazolam 5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409230802,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
midazolam 5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409230822,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% / phenylephrine 1.5% in BSS (PF) irrigant 1 mL Syringe,25000000,CDM,,,250,RC,08888800703,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323042405,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143968401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
BUPivacaine 0.25% 30 mL - lidocaine 1% 30 mL Solution 60 mL Vial,25000000,CDM,,,250,RC,88887800022,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
BUPvacaine 0.25% with epi 30 mL-lidocaine 1% 30 mL injection Solution 60 mL Vial,25000000,CDM,,,250,RC,88887800032,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2 % Solution 2 mL Vial,25000000,CDM,,,250,RC,63323020202,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2 % Solution 5 mL Vial,25000000,CDM,,,250,RC,69374094935,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Saline Bacteriostatic 0.9 % Solution 10 mL Vial,25000000,CDM,,,250,RC,63323092401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409729925,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409729945,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409553434,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 10 mL Syringe,25000000,CDM,,,250,RC,00409553424,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 10 mL Vial,25000000,CDM,,,250,RC,51754501201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 10 mL Vial,25000000,CDM,,,250,RC,51754501204,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 0.7 mL Vial,25000000,CDM,,,250,RC,00006430900,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00703950301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,67457077800,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70069036101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143987310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409177805,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323066005,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,36000003310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409177815,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,47781058720,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70860030041,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409955805,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409955849,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781322075,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781322095,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323042605,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,67457022805,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,67457022800,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,39822420001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,39822420002,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,55150022505,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143925001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,43066000710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409955811,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409955869,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,63323042602,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409318905,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409318910,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409140305,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409140310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409955810,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409955850,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781322092,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,25021066210,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457022810,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,39822420005,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,39822420006,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457022899,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,55150022610,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70860065110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,43066001310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409955831,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409955870,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,71288071810,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409703701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409516001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409516010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 10 mL Ampule,25000000,CDM,,,250,RC,00409428212,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70069014101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium bromide 50 MG/5ML solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,70092107344,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium bromide 50 MG/5ML solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,70092145244,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
oxytocin 30 units in 0.9% sodium chloride 500 mL premix 30-0.9 UT/500ML-% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,70092155207,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
oxytocin 30 units in 0.9% sodium chloride 500 mL premix 30-0.9 UT/500ML-% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,72196604401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
trace minerals cr-cu-mn-zn 0.01-1-0.5-5 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00517720125,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
trace minerals cr-cu-mn-zn 1-100-25-1000 MCG/ML Solution 3 mL Vial,25000000,CDM,,,250,RC,00517920325,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Vial,25000000,CDM,,,250,RC,00409664802,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409818301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409729973,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,71288070005,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,71288070006,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781322070,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,63323042610,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,51754020301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,42571031397,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,42571031375,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 10 mL Ampule,25000000,CDM,,,250,RC,63323049208,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 10 mL Ampule,25000000,CDM,,,250,RC,00409428202,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 2 mL Ampule,25000000,CDM,,,250,RC,55150016072,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 10 mL Ampule,25000000,CDM,,,250,RC,63323049603,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00074437805,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781315075,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781315095,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00703203301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00703203303,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70069014110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,71288071205,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,55150028401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,55150028410,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,25021066805,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70069016101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,70069016110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,71288071410,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,71288071411,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium glycerophosphate 1 MMOLE/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,63323024120,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
chromic chloride 40 MCG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409409301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium bromide 50 MG/5ML solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,71019032107,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fentaNYL 1.25-0.9 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,71286207301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fentaNYL 1.25-0.9 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,70092144405,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fentaNYL 2500 MCG/50ML Solution 50 mL Flex Cont,25000000,CDM,,,250,RC,70092150935,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fentaNYL 2500 MCG/50ML Solution 50 mL Flex Cont,25000000,CDM,,,250,RC,70092122335,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 1000 mg in 100 mL 0.7% sodium chloride (premix) 1000-0.7 MG/100ML-% Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,80830232901,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile diluent for flolan Solution 50 mL Vial,25000000,CDM,,,250,RC,00703925809,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Trace Minerals Cr-Cu-Mn-Se-Zn 4-400-100-20 MCG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517851025,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
trace minerals cr-cu-mn-zn 0.01-1-0.5-5 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517721025,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
trace minerals cr-cu-mn-zn 100-25-1500 MCG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00517620225,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457090200,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,67457090210,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
cysteine 50 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,66758000401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
cysteine 50 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,66758000402,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
cysteine 50 MG/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,66758000501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
cysteine 50 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781894070,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Vial,25000000,CDM,,,250,RC,00409664816,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
morphine in sodium chloride 100-0.9 MG/100ML-% Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,71286204006,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
morphine in sodium chloride 100-0.9 MG/100ML-% Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,70092138036,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
morphine in sodium chloride 100-0.9 MG/100ML-% Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,70092113036,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 100 mL Flex Cont,25000000,CDM,,,250,RC,51754010801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
flumazenil 0.5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781300375,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
magnesium chloride 200 MG/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,67457013450,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
pancuronium 1 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409464601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,00409329451,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,51754200104,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,00409329461,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409818311,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,51754200401,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
selenium 40 MCG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517651025,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,00409329905,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409729983,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,00409329916,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,00409329915,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,69784023020,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 4 MEQ/ML Solution 100 mL Vial,25000000,CDM,,,250,RC,63323003261,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sterile water (preservative free) Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00264785010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00703950303,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143966010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,25021066205,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,65293042605,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,47781061617,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,47781061620,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00143925010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,72611075601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,72611075610,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,25021068710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Flex Cont,25000000,CDM,,,250,RC,00143952601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
SUFentanil 50 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00409338221,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium phosphates-NaCl 15 MMOL/250ML Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,71285606001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409669509,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,63323082425,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 50 mL Syringe,25000000,CDM,,,250,RC,54569199101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dextrose 50 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409793619,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Aminosyn II 10% 10 % Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,00409416403,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409818325,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
potassium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409818315,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,00409329926,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,00409329946,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00641626101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,66794022841,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,66794022802,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143925101,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00143925110,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,66794022941,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
parenteral nutrition electrolytes Concentrate 20 mL Vial,25000000,CDM,,,250,RC,00409577901,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
parenteral nutrition electrolytes Concentrate 20 mL Vial,25000000,CDM,,,250,RC,00409577911,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
SUFentanil 50 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00409338211,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
tranexamic acid 100 mL Flex Cont,25000000,CDM,,,250,RC,51754010803,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% /epi 20 mL-bupivacaine 0.5% /epi 30 mL-NAHCO3 8.4% 5 mL Solution 55 mL Vial,25000000,CDM,,,250,RC,88887800012,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% 9.5 mL - epinephrine 1:1000 0.5 mL Solution 10 mL Vial,25000000,CDM,,,250,RC,88887800027,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
BUPivacaine 0.5% 20mL - EPINEPHrine 1:1000 0.52 mL Solution 20 mL Vial,25000000,CDM,,,250,RC,88887800075,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Saline Bacteriostatic 0.9 % Solution 30 mL Vial,25000000,CDM,,,250,RC,00409196607,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 50 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,67457057300,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
SUFentanil 100 MCG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409338222,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
SUFentanil 100 MCG/2ML Solution 2 mL Ampule,25000000,CDM,,,250,RC,17478005002,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 1% PF 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,63323049216,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % Solution 2 mL Ampule,25000000,CDM,,,250,RC,00409428225,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00409109812,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine 2% PF 2 % solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,71449002411,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium bromide 50 MG/5ML solution prefilled syringe 5 mL Syringe,25000000,CDM,,,250,RC,71449000411,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Ampule,25000000,CDM,,,250,RC,00409806201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
etomidate 2 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,65219044501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
metoprolol 5 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,72611074010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,63323042601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,72611075710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,71839014201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
rocuronium 100 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,71839014210,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Trace Minerals Cr-Cu-Mn-Se-Zn 10-1000-500-60 MCG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517821025,NDC,facility,both,1,ML,50.06,35.44,Aetna First Health,Commercial,,42.55,85,,,22.19,42.55,percent of total billed charges,
cysteine 50 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781894095,NDC,facility,both,1,ML,50.36,35.65,Aetna First Health,Commercial,,42.81,85,,,22.32,42.81,percent of total billed charges,
neomycin-polymyxin B GU 40-200000 Solution 1 mL Ampule,25000000,CDM,,,250,RC,00591219054,NDC,facility,both,1,ML,51,36.11,Aetna First Health,Commercial,,43.35,85,,,22.6,43.35,percent of total billed charges,
Trace Minerals Cu-Mn-Se-Zn 60-3-6-1000 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00517930201,NDC,facility,both,1,ML,51.35,36.36,Aetna First Health,Commercial,,43.65,85,,,22.76,43.65,percent of total billed charges,
Trace Minerals Cu-Mn-Se-Zn 60-3-6-1000 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,00517930225,NDC,facility,both,1,ML,51.35,36.36,Aetna First Health,Commercial,,43.65,85,,,22.76,43.65,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00703205601,NDC,facility,both,1,ML,51.75,36.64,Aetna First Health,Commercial,,43.99,85,,,22.94,43.99,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00703205603,NDC,facility,both,1,ML,51.75,36.64,Aetna First Health,Commercial,,43.99,85,,,22.94,43.99,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,55150028601,NDC,facility,both,1,ML,51.75,36.64,Aetna First Health,Commercial,,43.99,85,,,22.94,43.99,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,55150028610,NDC,facility,both,1,ML,51.75,36.64,Aetna First Health,Commercial,,43.99,85,,,22.94,43.99,percent of total billed charges,
oxytocin 30 units in 0.9% sodium chloride 500 mL premix 30-0.9 UT/500ML-% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,71449015770,NDC,facility,both,1,ML,51.75,36.64,Aetna First Health,Commercial,,43.99,85,,,22.94,43.99,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781903870,NDC,facility,both,1,ML,52.11,36.89,Aetna First Health,Commercial,,44.29,85,,,23.1,44.29,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409120801,NDC,facility,both,1,ML,52.27,37.01,Aetna First Health,Commercial,,44.43,85,,,23.17,44.43,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409120811,NDC,facility,both,1,ML,52.27,37.01,Aetna First Health,Commercial,,44.43,85,,,23.17,44.43,percent of total billed charges,
zinc chloride 1 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409409001,NDC,facility,both,1,ML,53.3,37.74,Aetna First Health,Commercial,,45.3,85,,,23.62,45.3,percent of total billed charges,
zinc chloride 1 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00409409011,NDC,facility,both,1,ML,53.3,37.74,Aetna First Health,Commercial,,45.3,85,,,23.62,45.3,percent of total billed charges,
epoprostenol 10000 ng/ml Solution 50 mL Syringe,25000000,CDM,,,250,RC,08888800645,NDC,facility,both,1,ML,54,38.23,Aetna First Health,Commercial,,45.9,85,,,23.93,45.9,percent of total billed charges,
multivitamin injection pediatric Solution 5 mL Vial,25000000,CDM,,,250,RC,54643564601,NDC,facility,both,1,ML,54.1,38.3,Aetna First Health,Commercial,,45.98,85,,,23.98,45.98,percent of total billed charges,
bupivacaine 0.25 % 30 mL in 0.9 % sodium chloride 30 mL 60 mL Syringe,25000000,CDM,,,250,RC,88888800342,NDC,facility,both,1,ML,55.5,39.29,Aetna First Health,Commercial,,47.18,85,,,24.6,47.18,percent of total billed charges,
timolol 0.25 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,64980051301,NDC,facility,both,1,ML,55.84,39.53,Aetna First Health,Commercial,,47.46,85,,,24.75,47.46,percent of total billed charges,
ciprofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314065605,NDC,facility,both,1,ML,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
ciprofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,69315030805,NDC,facility,both,1,ML,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
diclofenac 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208045705,NDC,facility,both,1,ML,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
lidocaine 1% 20 mL - Epinephrine 1:1000 0.52 mL Solution 20 mL Vial,25000000,CDM,,,250,RC,88887800026,NDC,facility,both,1,ML,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
diclofenac 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314001405,NDC,facility,both,1,ML,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
gentamicin 80 mg in omnipaque 300 mg/mL 50 mL Solution 50 mL Vial,25000000,CDM,,,250,RC,88887800036,NDC,facility,both,1,ML,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
sodium acetate 2 MEQ/ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,69784023120,NDC,facility,both,1,ML,56.03,39.67,Aetna First Health,Commercial,,47.63,85,,,24.83,47.63,percent of total billed charges,
norepinephrine 4-5 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,00338011220,NDC,facility,both,1,ML,56.25,39.83,Aetna First Health,Commercial,,47.81,85,,,24.93,47.81,percent of total billed charges,
fentaNYL 2500 MCG/50ML Solution 50 mL Flex Cont,25000000,CDM,,,250,RC,08888800646,NDC,facility,both,1,ML,56.25,39.83,Aetna First Health,Commercial,,47.81,85,,,24.93,47.81,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781315270,NDC,facility,both,1,ML,56.93,40.31,Aetna First Health,Commercial,,48.39,85,,,25.23,48.39,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781315295,NDC,facility,both,1,ML,56.93,40.31,Aetna First Health,Commercial,,48.39,85,,,25.23,48.39,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00781903895,NDC,facility,both,1,ML,56.93,40.31,Aetna First Health,Commercial,,48.39,85,,,25.23,48.39,percent of total billed charges,
diclofenac 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478089210,NDC,facility,both,1,ML,56.96,40.33,Aetna First Health,Commercial,,48.42,85,,,25.24,48.42,percent of total billed charges,
diclofenac 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,16571010150,NDC,facility,both,1,ML,56.96,40.33,Aetna First Health,Commercial,,48.42,85,,,25.24,48.42,percent of total billed charges,
zinc sulfate 1 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00517611025,NDC,facility,both,1,ML,57.42,40.65,Aetna First Health,Commercial,,48.81,85,,,25.45,48.81,percent of total billed charges,
pyRIDostigmine bromide 10 MG/2ML Solution 2 mL Ampule,25000000,CDM,,,250,RC,00781304072,NDC,facility,both,1,ML,57.76,40.89,Aetna First Health,Commercial,,49.1,85,,,25.6,49.1,percent of total billed charges,
ferric subsulfate Solution 8 mL Bottle,25000000,CDM,,,250,RC,10481011208,NDC,facility,both,1,ML,57.92,41.01,Aetna First Health,Commercial,,49.23,85,,,25.67,49.23,percent of total billed charges,
ferric subsulfate Solution 8 mL Bottle,25000000,CDM,,,250,RC,48783011208,NDC,facility,both,1,ML,57.92,41.01,Aetna First Health,Commercial,,49.23,85,,,25.67,49.23,percent of total billed charges,
ferric subsulfate Solution 8 mL Bottle,25000000,CDM,,,250,RC,05021700191,NDC,facility,both,1,ML,57.92,41.01,Aetna First Health,Commercial,,49.23,85,,,25.67,49.23,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 80 MCG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00781349380,NDC,facility,both,1,ML,58.5,41.42,Aetna First Health,Commercial,,49.72,85,,,25.93,49.72,percent of total billed charges,
dilTIAZem 125-0.9 MG/125ML-% Solution 125 mL Flex Cont,25000000,CDM,,,250,RC,63037011705,NDC,facility,both,1,ML,58.5,41.42,Aetna First Health,Commercial,,49.72,85,,,25.93,49.72,percent of total billed charges,
lidocaine 1% & BUPivacaine (PF) 0.25% 20 mL Vial,25000000,CDM,,,250,RC,98886800153,NDC,facility,both,1,ML,58.5,41.42,Aetna First Health,Commercial,,49.72,85,,,25.93,49.72,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 80 MCG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00781349395,NDC,facility,both,1,ML,58.5,41.42,Aetna First Health,Commercial,,49.72,85,,,25.93,49.72,percent of total billed charges,
norepinephrine 4-5 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,71285605601,NDC,facility,both,1,ML,58.5,41.42,Aetna First Health,Commercial,,49.72,85,,,25.93,49.72,percent of total billed charges,
BUPivacaine 0.5% 30 mL - lidocaine 1% 30 mL Solution 60 mL Vial,25000000,CDM,,,250,RC,88887800023,NDC,facility,both,1,ML,59.5,42.13,Aetna First Health,Commercial,,50.58,85,,,26.37,50.58,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 80 MCG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409166022,NDC,facility,both,1,ML,59.67,42.25,Aetna First Health,Commercial,,50.72,85,,,26.45,50.72,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 80 MCG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409166020,NDC,facility,both,1,ML,59.67,42.25,Aetna First Health,Commercial,,50.72,85,,,26.45,50.72,percent of total billed charges,
sulfacetamide sod-pred 10-0.23 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208031705,NDC,facility,both,1,ML,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
neomycin-polymyxin B GU irrigant 2 ml in sterile water 500 mL Solution 500 mL Bag,25000000,CDM,,,250,RC,88887800035,NDC,facility,both,1,ML,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
sulfacetamide sod-pred 10-0.23 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314029705,NDC,facility,both,1,ML,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
timolol 0.25 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314022615,NDC,facility,both,1,ML,61.26,43.37,Aetna First Health,Commercial,,52.07,85,,,27.15,52.07,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00074438010,NDC,facility,both,1,ML,61.88,43.81,Aetna First Health,Commercial,,52.6,85,,,27.43,52.6,percent of total billed charges,
CISatracurium 20 MG/10ML Solution 10 mL Vial,25000000,CDM,,,250,RC,00074438081,NDC,facility,both,1,ML,61.88,43.81,Aetna First Health,Commercial,,52.6,85,,,27.43,52.6,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,76014000525,NDC,facility,both,1,ML,62.53,44.27,Aetna First Health,Commercial,,53.15,85,,,27.71,53.15,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,76014000530,NDC,facility,both,1,ML,62.53,44.27,Aetna First Health,Commercial,,53.15,85,,,27.71,53.15,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Glass Cont,25000000,CDM,,,250,RC,00409166050,NDC,facility,both,1,ML,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Glass Cont,25000000,CDM,,,250,RC,00409166055,NDC,facility,both,1,ML,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
sodium chloride 5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208027715,NDC,facility,both,1,ML,63.9,45.24,Aetna First Health,Commercial,,54.32,85,,,28.32,54.32,percent of total billed charges,
Methylcellulose 1 % Gel 500 mL Bottle,25000000,CDM,,,250,RC,51552070207,NDC,facility,both,1,ML,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 80 MCG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,63323067102,NDC,facility,both,1,ML,64.08,45.37,Aetna First Health,Commercial,,54.47,85,,,28.4,54.47,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 80 MCG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,63323067120,NDC,facility,both,1,ML,64.08,45.37,Aetna First Health,Commercial,,54.47,85,,,28.4,54.47,percent of total billed charges,
verapamil 2.5 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00409114405,NDC,facility,both,1,ML,66.1,46.8,Aetna First Health,Commercial,,56.18,85,,,29.3,56.18,percent of total billed charges,
phenylephrine 2.5 % Solution 3 mL Bottle,25000000,CDM,,,250,RC,61314034201,NDC,facility,both,1,ML,66.4,47.01,Aetna First Health,Commercial,,56.44,85,,,29.43,56.44,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Bottle,25000000,CDM,,,250,RC,71225013201,NDC,facility,both,1,ML,67.5,47.79,Aetna First Health,Commercial,,57.38,85,,,29.92,57.38,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Bottle,25000000,CDM,,,250,RC,71225013202,NDC,facility,both,1,ML,67.5,47.79,Aetna First Health,Commercial,,57.38,85,,,29.92,57.38,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Bottle,25000000,CDM,,,250,RC,71225012602,NDC,facility,both,1,ML,67.5,47.79,Aetna First Health,Commercial,,57.38,85,,,29.92,57.38,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Bottle,25000000,CDM,,,250,RC,71225012605,NDC,facility,both,1,ML,67.5,47.79,Aetna First Health,Commercial,,57.38,85,,,29.92,57.38,percent of total billed charges,
neostigmine-glycopyrrolate 3MG-0.6MG Solution 6 mL Syringe,25000000,CDM,,,250,RC,08888800022,NDC,facility,both,1,ML,70.61,49.99,Aetna First Health,Commercial,,60.02,85,,,31.29,60.02,percent of total billed charges,
fentaNYL 20 MCG/ML Solution 30 mL Syringe,25000000,CDM,J3010,CPT,250,RC,61553052269,NDC,facility,both,1,ML,70.88,50.18,Aetna First Health,Commercial,,60.25,85,,,31.41,60.25,percent of total billed charges,
fentaNYL 20 MCG/ML Solution 30 mL Syringe,25000000,CDM,J3010,CPT,250,RC,61553079268,NDC,facility,both,1,ML,70.88,50.18,Aetna First Health,Commercial,,60.25,85,,,31.41,60.25,percent of total billed charges,
fentaNYL 20 MCG/ML Solution 30 mL Syringe,25000000,CDM,J3010,CPT,250,RC,08888800418,NDC,facility,both,1,ML,70.88,50.18,Aetna First Health,Commercial,,60.25,85,,,31.41,60.25,percent of total billed charges,
ropiv-epi-cloNIDine-ketorolac 123-0.25-0.04- 15 MG/50ML solution prefilled syringe 50 mL Syringe,25000000,CDM,,,250,RC,70092143350,NDC,facility,both,1,ML,71.33,50.5,Aetna First Health,Commercial,,60.63,85,,,31.61,60.63,percent of total billed charges,
timolol 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478028812,NDC,facility,both,1,ML,71.7,50.76,Aetna First Health,Commercial,,60.94,85,,,31.78,60.94,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,00143952501,NDC,facility,both,1,ML,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,00143952510,NDC,facility,both,1,ML,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
ePHEDrine 50 MG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,17478051500,NDC,facility,both,1,ML,74.25,52.57,Aetna First Health,Commercial,,63.11,85,,,32.91,63.11,percent of total billed charges,
oxytocin 30 units in 0.9% sodium chloride 500 mL premix 30-0.9 UT/500ML-% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,71285604401,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
pyRIDostigmine bromide 10 MG/2ML Solution 2 mL Ampule,25000000,CDM,,,250,RC,00781304095,NDC,facility,both,1,ML,75.96,53.78,Aetna First Health,Commercial,,64.57,85,,,33.67,64.57,percent of total billed charges,
lidocaine 1% / phenylephrine 1.5% in BSS (PF) irrigant 1 mL Syringe,25000000,CDM,,,250,RC,98888800159,NDC,facility,both,1,ML,78,55.22,Aetna First Health,Commercial,,66.3,85,,,34.57,66.3,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,17478095510,NDC,facility,both,1,ML,78.75,55.76,Aetna First Health,Commercial,,66.94,85,,,34.9,66.94,percent of total billed charges,
amino acid injection 10 % Solution 500 mL Glass Cont,25000000,CDM,,,250,RC,00264934155,NDC,facility,both,1,ML,79.88,56.56,Aetna First Health,Commercial,,67.9,85,,,35.4,67.9,percent of total billed charges,
sulfacetamide sod-pred 10-0.23 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208031710,NDC,facility,both,1,ML,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
timolol 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314022715,NDC,facility,both,1,ML,82.02,58.07,Aetna First Health,Commercial,,69.72,85,,,36.35,69.72,percent of total billed charges,
norepinephrine 4-0.9 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,44567064001,NDC,facility,both,1,ML,83.25,58.94,Aetna First Health,Commercial,,70.76,85,,,36.9,70.76,percent of total billed charges,
sodium tetradecyl 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,65974016202,NDC,facility,both,1,ML,84.51,59.83,Aetna First Health,Commercial,,71.83,85,,,37.45,71.83,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG/5ML Solution 30 mL Vial,25000000,CDM,,,250,RC,00703952601,NDC,facility,both,1,ML,84.65,59.93,Aetna First Health,Commercial,,71.95,85,,,37.52,71.95,percent of total billed charges,
oxytocin 30 units in 0.9% sodium chloride 500 mL premix 30-0.9 UT/500ML-% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,71019025301,NDC,facility,both,1,ML,86,60.89,Aetna First Health,Commercial,,73.1,85,,,38.12,73.1,percent of total billed charges,
oxytocin 30 units in 0.9% sodium chloride 500 mL premix 30-0.9 UT/500ML-% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,70092106807,NDC,facility,both,1,ML,86,60.89,Aetna First Health,Commercial,,73.1,85,,,38.12,73.1,percent of total billed charges,
moxifloxacin HCl-BSS 1 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,71449009642,NDC,facility,both,1,ML,86.63,61.33,Aetna First Health,Commercial,,73.64,85,,,38.39,73.64,percent of total billed charges,
moxifloxacin HCl-BSS 1 MG/ML Solution 1 mL Syringe,25000000,CDM,,,250,RC,08888800792,NDC,facility,both,1,ML,86.63,61.33,Aetna First Health,Commercial,,73.64,85,,,38.39,73.64,percent of total billed charges,
isoflurane Solution 100 mL Bottle,25000000,CDM,,,250,RC,10019036040,NDC,facility,both,1,ML,88,62.3,Aetna First Health,Commercial,,74.8,85,,,39,74.8,percent of total billed charges,
dilTIAZem 100 mL Plas Cont,25000000,CDM,,,250,RC,08888800508,NDC,facility,both,1,ML,89.1,63.08,Aetna First Health,Commercial,,75.74,85,,,39.49,75.74,percent of total billed charges,
doxycycline 100 mL Flex Cont,25000000,CDM,,,250,RC,08888800690,NDC,facility,both,1,ML,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
cromolyn 4 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,61314023710,NDC,facility,both,1,ML,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
cromolyn 4 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,17478029111,NDC,facility,both,1,ML,91.16,64.54,Aetna First Health,Commercial,,77.49,85,,,40.4,77.49,percent of total billed charges,
fat emulsion 20 % Emulsion 500 mL Flex Cont,25000000,CDM,,,250,RC,00338051913,NDC,facility,both,1,ML,93.38,66.11,Aetna First Health,Commercial,,79.37,85,,,41.39,79.37,percent of total billed charges,
cyclopentolate 2 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,17478009702,NDC,facility,both,1,ML,94.44,66.86,Aetna First Health,Commercial,,80.27,85,,,41.86,80.27,percent of total billed charges,
doxapram 20 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00641601801,NDC,facility,both,1,ML,94.5,66.91,Aetna First Health,Commercial,,80.32,85,,,41.88,80.32,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,61314064705,NDC,facility,both,1,ML,95.06,67.3,Aetna First Health,Commercial,,80.8,85,,,42.13,80.8,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00574403105,NDC,facility,both,1,ML,95.06,67.3,Aetna First Health,Commercial,,80.8,85,,,42.13,80.8,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,69238137403,NDC,facility,both,1,ML,95.06,67.3,Aetna First Health,Commercial,,80.8,85,,,42.13,80.8,percent of total billed charges,
lidocaine 2% 5 mL + BUPivacaine 0.5% 5 mL + sodium bicarbonate 8.4% 1 mL 11 mL Syringe,25000000,CDM,,,250,RC,88888800301,NDC,facility,both,1,ML,95.5,67.61,Aetna First Health,Commercial,,81.18,85,,,42.33,81.18,percent of total billed charges,
ciclopirox 8 % Solution 6.6 mL Bottle,25000000,CDM,,,250,RC,45802014167,NDC,facility,both,1,ML,95.99,67.96,Aetna First Health,Commercial,,81.59,85,,,42.54,81.59,percent of total billed charges,
isoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,66794001125,NDC,facility,both,1,ML,96,67.97,Aetna First Health,Commercial,,81.6,85,,,42.55,81.6,percent of total billed charges,
clindamycin 1 % Solution 30 mL Bottle,25000000,CDM,,,250,RC,45802056201,NDC,facility,both,1,ML,96.48,68.31,Aetna First Health,Commercial,,82.01,85,,,42.76,82.01,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Flex Cont,25000000,CDM,,,250,RC,00338955524,NDC,facility,both,1,ML,96.75,68.5,Aetna First Health,Commercial,,82.24,85,,,42.88,82.24,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Glass Cont,25000000,CDM,,,250,RC,63323067150,NDC,facility,both,1,ML,96.75,68.5,Aetna First Health,Commercial,,82.24,85,,,42.88,82.24,percent of total billed charges,
cysteine 50 MG/ML Solution 50 mL Vial,25000000,CDM,,,250,RC,66758000502,NDC,facility,both,1,ML,98.89,70.01,Aetna First Health,Commercial,,84.06,85,,,43.83,84.06,percent of total billed charges,
carteolol 1 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208036710,NDC,facility,both,1,ML,99.8,70.66,Aetna First Health,Commercial,,84.83,85,,,44.23,84.83,percent of total billed charges,
tetracaine 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,54799050505,NDC,facility,both,1,ML,100.56,71.2,Aetna First Health,Commercial,,85.48,85,,,44.57,85.48,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Glass Cont,25000000,CDM,,,250,RC,70121138801,NDC,facility,both,1,ML,100.69,71.29,Aetna First Health,Commercial,,85.59,85,,,44.63,85.59,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 200 MCG/50ML Solution 50 mL Glass Cont,25000000,CDM,,,250,RC,70121138808,NDC,facility,both,1,ML,100.69,71.29,Aetna First Health,Commercial,,85.59,85,,,44.63,85.59,percent of total billed charges,
dextrose 10% amino acid 4% injection heparin 0.5 units/mL calcium 0.015 mEq/mL in sterile water 4 % Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,71285042201,NDC,facility,both,1,ML,101.25,71.68,Aetna First Health,Commercial,,86.06,85,,,44.87,86.06,percent of total billed charges,
dextrose 10% amino acid 4% injection heparin 0.5 units/mL calcium 0.015 mEq/mL in sterile water 4 % Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,72196042201,NDC,facility,both,1,ML,101.25,71.68,Aetna First Health,Commercial,,86.06,85,,,44.87,86.06,percent of total billed charges,
fat emulsion 20 % Emulsion 250 mL Flex Cont,25000000,CDM,,,250,RC,00338051909,NDC,facility,both,1,ML,105.75,74.87,Aetna First Health,Commercial,,89.89,85,,,46.87,89.89,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,17478041501,NDC,facility,both,1,ML,106.4,75.33,Aetna First Health,Commercial,,90.44,85,,,47.16,90.44,percent of total billed charges,
ePHEDrine sulfate 50 MG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,17478041510,NDC,facility,both,1,ML,106.4,75.33,Aetna First Health,Commercial,,90.44,85,,,47.16,90.44,percent of total billed charges,
brimonidine 0.2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208041110,NDC,facility,both,1,ML,109,77.17,Aetna First Health,Commercial,,92.65,85,,,48.31,92.65,percent of total billed charges,
brimonidine 0.2 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,17478071511,NDC,facility,both,1,ML,109.76,77.71,Aetna First Health,Commercial,,93.3,85,,,48.65,93.3,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,00409166010,NDC,facility,both,1,ML,112.5,79.65,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,00409166035,NDC,facility,both,1,ML,112.5,79.65,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,00409117401,NDC,facility,both,1,ML,112.5,79.65,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,00409159601,NDC,facility,both,1,ML,112.5,79.65,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
moxifloxacin HCl-BSS 1 MG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,70360000335,NDC,facility,both,1,ML,115.5,81.77,Aetna First Health,Commercial,,98.18,85,,,51.19,98.18,percent of total billed charges,
prednisoLONE acetate 1 % Suspension 1 mL Bottle,25000000,CDM,,,250,RC,11980018001,NDC,facility,both,1,ML,116.4,82.41,Aetna First Health,Commercial,,98.94,85,,,51.59,98.94,percent of total billed charges,
BUPivacaine PF 0.125 % in sodium chloride 0.9 % 0.125-0.9 % Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,61553019452,NDC,facility,both,1,ML,118.24,83.71,Aetna First Health,Commercial,,100.5,85,,,52.4,100.5,percent of total billed charges,
lidocaine 4 % Solution 4 mL Bottle,25000000,CDM,,,250,RC,76329630005,NDC,facility,both,1,ML,120.8,85.53,Aetna First Health,Commercial,,102.68,85,,,53.54,102.68,percent of total billed charges,
amino acid injection 10 % Solution 500 mL Plas Cont,25000000,CDM,,,250,RC,00338113003,NDC,facility,both,1,ML,121.5,86.02,Aetna First Health,Commercial,,103.28,85,,,53.85,103.28,percent of total billed charges,
Premasol 10 % Solution 500 mL Plas Cont,25000000,CDM,,,250,RC,00338113003,NDC,facility,both,1,ML,121.5,86.02,Aetna First Health,Commercial,,103.28,85,,,53.85,103.28,percent of total billed charges,
norepinephrine 4-0.9 MG/250ML-% Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,08886800376,NDC,facility,both,1,ML,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
ethyl chloride Aerosol 116 mL Can,25000000,CDM,,,250,RC,00386000102,NDC,facility,both,1,ML,123.42,87.38,Aetna First Health,Commercial,,104.91,85,,,54.7,104.91,percent of total billed charges,
doxapram 20 MG/ML Solution 20 mL Vial,25000000,CDM,,,250,RC,55390003501,NDC,facility,both,1,ML,123.75,87.62,Aetna First Health,Commercial,,105.19,85,,,54.85,105.19,percent of total billed charges,
phenylephrine 2.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314034202,NDC,facility,both,1,ML,124.48,88.13,Aetna First Health,Commercial,,105.81,85,,,55.17,105.81,percent of total billed charges,
sulfacetamide 10 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,60758001805,NDC,facility,both,1,ML,125,88.5,Aetna First Health,Commercial,,106.25,85,,,55.4,106.25,percent of total billed charges,
endoscopic ink marker Solution 5 mL Syringe,25000000,CDM,,,250,RC,08888800410,NDC,facility,both,1,ML,126,89.21,Aetna First Health,Commercial,,107.1,85,,,55.84,107.1,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,24208029505,NDC,facility,both,1,ML,126.75,89.74,Aetna First Health,Commercial,,107.74,85,,,56.18,107.74,percent of total billed charges,
ethyl chloride Aerosol 116 mL Glass Cont,25000000,CDM,,,250,RC,00386000104,NDC,facility,both,1,ML,128.53,91,Aetna First Health,Commercial,,109.25,85,,,56.96,109.25,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Bottle,25000000,CDM,,,250,RC,71225012603,NDC,facility,both,1,ML,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Bottle,25000000,CDM,,,250,RC,71225012606,NDC,facility,both,1,ML,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,71225013301,NDC,facility,both,1,ML,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,71225013302,NDC,facility,both,1,ML,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
lidocaine 2% 50 mL - sodium bicarbonate 8.4% 5 mL Solution 55 mL Vial,25000000,CDM,,,250,RC,88887800030,NDC,facility,both,1,ML,136.13,96.38,Aetna First Health,Commercial,,115.71,85,,,60.33,115.71,percent of total billed charges,
azelastine 0.05 % Solution 6 mL Bottle,25000000,CDM,,,250,RC,61314030802,NDC,facility,both,1,ML,139.99,99.11,Aetna First Health,Commercial,,118.99,85,,,62.04,118.99,percent of total billed charges,
azelastine 0.05 % Solution 6 mL Bottle,25000000,CDM,,,250,RC,70069009101,NDC,facility,both,1,ML,139.99,99.11,Aetna First Health,Commercial,,118.99,85,,,62.04,118.99,percent of total billed charges,
 lidocaine jelly 2% 5 mL -gelfoam 50 Misc 5 mL Pack,25000000,CDM,,,250,RC,88887800015,NDC,facility,both,1,ML,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
sodium tetradecyl 3 % Solution 2 mL Vial,25000000,CDM,,,250,RC,67457016300,NDC,facility,both,1,ML,140.63,99.57,Aetna First Health,Commercial,,119.54,85,,,62.33,119.54,percent of total billed charges,
hydroxypropyl methylcellulose 2 % Solution 1 mL Syringe,25000000,CDM,,,250,RC,57770005500,NDC,facility,both,1,ML,141.75,100.36,Aetna First Health,Commercial,,120.49,85,,,62.82,120.49,percent of total billed charges,
flurbiprofen 0.03 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,69292072225,NDC,facility,both,1,ML,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
endoscopic ink marker Solution 10 mL Vial,25000000,CDM,,,250,RC,08888800020,NDC,facility,both,1,ML,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
fluorescein-proparacaine 0.25-0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,54799050721,NDC,facility,both,1,ML,147.4,104.36,Aetna First Health,Commercial,,125.29,85,,,65.33,125.29,percent of total billed charges,
nitroPRUSSide in 0.9% sodium chloride 100 MCG/ML Solution 250 mL Flex Cont,25000000,CDM,,,250,RC,08888800460,NDC,facility,both,1,ML,150,106.2,Aetna First Health,Commercial,,127.5,85,,,66.48,127.5,percent of total billed charges,
potassium phosphates 150 MMOLE/50ML Solution 50 mL Vial,25000000,CDM,,,250,RC,63323008650,NDC,facility,both,1,ML,151.31,107.13,Aetna First Health,Commercial,,128.61,85,,,67.06,128.61,percent of total billed charges,
diclofenac 0.1 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,16571010125,NDC,facility,both,1,ML,151.92,107.56,Aetna First Health,Commercial,,129.13,85,,,67.33,129.13,percent of total billed charges,
isopropyl alcohol 99 % Solution 500 mL Bottle,25000000,CDM,,,250,RC,38779081008,NDC,facility,both,1,ML,157.5,111.51,Aetna First Health,Commercial,,133.88,85,,,69.8,133.88,percent of total billed charges,
tropicamide-cyclopentolate-phenylephrine 1-1-2.5 % Solution 1 mL Bottle,25000000,CDM,,,250,RC,71449009245,NDC,facility,both,1,ML,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
tropicamide-cyclopentolate-phenylephrine 1-1-2.5 % Solution 1 mL Bottle,25000000,CDM,,,250,RC,71449009345,NDC,facility,both,1,ML,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
erythromycin 2 % Solution 60 mL Bottle,25000000,CDM,,,250,RC,00168021560,NDC,facility,both,1,ML,158.88,112.49,Aetna First Health,Commercial,,135.05,85,,,70.42,135.05,percent of total billed charges,
isoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,66794001725,NDC,facility,both,1,ML,160,113.28,Aetna First Health,Commercial,,136,85,,,70.91,136,percent of total billed charges,
BUPivacaine 0.5% (PF) & lidocaine 2% & hyaluronidase 75 units 10.5 mL Syringe,25000000,CDM,,,250,RC,98888800157,NDC,facility,both,1,ML,167.5,118.59,Aetna First Health,Commercial,,142.38,85,,,74.24,142.38,percent of total billed charges,
arginine 10 % Solution 300 mL Glass Cont,25000000,CDM,,,250,RC,00009043601,NDC,facility,both,1,ML,168,118.94,Aetna First Health,Commercial,,142.8,85,,,74.46,142.8,percent of total billed charges,
mitoMYcin-C 0.2 mg/mL Solution 0.8 mL Syringe,25000000,CDM,,,250,RC,05446101101,NDC,facility,both,1,ML,168.75,119.48,Aetna First Health,Commercial,,143.44,85,,,74.79,143.44,percent of total billed charges,
lidocaine 2% /epi 20 mL-bupivacaine 0.25% /epi 30 mL-NaHCO3 5 mL Solution 55 mL Vial,25000000,CDM,,,250,RC,88887800044,NDC,facility,both,1,ML,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
tetracaine 1 % Solution 2 mL Ampule,25000000,CDM,,,250,RC,17478004532,NDC,facility,both,1,ML,170.87,120.98,Aetna First Health,Commercial,,145.24,85,,,75.73,145.24,percent of total billed charges,
EPINEPHrine 0.25 mg & dextrose 50 % 3 mL in BSS 500 mL 500 mL Bag,25000000,CDM,,,250,RC,88888800293,NDC,facility,both,1,ML,172.5,122.13,Aetna First Health,Commercial,,146.62,85,,,76.45,146.62,percent of total billed charges,
sodium tetradecyl 3 % Solution 2 mL Vial,25000000,CDM,,,250,RC,24201020101,NDC,facility,both,1,ML,173.25,122.66,Aetna First Health,Commercial,,147.26,85,,,76.78,147.26,percent of total billed charges,
sodium tetradecyl 3 % Solution 2 mL Vial,25000000,CDM,,,250,RC,24201020105,NDC,facility,both,1,ML,173.25,122.66,Aetna First Health,Commercial,,147.26,85,,,76.78,147.26,percent of total billed charges,
sodium tetradecyl 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,67457016202,NDC,facility,both,1,ML,175.78,124.45,Aetna First Health,Commercial,,149.41,85,,,77.91,149.41,percent of total billed charges,
sodium tetradecyl 3 % Solution 2 mL Vial,25000000,CDM,,,250,RC,67457016302,NDC,facility,both,1,ML,175.78,124.45,Aetna First Health,Commercial,,149.41,85,,,77.91,149.41,percent of total billed charges,
sodium tetradecyl 1 % Solution 2 mL Vial,25000000,CDM,,,250,RC,67457016200,NDC,facility,both,1,ML,175.78,124.45,Aetna First Health,Commercial,,149.41,85,,,77.91,149.41,percent of total billed charges,
cyclopentolate 2 % Solution 2 mL Bottle,25000000,CDM,,,250,RC,00065039702,NDC,facility,both,1,ML,176.64,125.06,Aetna First Health,Commercial,,150.14,85,,,78.29,150.14,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,42023018710,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,00338955712,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,43066055712,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Flex Cont,25000000,CDM,,,250,RC,55150029701,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,63323067101,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Vial,25000000,CDM,,,250,RC,43598097511,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,42023018701,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,43598097558,NDC,facility,both,1,ML,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Glass Cont,25000000,CDM,,,250,RC,70121138901,NDC,facility,both,1,ML,184.5,130.63,Aetna First Health,Commercial,,156.82,85,,,81.77,156.82,percent of total billed charges,
dexmedeTOMIDine in sodium chloride 400 MCG/100ML Solution 100 mL Bottle,25000000,CDM,,,250,RC,67457092500,NDC,facility,both,1,ML,184.5,130.63,Aetna First Health,Commercial,,156.82,85,,,81.77,156.82,percent of total billed charges,
ferric subsulfate Solution 500 mL Bottle,25000000,CDM,,,250,RC,49452308102,NDC,facility,both,1,ML,185.25,131.16,Aetna First Health,Commercial,,157.46,85,,,82.1,157.46,percent of total billed charges,
gatifloxacin 0.5 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,61314067225,NDC,facility,both,1,ML,189.08,133.87,Aetna First Health,Commercial,,160.72,85,,,83.8,160.72,percent of total billed charges,
azelastine 0.05 % Solution 6 mL Bottle,25000000,CDM,,,250,RC,60505057804,NDC,facility,both,1,ML,199.99,141.59,Aetna First Health,Commercial,,169.99,85,,,88.64,169.99,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,71839013701,NDC,facility,both,1,ML,202.5,143.37,Aetna First Health,Commercial,,172.12,85,,,89.75,172.12,percent of total billed charges,
betaxolol 0.5% 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314024501,NDC,facility,both,1,ML,203.92,144.38,Aetna First Health,Commercial,,173.33,85,,,90.38,173.33,percent of total billed charges,
neomycin-polymyxin-gramicidin 1.75-10000-.025 Solution 10 mL Bottle,25000000,CDM,,,250,RC,24208079062,NDC,facility,both,1,ML,204.2,144.57,Aetna First Health,Commercial,,173.57,85,,,90.5,173.57,percent of total billed charges,
ROPivacaine (Naropin) 0.1% in sodium chloride 0.9% (NS) 0.1% Solution 500 mL Flex Cont,25000000,CDM,,,250,RC,88888800250,NDC,facility,both,1,ML,207.5,146.91,Aetna First Health,Commercial,,176.38,85,,,91.96,176.38,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00065064705,NDC,facility,both,1,ML,208.2,147.41,Aetna First Health,Commercial,,176.97,85,,,92.27,176.97,percent of total billed charges,
cysteine 50 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,51754100701,NDC,facility,both,1,ML,213.08,150.86,Aetna First Health,Commercial,,181.12,85,,,94.44,181.12,percent of total billed charges,
cysteine 50 MG/ML Solution 10 mL Vial,25000000,CDM,,,250,RC,51754100703,NDC,facility,both,1,ML,213.08,150.86,Aetna First Health,Commercial,,181.12,85,,,94.44,181.12,percent of total billed charges,
dexAMETHasone 0.1 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,24208072002,NDC,facility,both,1,ML,215.6,152.64,Aetna First Health,Commercial,,183.26,85,,,95.55,183.26,percent of total billed charges,
Methylcellulose 1 % Gel 500 mL Bottle,25000000,CDM,,,250,RC,38779306008,NDC,facility,both,1,ML,220,155.76,Aetna First Health,Commercial,,187,85,,,97.5,187,percent of total billed charges,
CISatracurium 200 MG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,70069015101,NDC,facility,both,1,ML,223.88,158.51,Aetna First Health,Commercial,,190.3,85,,,99.22,190.3,percent of total billed charges,
isoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,10019036060,NDC,facility,both,1,ML,230,162.84,Aetna First Health,Commercial,,195.5,85,,,101.94,195.5,percent of total billed charges,
levoFLOXacin 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,16571015050,NDC,facility,both,1,ML,255,180.54,Aetna First Health,Commercial,,216.75,85,,,113.02,216.75,percent of total billed charges,
apraclonidine 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,61314066505,NDC,facility,both,1,ML,257,181.96,Aetna First Health,Commercial,,218.45,85,,,113.9,218.45,percent of total billed charges,
cyclopentolate 2 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478009712,NDC,facility,both,1,ML,259.38,183.64,Aetna First Health,Commercial,,220.47,85,,,114.96,220.47,percent of total billed charges,
clindamycin 1 % Solution 60 mL Bottle,25000000,CDM,,,250,RC,59762372802,NDC,facility,both,1,ML,261.12,184.87,Aetna First Health,Commercial,,221.95,85,,,115.73,221.95,percent of total billed charges,
potassium phosphates 150 MMOLE/50ML Solution 50 mL Vial,25000000,CDM,,,250,RC,65219005609,NDC,facility,both,1,ML,267.08,189.09,Aetna First Health,Commercial,,227.02,85,,,118.37,227.02,percent of total billed charges,
potassium phosphates 150 MMOLE/50ML Solution 50 mL Vial,25000000,CDM,,,250,RC,65219005629,NDC,facility,both,1,ML,267.08,189.09,Aetna First Health,Commercial,,227.02,85,,,118.37,227.02,percent of total billed charges,
sodium hyaluronate 13.8 mg/0.6 mL solution prefilled syringe 0.6 mL Syringe,25000000,CDM,,,250,RC,08544636991,NDC,facility,both,1,ML,267.66,189.5,Aetna First Health,Commercial,,227.51,85,,,118.63,227.51,percent of total billed charges,
apraclonidine 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478071610,NDC,facility,both,1,ML,283,200.36,Aetna First Health,Commercial,,240.55,85,,,125.43,240.55,percent of total billed charges,
sodium hyaluronate 9.6 mg/0.8 mL solution prefilled syringe 0.8 mL Syringe,25000000,CDM,,,250,RC,61772059081,NDC,facility,both,1,ML,283.5,200.72,Aetna First Health,Commercial,,240.98,85,,,125.65,240.98,percent of total billed charges,
sugammadex sodium 200 MG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00006542302,NDC,facility,both,1,ML,291.74,206.55,Aetna First Health,Commercial,,247.98,85,,,129.3,247.98,percent of total billed charges,
sugammadex sodium 200 MG/2ML Solution 2 mL Vial,25000000,CDM,,,250,RC,00006542312,NDC,facility,both,1,ML,291.74,206.55,Aetna First Health,Commercial,,247.98,85,,,129.3,247.98,percent of total billed charges,
CISatracurium 10 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00781903775,NDC,facility,both,1,ML,297.07,210.33,Aetna First Health,Commercial,,252.51,85,,,131.66,252.51,percent of total billed charges,
sodium hyaluronate 8.5 MG/0.85ML solution prefilled syringe 0.85 mL Syringe,25000000,CDM,,,250,RC,08544508421,NDC,facility,both,1,ML,311.85,220.79,Aetna First Health,Commercial,,265.07,85,,,138.21,265.07,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,00009085608,NDC,facility,both,1,ML,315,223.02,Aetna First Health,Commercial,,267.75,85,,,139.61,267.75,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,00009085605,NDC,facility,both,1,ML,315,223.02,Aetna First Health,Commercial,,267.75,85,,,139.61,267.75,percent of total billed charges,
dexAMETHasone 0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00998061505,NDC,facility,both,1,ML,316.72,224.24,Aetna First Health,Commercial,,269.21,85,,,140.37,269.21,percent of total billed charges,
pilocarpine 4 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,70069020101,NDC,facility,both,1,ML,318.18,225.27,Aetna First Health,Commercial,,270.45,85,,,141.02,270.45,percent of total billed charges,
podofilox 0.5 % Solution 3.5 mL Bottle,25000000,CDM,,,250,RC,00591320413,NDC,facility,both,1,ML,318.32,225.37,Aetna First Health,Commercial,,270.57,85,,,141.08,270.57,percent of total billed charges,
sodium hyaluronate 8.5 MG/0.85ML solution prefilled syringe 0.85 mL Syringe,25000000,CDM,,,250,RC,08544636981,NDC,facility,both,1,ML,321.21,227.42,Aetna First Health,Commercial,,273.03,85,,,142.36,273.03,percent of total billed charges,
phenylephrine 2.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208074006,NDC,facility,both,1,ML,323.94,229.35,Aetna First Health,Commercial,,275.35,85,,,143.57,275.35,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,81298501001,NDC,facility,both,1,ML,333,235.76,Aetna First Health,Commercial,,283.05,85,,,147.59,283.05,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,81298501005,NDC,facility,both,1,ML,333,235.76,Aetna First Health,Commercial,,283.05,85,,,147.59,283.05,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,81298501003,NDC,facility,both,1,ML,333,235.76,Aetna First Health,Commercial,,283.05,85,,,147.59,283.05,percent of total billed charges,
pilocarpine 4 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,61314020615,NDC,facility,both,1,ML,338.22,239.46,Aetna First Health,Commercial,,287.49,85,,,149.9,287.49,percent of total billed charges,
sodium hyaluronate 9.6 mg/0.8 mL solution prefilled syringe 0.8 mL Syringe,25000000,CDM,,,250,RC,57770049567,NDC,facility,both,1,ML,342,242.14,Aetna First Health,Commercial,,290.7,85,,,151.57,290.7,percent of total billed charges,
epinastine 0.05 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,70069000801,NDC,facility,both,1,ML,342,242.14,Aetna First Health,Commercial,,290.7,85,,,151.57,290.7,percent of total billed charges,
epinastine 0.05 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,51991083675,NDC,facility,both,1,ML,342.36,242.39,Aetna First Health,Commercial,,291.01,85,,,151.73,291.01,percent of total billed charges,
dexAMETHasone 0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00078092525,NDC,facility,both,1,ML,348.08,246.44,Aetna First Health,Commercial,,295.87,85,,,154.27,295.87,percent of total billed charges,
thrombin topical 5000 units in 0.9% sodium chloride 50 mL Solution 50 mL Vial,25000000,CDM,,,250,RC,88887800018,NDC,facility,both,1,ML,352,249.22,Aetna First Health,Commercial,,299.2,85,,,156.01,299.2,percent of total billed charges,
thrombin topical 5000 units in calcium chloride 10% 5 mL Solution 5 mL Vial,25000000,CDM,,,250,RC,88887800025,NDC,facility,both,1,ML,352,249.22,Aetna First Health,Commercial,,299.2,85,,,156.01,299.2,percent of total billed charges,
sevoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,66794002225,NDC,facility,both,1,ML,356,252.05,Aetna First Health,Commercial,,302.6,85,,,157.78,302.6,percent of total billed charges,
phenylephrine 2.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,42702010215,NDC,facility,both,1,ML,360,254.88,Aetna First Health,Commercial,,306,85,,,159.55,306,percent of total billed charges,
phenylephrine 2.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478020115,NDC,facility,both,1,ML,360,254.88,Aetna First Health,Commercial,,306,85,,,159.55,306,percent of total billed charges,
gentamicin 0.3 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,24208058064,NDC,facility,both,1,ML,364.26,257.9,Aetna First Health,Commercial,,309.62,85,,,161.44,309.62,percent of total billed charges,
betaxolol 0.5% 0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,17478070511,NDC,facility,both,1,ML,377.32,267.14,Aetna First Health,Commercial,,320.72,85,,,167.23,320.72,percent of total billed charges,
gatifloxacin 0.5 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,68180043501,NDC,facility,both,1,ML,378.12,267.71,Aetna First Health,Commercial,,321.4,85,,,167.58,321.4,percent of total billed charges,
gatifloxacin 0.5 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,50383018902,NDC,facility,both,1,ML,378.12,267.71,Aetna First Health,Commercial,,321.4,85,,,167.58,321.4,percent of total billed charges,
gatifloxacin 0.5 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,60758061525,NDC,facility,both,1,ML,378.12,267.71,Aetna First Health,Commercial,,321.4,85,,,167.58,321.4,percent of total billed charges,
tranexamic acid 100 mL Flex Cont,25000000,CDM,,,250,RC,08888800257,NDC,facility,both,1,ML,381,269.75,Aetna First Health,Commercial,,323.85,85,,,168.86,323.85,percent of total billed charges,
sulfacetamide 10 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,11980001105,NDC,facility,both,1,ML,384.48,272.21,Aetna First Health,Commercial,,326.81,85,,,170.4,326.81,percent of total billed charges,
clindamycin 1 % Lotion 60 mL Bottle,25000000,CDM,,,250,RC,59762374401,NDC,facility,both,1,ML,384.72,272.38,Aetna First Health,Commercial,,327.01,85,,,170.51,327.01,percent of total billed charges,
cyclopentolate 0.5% 0.5 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00065039515,NDC,facility,both,1,ML,385.68,273.06,Aetna First Health,Commercial,,327.83,85,,,170.93,327.83,percent of total billed charges,
balanced salt solution plus Solution 500 mL Glass Cont,25000000,CDM,,,250,RC,00065080050,NDC,facility,both,1,ML,398,281.78,Aetna First Health,Commercial,,338.3,85,,,176.39,338.3,percent of total billed charges,
sodium hyaluronate 5.5 mg/0.55 mL solution prefilled syringe 0.55 mL Syringe,25000000,CDM,,,250,RC,08065183055,NDC,facility,both,1,ML,404.37,286.29,Aetna First Health,Commercial,,343.71,85,,,179.22,343.71,percent of total billed charges,
lidocaine 2% 5 mL + bupivacaine 0.75% 5 mL + vitrase 200 units/mL 0.5 mL 10.5 mL Syringe,25000000,CDM,,,250,RC,88888800298,NDC,facility,both,1,ML,418.5,296.3,Aetna First Health,Commercial,,355.72,85,,,185.48,355.72,percent of total billed charges,
lidocaine urethral/mucosal 2 % Gel 30 mL Tube,25000000,CDM,,,250,RC,17478071130,NDC,facility,both,1,ML,427.8,302.88,Aetna First Health,Commercial,,363.63,85,,,189.6,363.63,percent of total billed charges,
sugammadex sodium 500 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00006542305,NDC,facility,both,1,ML,431.55,305.54,Aetna First Health,Commercial,,366.82,85,,,191.26,366.82,percent of total billed charges,
sugammadex sodium 500 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00006542315,NDC,facility,both,1,ML,431.55,305.54,Aetna First Health,Commercial,,366.82,85,,,191.26,366.82,percent of total billed charges,
neomycin-polymyxin-dexameth 0.1 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00998063006,NDC,facility,both,1,ML,452.12,320.1,Aetna First Health,Commercial,,384.3,85,,,200.38,384.3,percent of total billed charges,
ROPivacaine 0.5% 25 mL ketorolac 15 mg EPINEPHrine 0.25 mg cloNIDine 0.04 mg in 0.9% sodium chloride 30 mL 55 mL Bag,25000000,CDM,,,250,RC,88888800313,NDC,facility,both,1,ML,456,322.85,Aetna First Health,Commercial,,387.6,85,,,202.1,387.6,percent of total billed charges,
levoFLOXacin 0.5 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,17478010610,NDC,facility,both,1,ML,459.56,325.37,Aetna First Health,Commercial,,390.63,85,,,203.68,390.63,percent of total billed charges,
clindamycin 1 % Lotion 60 mL Bottle,25000000,CDM,,,250,RC,00168020360,NDC,facility,both,1,ML,461.52,326.76,Aetna First Health,Commercial,,392.29,85,,,204.55,392.29,percent of total billed charges,
sodium hyaluronate 13.8 mg/0.6 mL solution prefilled syringe 0.6 mL Syringe,25000000,CDM,,,250,RC,08544508321,NDC,facility,both,1,ML,462,327.1,Aetna First Health,Commercial,,392.7,85,,,204.76,392.7,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Lotion 30 mL Bottle,25000000,CDM,,,250,RC,51672130803,NDC,facility,both,1,ML,470.4,333.04,Aetna First Health,Commercial,,399.84,85,,,208.48,399.84,percent of total billed charges,
sevoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,66794001525,NDC,facility,both,1,ML,476,337.01,Aetna First Health,Commercial,,404.6,85,,,210.96,404.6,percent of total billed charges,
azithromycin 1 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,17478030703,NDC,facility,both,1,ML,478.76,338.96,Aetna First Health,Commercial,,406.95,85,,,212.19,406.95,percent of total billed charges,
ciprofloxacin 0.3 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00065065605,NDC,facility,both,1,ML,483.68,342.45,Aetna First Health,Commercial,,411.13,85,,,214.37,411.13,percent of total billed charges,
cyclopentolate 2 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,00065039715,NDC,facility,both,1,ML,484.98,343.37,Aetna First Health,Commercial,,412.23,85,,,214.94,412.23,percent of total billed charges,
clindamycin 1 % Lotion 60 mL Bottle,25000000,CDM,,,250,RC,00009332901,NDC,facility,both,1,ML,493.92,349.7,Aetna First Health,Commercial,,419.83,85,,,218.91,419.83,percent of total billed charges,
clotrimazole-betamethasone 1-0.05 % Lotion 30 mL Bottle,25000000,CDM,,,250,RC,00168037030,NDC,facility,both,1,ML,495.24,350.63,Aetna First Health,Commercial,,420.95,85,,,219.49,420.95,percent of total billed charges,
mitoMYcin 0.3 mg/mL Solution 1 mL Syringe,25000000,CDM,,,250,RC,88888800287,NDC,facility,both,1,ML,502,355.42,Aetna First Health,Commercial,,426.7,85,,,222.49,426.7,percent of total billed charges,
gatifloxacin 0.5 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,00023361525,NDC,facility,both,1,ML,505.72,358.05,Aetna First Health,Commercial,,429.86,85,,,224.14,429.86,percent of total billed charges,
sevoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,00781616043,NDC,facility,both,1,ML,526,372.41,Aetna First Health,Commercial,,447.1,85,,,233.12,447.1,percent of total billed charges,
atropine 1 % Solution 15 mL Bottle,25000000,CDM,,,250,RC,17478021515,NDC,facility,both,1,ML,528.18,373.95,Aetna First Health,Commercial,,448.95,85,,,234.09,448.95,percent of total billed charges,
sugammadex sodium 500 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00006542515,NDC,facility,both,1,ML,534.38,378.34,Aetna First Health,Commercial,,454.22,85,,,236.84,454.22,percent of total billed charges,
sugammadex sodium 500 MG/5ML Solution 5 mL Vial,25000000,CDM,,,250,RC,00006542505,NDC,facility,both,1,ML,534.38,378.34,Aetna First Health,Commercial,,454.22,85,,,236.84,454.22,percent of total billed charges,
sevoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,10019065164,NDC,facility,both,1,ML,544,385.15,Aetna First Health,Commercial,,462.4,85,,,241.1,462.4,percent of total billed charges,
multivitamin injection pediatric Solution 50 mL Vial,25000000,CDM,,,250,RC,54643564700,NDC,facility,both,1,ML,553.39,391.8,Aetna First Health,Commercial,,470.38,85,,,245.26,470.38,percent of total billed charges,
multivitamin injection pediatric Solution 50 mL Vial,25000000,CDM,,,250,RC,54643903100,NDC,facility,both,1,ML,553.39,391.8,Aetna First Health,Commercial,,470.38,85,,,245.26,470.38,percent of total billed charges,
apraclonidine 0.5 % Solution 10 mL Bottle,25000000,CDM,,,250,RC,17478071611,NDC,facility,both,1,ML,562,397.9,Aetna First Health,Commercial,,477.7,85,,,249.08,477.7,percent of total billed charges,
sodium chondroit-sodium hyaluron 30-22.5 MG/0.75ML solution prefilled syringe 0.75 mL Syringe,25000000,CDM,,,250,RC,08065183975,NDC,facility,both,1,ML,563.65,399.06,Aetna First Health,Commercial,,479.1,85,,,249.81,479.1,percent of total billed charges,
bromfenac once daily 0.09 % Solution 1.7 mL Bottle,25000000,CDM,,,250,RC,72266014201,NDC,facility,both,1,ML,569.84,403.45,Aetna First Health,Commercial,,484.36,85,,,252.55,484.36,percent of total billed charges,
bromfenac once daily 0.09 % Solution 1.7 mL Bottle,25000000,CDM,,,250,RC,65862078917,NDC,facility,both,1,ML,569.84,403.45,Aetna First Health,Commercial,,484.36,85,,,252.55,484.36,percent of total billed charges,
ascorbic acid 25000 MG/50ML Solution 50 mL Vial,25000000,CDM,,,250,RC,67157010151,NDC,facility,both,1,ML,601.43,425.81,Aetna First Health,Commercial,,511.22,85,,,266.55,511.22,percent of total billed charges,
desflurane Solution 240 mL Bottle,25000000,CDM,,,250,RC,10019064624,NDC,facility,both,1,ML,604.8,428.2,Aetna First Health,Commercial,,514.08,85,,,268.05,514.08,percent of total billed charges,
desflurane Solution 240 mL Bottle,25000000,CDM,,,250,RC,10019064460,NDC,facility,both,1,ML,604.8,428.2,Aetna First Health,Commercial,,514.08,85,,,268.05,514.08,percent of total billed charges,
tobramycin-dexAMETHasone 0.3-0.05 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,00065065205,NDC,facility,both,1,ML,607.2,429.9,Aetna First Health,Commercial,,516.12,85,,,269.11,516.12,percent of total billed charges,
sodium hyaluronate 12.8 mg/0.8 mL solution prefilled syringe 0.8 mL Syringe,25000000,CDM,,,250,RC,61772060081,NDC,facility,both,1,ML,608,430.46,Aetna First Health,Commercial,,516.8,85,,,269.47,516.8,percent of total billed charges,
CISatracurium 200 MG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,63323041820,NDC,facility,both,1,ML,608.63,430.91,Aetna First Health,Commercial,,517.34,85,,,269.74,517.34,percent of total billed charges,
ascorbic acid 25000 MG/50ML Solution 50 mL Vial,25000000,CDM,,,250,RC,67157010150,NDC,facility,both,1,ML,608.85,431.07,Aetna First Health,Commercial,,517.52,85,,,269.84,517.52,percent of total billed charges,
CISatracurium 200 MG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409110301,NDC,facility,both,1,ML,614.7,435.21,Aetna First Health,Commercial,,522.5,85,,,272.44,522.5,percent of total billed charges,
CISatracurium 200 MG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00409110311,NDC,facility,both,1,ML,614.7,435.21,Aetna First Health,Commercial,,522.5,85,,,272.44,522.5,percent of total billed charges,
desflurane Solution 240 mL Bottle,25000000,CDM,,,250,RC,10019064164,NDC,facility,both,1,ML,615.36,435.67,Aetna First Health,Commercial,,523.06,85,,,272.73,523.06,percent of total billed charges,
fluorometholone 0.1 % Suspension 10 mL Bottle,25000000,CDM,,,250,RC,60758088010,NDC,facility,both,1,ML,619.48,438.59,Aetna First Health,Commercial,,526.56,85,,,274.55,526.56,percent of total billed charges,
sulfacetamide (acne) 10 % Lotion 118 mL Bottle,25000000,CDM,,,250,RC,68682001004,NDC,facility,both,1,ML,628.23,444.79,Aetna First Health,Commercial,,534,85,,,278.43,534,percent of total billed charges,
clindamycin 1 % Solution 60 mL Bottle,25000000,CDM,,,250,RC,45802056202,NDC,facility,both,1,ML,630.48,446.38,Aetna First Health,Commercial,,535.91,85,,,279.43,535.91,percent of total billed charges,
desflurane Solution 240 mL Bottle,25000000,CDM,,,250,RC,10019064134,NDC,facility,both,1,ML,641.28,454.03,Aetna First Health,Commercial,,545.09,85,,,284.22,545.09,percent of total billed charges,
prednisoLONE acetate 0.12 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,11980017405,NDC,facility,both,1,ML,641.6,454.25,Aetna First Health,Commercial,,545.36,85,,,284.36,545.36,percent of total billed charges,
CISatracurium 200 MG/20ML Solution 20 mL Vial,25000000,CDM,,,250,RC,00074438220,NDC,facility,both,1,ML,668.25,473.12,Aetna First Health,Commercial,,568.01,85,,,296.17,568.01,percent of total billed charges,
benzylpenicilloyl polylysine 0.25 ML Solution 0.25 mL Ampule,25000000,CDM,,,250,RC,49471000105,NDC,facility,both,1,ML,676,478.61,Aetna First Health,Commercial,,574.6,85,,,299.6,574.6,percent of total billed charges,
benzylpenicilloyl polylysine 0.25 ML Solution 0.25 mL Ampule,25000000,CDM,,,250,RC,49471000101,NDC,facility,both,1,ML,676,478.61,Aetna First Health,Commercial,,574.6,85,,,299.6,574.6,percent of total billed charges,
epinastine 0.05 % Solution 5 mL Bottle,25000000,CDM,,,250,RC,00023920105,NDC,facility,both,1,ML,690.2,488.66,Aetna First Health,Commercial,,586.67,85,,,305.9,586.67,percent of total billed charges,
cantharidin 0.7 % Solution 10 mL Vial,25000000,CDM,C9164,CPT,250,RC,71449010236,NDC,facility,both,1,ML,706,499.85,Aetna First Health,Commercial,,600.1,85,,,312.9,600.1,percent of total billed charges,
sodium hyaluronate & sodium chondroitin sulfate-sodium hyaluronate 0.85-0.5 ML Kit 1.35 mL Syringe,25000000,CDM,,,250,RC,08065199907,NDC,facility,both,1,ML,709.85,502.57,Aetna First Health,Commercial,,603.37,85,,,314.61,603.37,percent of total billed charges,
bromfenac once daily 0.09 % Solution 1.7 mL Bottle,25000000,CDM,,,250,RC,62332050817,NDC,facility,both,1,ML,712.24,504.27,Aetna First Health,Commercial,,605.4,85,,,315.66,605.4,percent of total billed charges,
bromfenac once daily 0.09 % Solution 1.7 mL Bottle,25000000,CDM,,,250,RC,50383024971,NDC,facility,both,1,ML,712.28,504.29,Aetna First Health,Commercial,,605.44,85,,,315.68,605.44,percent of total billed charges,
dinoprostone 5 mL Syringe,25000000,CDM,,,250,RC,88886800102,NDC,facility,both,1,ML,715,506.22,Aetna First Health,Commercial,,607.75,85,,,316.89,607.75,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,43598069811,NDC,facility,both,1,ML,717.73,508.15,Aetna First Health,Commercial,,610.07,85,,,318.1,610.07,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,43598069858,NDC,facility,both,1,ML,717.73,508.15,Aetna First Health,Commercial,,610.07,85,,,318.1,610.07,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,43598091711,NDC,facility,both,1,ML,717.73,508.15,Aetna First Health,Commercial,,610.07,85,,,318.1,610.07,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Vial,25000000,CDM,,,250,RC,43598091758,NDC,facility,both,1,ML,717.73,508.15,Aetna First Health,Commercial,,610.07,85,,,318.1,610.07,percent of total billed charges,
carboprost 250 MCG/ML Solution 1 mL Ampule,25000000,CDM,,,250,RC,69784024001,NDC,facility,both,1,ML,717.73,508.15,Aetna First Health,Commercial,,610.07,85,,,318.1,610.07,percent of total billed charges,
ibuprofen lysine 10 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,39822103002,NDC,facility,both,1,ML,742.5,525.69,Aetna First Health,Commercial,,631.12,85,,,329.08,631.12,percent of total billed charges,
ibuprofen lysine 10 MG/ML Solution 2 mL Vial,25000000,CDM,,,250,RC,39822103001,NDC,facility,both,1,ML,742.5,525.69,Aetna First Health,Commercial,,631.12,85,,,329.08,631.12,percent of total billed charges,
loteprednol etabonate 0.5 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,50383026505,NDC,facility,both,1,ML,751.2,531.85,Aetna First Health,Commercial,,638.52,85,,,332.93,638.52,percent of total billed charges,
calcipotriene 0.005% solution 0.005 % Solution 60 mL Bottle,25000000,CDM,,,250,RC,00115147555,NDC,facility,both,1,ML,751.92,532.36,Aetna First Health,Commercial,,639.13,85,,,333.25,639.13,percent of total billed charges,
sevoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,00074445651,NDC,facility,both,1,ML,752,532.42,Aetna First Health,Commercial,,639.2,85,,,333.29,639.2,percent of total billed charges,
sevoflurane Solution 250 mL Bottle,25000000,CDM,,,250,RC,00074445604,NDC,facility,both,1,ML,752,532.42,Aetna First Health,Commercial,,639.2,85,,,333.29,639.2,percent of total billed charges,
travoprost (BAK Free) 0.004 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,00065026025,NDC,facility,both,1,ML,775.92,549.35,Aetna First Health,Commercial,,659.53,85,,,343.89,659.53,percent of total billed charges,
trifluridine 1 % Solution 7.5 mL Bottle,25000000,CDM,,,250,RC,61314004475,NDC,facility,both,1,ML,784.05,555.11,Aetna First Health,Commercial,,666.44,85,,,347.49,666.44,percent of total billed charges,
isoproterenol 0.2 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70121160501,NDC,facility,both,1,ML,793.46,561.77,Aetna First Health,Commercial,,674.44,85,,,351.66,674.44,percent of total billed charges,
isoproterenol 0.2 MG/ML Solution 5 mL Vial,25000000,CDM,,,250,RC,70121160507,NDC,facility,both,1,ML,793.46,561.77,Aetna First Health,Commercial,,674.44,85,,,351.66,674.44,percent of total billed charges,
metroNIDAZOLE 0.75 % Lotion 59 mL Bottle,25000000,CDM,,,250,RC,00168038360,NDC,facility,both,1,ML,823.88,583.31,Aetna First Health,Commercial,,700.3,85,,,365.14,700.3,percent of total billed charges,
sodium hyaluronate 8.5 MG/0.85ML solution prefilled syringe 0.85 mL Syringe,25000000,CDM,,,250,RC,08065183085,NDC,facility,both,1,ML,825.72,584.61,Aetna First Health,Commercial,,701.86,85,,,365.96,701.86,percent of total billed charges,
metroNIDAZOLE 0.75 % Lotion 59 mL Bottle,25000000,CDM,,,250,RC,66993096159,NDC,facility,both,1,ML,828.6,586.65,Aetna First Health,Commercial,,704.31,85,,,367.24,704.31,percent of total billed charges,
loteprednol etabonate 0.5 % Suspension 5 mL Bottle,25000000,CDM,,,250,RC,68682029905,NDC,facility,both,1,ML,854.84,605.23,Aetna First Health,Commercial,,726.61,85,,,378.87,726.61,percent of total billed charges,
lidocaine 1% w/epi 30 mL-bupivacaine 0.25% w/epi 30mL-NAHCO3 8.4% 6 mL Solution 65 mL Vial,25000000,CDM,,,250,RC,88887800013,NDC,facility,both,1.01538,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
lidocaine buffered 1 % Solution 22.2 mL Vial,25000000,CDM,,,250,RC,08888800251,NDC,facility,both,1.11,ML,1.21,0.86,Aetna First Health,Commercial,,1.03,85,,,0.54,1.03,percent of total billed charges,
gentamicin 0.3 % Ointment 3.5 g Tube,25000000,CDM,,,250,RC,17478028435,NDC,facility,both,1.14286,GR,142.45,100.85,Aetna First Health,Commercial,,121.08,85,,,63.13,121.08,percent of total billed charges,
flurbiprofen 0.03 % Solution 2.5 mL Bottle,25000000,CDM,,,250,RC,24208031425,NDC,facility,both,1.2,ML,33.5,23.72,Aetna First Health,Commercial,,28.48,85,,,14.85,28.48,percent of total billed charges,
lidocaine 1.4% - phenylephrine 0.28% sterile topical Solution 7 mL Syringe,25000000,CDM,,,250,RC,08888800700,NDC,facility,both,1.4,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
chlorambucil 2 MG Tablet 10 Each Bottle,25000000,CDM,,,250,RC,54868112602,NDC,facility,both,2,EA,24.12,17.08,Aetna First Health,Commercial,,20.5,85,,,10.69,20.5,percent of total billed charges,
chlorambucil 2 MG Tablet 25 Each Bottle,25000000,CDM,,,250,RC,76388063525,NDC,facility,both,2,EA,185.62,131.42,Aetna First Health,Commercial,,157.78,85,,,82.27,157.78,percent of total billed charges,
chlorambucil 2 MG Tablet 50 Each Bottle,25000000,CDM,,,250,RC,76388063550,NDC,facility,both,2,EA,74.7,52.89,Aetna First Health,Commercial,,63.5,85,,,33.11,63.5,percent of total billed charges,
eltrombopag 12.5 MG Tablet 30 Each Bottle,25000000,CDM,,,250,RC,00007464313,NDC,facility,both,2,EA,677.18,479.44,Aetna First Health,Commercial,,575.6,85,,,300.13,575.6,percent of total billed charges,
enzalutamide 40 MG capsule 120 Each Bottle,25000000,CDM,,,250,RC,00469012599,NDC,facility,both,2,EA,516.13,365.42,Aetna First Health,Commercial,,438.71,85,,,228.75,438.71,percent of total billed charges,
flucytosine 250 MG capsule 1 Each Blister,25000000,CDM,,,250,RC,60687035295,NDC,facility,both,2,EA,573.03,405.71,Aetna First Health,Commercial,,487.08,85,,,253.97,487.08,percent of total billed charges,
flucytosine 250 MG capsule 100 Each Bottle,25000000,CDM,,,250,RC,42494033901,NDC,facility,both,2,EA,385,272.58,Aetna First Health,Commercial,,327.25,85,,,170.63,327.25,percent of total billed charges,
flucytosine 250 MG capsule 30 Each Box,25000000,CDM,,,250,RC,60687035225,NDC,facility,both,2,EA,573.03,405.71,Aetna First Health,Commercial,,487.08,85,,,253.97,487.08,percent of total billed charges,
hydromorphone variable dose 1 Each Crtrdg-NDL,25000000,CDM,,,250,RC,88888800017,NDC,facility,both,2,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
megestrol 20 MG Tablet 1 Each Blister,25000000,CDM,,,250,RC,51079043401,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 20 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,00555060602,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 20 MG Tablet 100 Each Bottle,25000000,CDM,,,250,RC,49884028901,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
megestrol 20 MG Tablet 100 Each Box,25000000,CDM,,,250,RC,51079043420,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venetoclax 10 MG Tablet 14 Each Box,25000000,CDM,,,250,RC,00074056114,NDC,facility,both,2,EA,89.05,63.05,Aetna First Health,Commercial,,75.69,85,,,39.47,75.69,percent of total billed charges,
cromolyn 100 MG/5ML Concentrate 5 mL Plas Cont,25000000,CDM,,,250,RC,69784020096,NDC,facility,both,2,ML,14.6,10.34,Aetna First Health,Commercial,,12.41,85,,,6.47,12.41,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 5 mL Vial,25000000,CDM,,,250,RC,63323002605,NDC,facility,both,2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 5 mL Vial,25000000,CDM,,,250,RC,00409555502,NDC,facility,both,2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 5 mL Vial,25000000,CDM,,,250,RC,00409555512,NDC,facility,both,2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
SUFentanil 250 MCG/5ML Solution 5 mL Ampule,25000000,CDM,,,250,RC,17478005005,NDC,facility,both,2,ML,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
fat emulsion (fish oil/plant based) 20 % Emulsion 100 mL Flex Cont,25000000,CDM,,,250,RC,63323082000,NDC,facility,both,2,ML,99,70.09,Aetna First Health,Commercial,,84.15,85,,,43.88,84.15,percent of total billed charges,
fat emulsion (fish oil/plant based) 20 % Emulsion 100 mL Flex Cont,25000000,CDM,,,250,RC,63323082001,NDC,facility,both,2,ML,99,70.09,Aetna First Health,Commercial,,84.15,85,,,43.88,84.15,percent of total billed charges,
sodium bicarbonate 4.2 % Solution 5 mL Vial,25000000,CDM,,,250,RC,63323008305,NDC,facility,both,2,ML,105.89,74.97,Aetna First Health,Commercial,,90.01,85,,,46.93,90.01,percent of total billed charges,
fat emulsion 20 % Emulsion 100 mL Flex Cont,25000000,CDM,,,250,RC,00338051958,NDC,facility,both,2,ML,141.3,100.04,Aetna First Health,Commercial,,120.1,85,,,62.62,120.1,percent of total billed charges,
oxytocin 30 units in 0.9% sodium chloride 500 mL premix 30-0.9 UT/500ML-% Solution 500 mL Bag,25000000,CDM,,,250,RC,08888800417,NDC,facility,both,3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
dexAMETHasone 0.5 MG/5ML Solution 500 mL Bottle,25000000,CDM,,,250,RC,00054317763,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
EPINEPHrine PF 1 mL Ampule,25000000,CDM,,,250,RC,54288010310,NDC,facility,both,5,ML,123.75,87.62,Aetna First Health,Commercial,,105.19,85,,,54.85,105.19,percent of total billed charges,
meperidine variable dose 12.5 Each Syringe,25000000,CDM,,,250,RC,88887800046,NDC,facility,both,12.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Travasol 10% 10 % Solution 500 mL Plas Cont,25000000,CDM,,,250,RC,00338064403,NDC,facility,both,500,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
DESFLURANE GAS,25007004,CDM,,,270,RC,,,facility,both,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SEVOFLURANE GAS,25007005,CDM,,,270,RC,,,facility,both,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SNARE COIN TIP   BX00711110,27100000,CDM,,,272,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
INSTRUMENT ORTHOPEDIC COMP SHOULDER R AUG GUIDE RVS SYST  20809000402,27100000,CDM,,,272,RC,,,facility,inpatient,,,1990,1408.92,Aetna First Health,Commercial,,1691.5,85,,,881.97,1691.5,percent of total billed charges,
O2 PER DAY,27109007,CDM,,,270,RC,,,facility,both,,,510,361.08,Aetna First Health,Commercial,,433.5,85,,,226.03,433.5,percent of total billed charges,
COMPR MED GAS - PER DAY,27109008,CDM,,,271,RC,,,facility,both,,,191,135.23,Aetna First Health,Commercial,,162.35,85,,,84.65,162.35,percent of total billed charges,
ENDOTRACHEAL TUBE HOLDER,27109019,CDM,,,271,RC,,,facility,both,,,22,15.58,Aetna First Health,Commercial,,18.7,85,,,9.75,18.7,percent of total billed charges,
VENTI MASK SUPPLIES,27109020,CDM,,,271,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
TRACH TUBE BIVONA TTS,27109039,CDM,,,272,RC,,,facility,both,,,210,148.68,Aetna First Health,Commercial,,178.5,85,,,93.07,178.5,percent of total billed charges,
CPM FLEECE LINER,27145678,CDM,,,271,RC,,,facility,both,,,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
SUTURE SILK 2-0 BRAIDED 18IN FS  685G,27200000,CDM,,,272,RC,,,facility,both,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
TIP SUCTION FRAZIER W/VENT 12FR STERILE  K73,27200000,CDM,,,272,RC,,,facility,both,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
TRAY SKIN PREP DRY STRL   11-7003,27200000,CDM,,,272,RC,,,facility,both,,,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
NEEDLE ARTERIAL 18GA X 7.0CM W/O BASE  G00166,27200000,CDM,,,272,RC,,,facility,both,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
SUPPLIES STERILE,27200000,CDM,,,272,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
FORCEPS BIOPSY GI CAPTURA PRO LG 2.4MM  G50696,27200000,CDM,,,272,RC,,,facility,both,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
MANIFOLD SINGLE PORT   0702-025-000,27200000,CDM,,,272,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,,34.85,85,,,18.17,34.85,percent of total billed charges,
LINE FILTER SAMPLING ADULT O2 NASAL LONG TERM MICROSTREAM  MVANOH,27200000,CDM,,,272,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
SNARE LARIAT HOT/COLD THIN WIRE  00711119,27200000,CDM,,,272,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
SNARE MINI-HEX EXACTO 230CM LENGTH  00711115,27200000,CDM,,,272,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
KIT ENDO W/VALVE & KEY   4005914,27200000,CDM,,,272,RC,,,facility,both,,,52,36.82,Aetna First Health,Commercial,,44.2,85,,,23.05,44.2,percent of total billed charges,
SET IRRIGATION Y-TYPE TUR NONVENTED TUBING LF  6543-01,27200000,CDM,,,272,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
DEVICE SECURE STATLOCK PSI (EA=BX/20)  0684-00-0493,27200000,CDM,,,272,RC,,,facility,both,,,66,46.73,Aetna First Health,Commercial,,56.1,85,,,29.25,56.1,percent of total billed charges,
KIT MANIFOLD ACIST   BT-2000,27200000,CDM,,,272,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
PENCIL SMOKE PLUMEPEN PRO 10FT   PLPRO4020,27200000,CDM,,,272,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,,62.05,85,,,32.35,62.05,percent of total billed charges,
CATHETER SLEEVE REPOSITIONING (ORDER IN MULT OF 5)  406501,27200000,CDM,,,272,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
KIT HAND CONTROL ANGIO TOUCH   AT-P65,27200000,CDM,,,272,RC,,,facility,both,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
GUIDEWIRE MICROPUNCTURE SET 5FR X10CM STD MINI STICK MAS  H965457561,27200000,CDM,,,272,RC,,,facility,both,,,137,97,Aetna First Health,Commercial,,116.45,85,,,60.72,116.45,percent of total billed charges,
SUTURE VICRYL #1 DYD 27IN CTX   J365H,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE VICRYL 2-0 27IN CP-2   J869H,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE VICRYL 4-0 27IN KS   J662H,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
NEEDLE ANGIOGRAPHIC 21G X 4CM ADVANCE ONE WALL  AD21T41W,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
PADDING CAST WEBRIL 3INX4YD COTTON STRL  2394-,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
PADDING CAST WEBRIL 4INX4YD COTTON STRL  2502-,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
PADDING CAST WEBRIL 6INX4YD COTTON STRL  2554,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
SUTURE SILK 2-0 BRAIDED 13-24IN  SA75H,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
SUTURE VICRYL 0 DYD 27IN UR-5   J376H,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
SUTURE VICRYL 0 DYD 3-18IN   J636H,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
TIP SUCTION FRAZIER W/VENT 12FR STERILE  K73,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
SUTURE PDS II 2-0 DYD 27IN SH   Z317H,27200000,CDM,,,272,RC,,,facility,inpatient,,,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
SUTURE PROLENE 0 DYD 30IN CT-2   8412H,27200000,CDM,,,272,RC,,,facility,inpatient,,,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
TRAY SKIN PREP DRY STRL   11-7003,27200000,CDM,,,272,RC,,,facility,inpatient,,,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
SYSTEM TUBING BIFURCATED 72IN   H965913000521,27200000,CDM,,,272,RC,,,facility,inpatient,,,11,7.79,Aetna First Health,Commercial,,9.35,85,,,4.88,9.35,percent of total billed charges,
BOOT SUTURE (5 PAIR YELLOW)   DYNJSBY5,27200000,CDM,,,272,RC,,,facility,inpatient,,,11,7.79,Aetna First Health,Commercial,,9.35,85,,,4.88,9.35,percent of total billed charges,
TRAP SPECIMEN POLYP QUICK CATCH SUCTION IN-LINE  710201,27200000,CDM,,,272,RC,,,facility,inpatient,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
TIP SUCTION SIGMOID 23FR   166035,27200000,CDM,,,272,RC,,,facility,inpatient,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
BANDAGE COMPRESSION ELASTIC MD 4IN X 5YD STRL LF DISP  DYNJ05154LF,27200000,CDM,,,272,RC,,,facility,inpatient,,,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
NEEDLE SPINAL 22GA 3-1/2IN QUINCKE  333320,27200000,CDM,,,272,RC,,,facility,inpatient,,,14.5,10.27,Aetna First Health,Commercial,,12.32,85,,,6.43,12.32,percent of total billed charges,
SUTURE ETHILON 3-0 DYD 18IN PS-1  1663G,27200000,CDM,,,272,RC,,,facility,inpatient,,,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
SUTURE ETHILON 3-0 DYD 18IN PS-1 BLK  1663G,27200000,CDM,,,272,RC,,,facility,inpatient,,,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
SUTURE ETHILON 4-0 DYD 18IN P-3  699G,27200000,CDM,,,272,RC,,,facility,inpatient,,,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
BANDAGE WRAP ELASTIC DOUBLE STERILE 6IN X 11YD  59790000,27200000,CDM,,,272,RC,,,facility,inpatient,,,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
EVACUATOR WOUND DRAIN RESERVOIR 100ML LF  V0070740,27200000,CDM,,,272,RC,,,facility,inpatient,,,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
SUTURE ETHIBOND #5 DYD 30IN MO-6  B499T,27200000,CDM,,,272,RC,,,facility,inpatient,,,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
SUTURE VICRYL 3-0 DYD 36IN CT   J356H,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE VICRYL MULTIPASS 4-0 18IN P-3  J494H,27200000,CDM,,,272,RC,,,facility,inpatient,,,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
SPONGE SURGIFOAM ABS GELATIN 2 X 6CM X 7MM  1972,27200000,CDM,,,272,RC,,,facility,inpatient,,,17,12.04,Aetna First Health,Commercial,,14.45,85,,,7.53,14.45,percent of total billed charges,
NEEDLE ARTERIAL 18GA X 7.0CM W/O BASE  G00166,27200000,CDM,,,272,RC,,,facility,inpatient,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
SUTURE PROLENE 4-0 18IN PS-4   8603G,27200000,CDM,,,272,RC,,,facility,inpatient,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
TRAP FLUID SMOKE EVACUATION   VSFT10,27200000,CDM,,,272,RC,,,facility,inpatient,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
VALVE BRONCHOSCOPY BIOPSY DISP   MAJ-210,27200000,CDM,,,272,RC,,,facility,inpatient,,,19,13.45,Aetna First Health,Commercial,,16.15,85,,,8.42,16.15,percent of total billed charges,
DRAIN WOUND PENROSE RADIOPAQUE SILICONE 1/4 X 12IN  GR101,27200000,CDM,,,272,RC,,,facility,inpatient,,,19,13.45,Aetna First Health,Commercial,,16.15,85,,,8.42,16.15,percent of total billed charges,
REMOVER STAPLE SKIN   TSR-1,27200000,CDM,,,272,RC,,,facility,inpatient,,,19,13.45,Aetna First Health,Commercial,,16.15,85,,,8.42,16.15,percent of total billed charges,
BAG URINARY DRAINAGE 2000ML LF   154114A,27200000,CDM,,,272,RC,,,facility,inpatient,,,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
CAUTERY TIP NEEDLE INSULATED 6IN  E1465-6,27200000,CDM,,,272,RC,,,facility,inpatient,,,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
SUTURE ETHIBOND 2-0 DYD 30IN V-5  X937H,27200000,CDM,,,272,RC,,,facility,inpatient,,,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
BLADE ELECTRODE INSULATED EDGE COATED 6IN  E1455-6,27200000,CDM,,,272,RC,,,facility,inpatient,,,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
SUTURE 3-0 COATED VICRYL PLUS VIOLET 1X36IN CT  VCP356H,27200000,CDM,,,272,RC,,,facility,inpatient,,,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
TUBE FEEDING 5FR X20IN W/ENFIT   461412E,27200000,CDM,,,272,RC,,,facility,inpatient,,,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
SUTURE CHROMIC GUT 5-0 12IN C-3  723G,27200000,CDM,,,272,RC,,,facility,inpatient,,,22,15.58,Aetna First Health,Commercial,,18.7,85,,,9.75,18.7,percent of total billed charges,
SUTURE ETHIBOND #2 DYD 30IN OS-4  X519H,27200000,CDM,,,272,RC,,,facility,inpatient,,,11,7.79,Aetna First Health,Commercial,,9.35,85,,,4.88,9.35,percent of total billed charges,
SLEEVE STL F/SHOCKWAVE CABLE   IVL10CS,27200000,CDM,,,272,RC,,,facility,inpatient,,,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
BAG DRAINAGE URNRY CENTR-ENTRY SAMP-PRT ANTI-REFLUX 4000ML  153509,27200000,CDM,,,272,RC,,,facility,inpatient,,,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
CATHETER THORACIC 28FR STRAIGHT PVC  8028,27200000,CDM,,,272,RC,,,facility,inpatient,,,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
PENCIL CAUTERY EDGE HOLSTER ROCKER HAND CONTRL  E2350H,27200000,CDM,,,272,RC,,,facility,inpatient,,,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
SUTURE PDS II 0 DYD 60IN CTX   Z990G,27200000,CDM,,,272,RC,,,facility,inpatient,,,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
TRAY URINARY CATH INTERMITTENT 14FR SURESTEP  INTS14,27200000,CDM,,,272,RC,,,facility,inpatient,,,26,18.41,Aetna First Health,Commercial,,22.1,85,,,11.52,22.1,percent of total billed charges,
DEVICE TORQUE ACCOMODATES WIRES .010IN TO .038IN  TD01,27200000,CDM,,,272,RC,,,facility,inpatient,,,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
SUPPLIES STERILE,27200000,CDM,,,272,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
CATHETER 4FR INF JL3.5 100CM   538418,27200000,CDM,,,272,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
SUTURE VICRYL 3-0 DYD 27IN CT-1  J338H,27200000,CDM,,,272,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
SUTURE VICRYL 4-0 18IN PS-2   J496H,27200000,CDM,,,272,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
CATHETER ANGIOGRAPHIC 5FR DIAGNOSTIC FL4.5  H74908526232,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
CATHETER ANGIOGRAPHIC 5FR DIAGNOSTIC FL 5  H74908526242,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
CATHETER ANGIOGRAPHIC IMPULSE FL3.5 5FR 100CM  H74916391212,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
CATHETER ANGIOGRAPHIC IMPULSE FL4.5 5FR 100CM  H74916391232,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
CATHETER ANGIOGRAPHIC IMPULSE FR4 5FR 100CM  H74916391022,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
SUPPORT WRIST FLEXBOARD BENDABLE  140-0400-00,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
BAG DRAIN CYSTO TABLE SKYTRON/OR BEDS  LG3000N,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
CIRCUIT ANESTHESIA ADULT WITH MASK  DYNJAA6481C,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
SET IRRIGATION CYSTOSCOPY   6544-01,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
TROCAR ENDO SLEEVE 5MM   CTS02,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
SUTURE MONOCRYL 4-0 27IN PS-2   Y426H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
DRAIN W/RESERVOIR 15FR   0043630,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE CHROMIC GUT 0 27IN SH   G124H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE CHROMIC GUT 3-0 27IN CT-1  810H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE CHROMIC GUT 3-0 27IN SH   G122H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE ETHIBOND 0 DYD 30IN CT-1  X424H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE ETHIBOND #2 DYD 30IN LR   X496T,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE ETHILON 4-0 DYD 18IN PS-2  1667H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE MONOCRYL 3-0 27IN PS-2   Y427H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE PDS II 0 DYD 36IN CT-1   Z346H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE PDS II 3-0 DYD 27IN RB-1  Z305H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE PROLENE #1 DYD 60IN TP-1  8824G,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE PROLENE 2-0 DYD 30IN SH   8833H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE PROLENE 4-0 DYD 36IN RB-1  8557H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE SILK 2-0 BRAIDED 30IN SH  K833H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE SILK 3-0 DYD 30IN SH   K832H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 0 DYD 27IN CT-1   J340H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 0 DYD 36IN CTX   J370H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 2-0 27IN SH   J417H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 2-0 DYD 12-18IN SINGLE STRAND DELIVERY  J105T,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 2-0 DYD 27IN CT-2  J333H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 2-0 DYD 36IN CT-1  J345H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 3-0 27IN FS-2   J423H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 3-0 27IN SH   J416H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE VICRYL 3-0 DYD 27IN SH   J316H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
TUBE CHEST THORACIC RT ANGLE 28FR  8888571042,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
CATHETER 4FR INF AL1 100CM   538445,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
CATHETER 4FR INFINITI PIGTAIL 155D  538455S,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
CATHETER 5F INF JR 4.0 100CM   534-521T,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
CATHETER 5FR INFINITI DIAGNOSTIC AR1 MOD 100CM  534541T,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
CATHETER INFINITI AL1 5FR 100CM  534545T,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
FORCEPS BIOPSY GI CAPTURA PRO LG 2.4MM  G50696,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
CATHETER URETH 18FR 5ML FOLEY IC LATEX  0165SI18,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
DRESSING MEPITEL ONE W/SAFETAC 4INX7IN  289500,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
SUTURE PROLENE 4-0 DYD 18IN PS-2  8682G,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
SUTURE PROLENE MULTIPASS 4-0 DYD 18IN PS-2  8682G,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
SUTURE VICRYL 4-0 18IN P-3   J494H,27200000,CDM,,,272,RC,,,facility,inpatient,,,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
CATHETER URETH 16FR 5ML FOLEY IC LATEX  0165SI16,27200000,CDM,,,272,RC,,,facility,inpatient,,,33,23.36,Aetna First Health,Commercial,,28.05,85,,,14.63,28.05,percent of total billed charges,
CATHETER URETH 20FR 5ML FOLEY IC LATEX  0165SI20,27200000,CDM,,,272,RC,,,facility,inpatient,,,33,23.36,Aetna First Health,Commercial,,28.05,85,,,14.63,28.05,percent of total billed charges,
SUTURE VICRYL 3-0 DYD 8-18IN CRSH  J774D,27200000,CDM,,,272,RC,,,facility,inpatient,,,33,23.36,Aetna First Health,Commercial,,28.05,85,,,14.63,28.05,percent of total billed charges,
BIT DRILL 3/32 X 5 NON-STRL   KM166-00-02,27200000,CDM,,,272,RC,,,facility,inpatient,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
BLADE ELECTRODE INSULATED 2.75IN SAFETY SLEEVE  E1455B,27200000,CDM,,,272,RC,,,facility,inpatient,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
CATHETER ANGIOGRAPHIC 5FR DIAGNOSTIC AL2  H74908526982,27200000,CDM,,,272,RC,,,facility,inpatient,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
CATHETER IMPULSE 5FR IM   H749163912012,27200000,CDM,,,272,RC,,,facility,inpatient,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
BLADE SAW OSCILLATING SM BONE   KM3-111,27200000,CDM,,,272,RC,,,facility,inpatient,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
TOURNIQUET 2 PORT 42IN DISP SGL BLADDER MAROON PLC  60-7070-107,27200000,CDM,,,272,RC,,,facility,inpatient,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
CATHETER ANGIOGRAPHIC 5FR 4.0 EXPO  H74908526022,27200000,CDM,,,272,RC,,,facility,inpatient,,,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
CATHETER ANGIOGRAPHIC 5FR DIAGNOSTIC FL3.5  H74908526212,27200000,CDM,,,272,RC,,,facility,inpatient,,,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
SUTURE VICRYL 4-0 DYD 18IN   J633H,27200000,CDM,,,272,RC,,,facility,inpatient,,,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
STAPLER SKIN FIXED HEAD DISP WIDE 35.  25-3001,27200000,CDM,,,272,RC,,,facility,inpatient,,,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
VALVE BRONCHOSCOPY SUCTION DISP  MAJ-209,27200000,CDM,,,272,RC,,,facility,inpatient,,,38,26.9,Aetna First Health,Commercial,,32.3,85,,,16.84,32.3,percent of total billed charges,
SUTURE PDS II #1 DYD 96IN TP-1   Z880G,27200000,CDM,,,272,RC,,,facility,inpatient,,,19,13.45,Aetna First Health,Commercial,,16.15,85,,,8.42,16.15,percent of total billed charges,
CATHETER URETH 14FR 5ML FOLEY IC SILICONE  1758SI14,27200000,CDM,,,272,RC,,,facility,inpatient,,,39,27.61,Aetna First Health,Commercial,,33.15,85,,,17.28,33.15,percent of total billed charges,
CATHETER URETH 16FR 5ML FOLEY IC SILICONE  1758SI16,27200000,CDM,,,272,RC,,,facility,inpatient,,,39,27.61,Aetna First Health,Commercial,,33.15,85,,,17.28,33.15,percent of total billed charges,
DRESSING MEPILEX BORDER AG 4X4   395390,27200000,CDM,,,272,RC,,,facility,inpatient,,,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
DRESSING TEGADERM TRANSPARENT 8IN X 12IN  1629,27200000,CDM,,,272,RC,,,facility,inpatient,,,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
MANIFOLD SINGLE PORT   0702-025-000,27200000,CDM,,,272,RC,,,facility,inpatient,,,41,29.03,Aetna First Health,Commercial,,34.85,85,,,18.17,34.85,percent of total billed charges,
SUTURE VICRYL 0 27IN CT-1 CONTROL RELEASE  JJ41G,27200000,CDM,,,272,RC,,,facility,inpatient,,,41,29.03,Aetna First Health,Commercial,,34.85,85,,,18.17,34.85,percent of total billed charges,
BIT DRILL 3/32 X 5 STERILE   KM166-10-02,27200000,CDM,,,272,RC,,,facility,inpatient,,,42,29.74,Aetna First Health,Commercial,,35.7,85,,,18.61,35.7,percent of total billed charges,
SUPPLIES STERILE,27200000,CDM,,,272,RC,,,facility,inpatient,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
DRAIN CHANNEL RND 15FR HBLS LF 3/16IN FULL-FLUTED  V072228,27200000,CDM,,,272,RC,,,facility,inpatient,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
ADAPTER CHECK-FLO W/SIDEARM   G15475,27200000,CDM,,,272,RC,,,facility,inpatient,,,44,31.15,Aetna First Health,Commercial,,37.4,85,,,19.5,37.4,percent of total billed charges,
BUR OVAL CARBIDE 10 FLT 5.5 HEAD DIAM X 70MM AC  09-C0905,27200000,CDM,,,272,RC,,,facility,inpatient,,,45,31.86,Aetna First Health,Commercial,,38.25,85,,,19.94,38.25,percent of total billed charges,
CANNULA NASAL CO2 W/O2 ADULT   2013066-004,27200000,CDM,,,272,RC,,,facility,inpatient,,,45,31.86,Aetna First Health,Commercial,,38.25,85,,,19.94,38.25,percent of total billed charges,
KIT ENDO W/VALVE   101955,27200000,CDM,,,272,RC,,,facility,inpatient,,,45,31.86,Aetna First Health,Commercial,,38.25,85,,,19.94,38.25,percent of total billed charges,
DRAIN CHANNEL ROUND 19FR FULL-FLUTED LF  072190,27200000,CDM,,,272,RC,,,facility,inpatient,,,46,32.57,Aetna First Health,Commercial,,39.1,85,,,20.39,39.1,percent of total billed charges,
NEEDLE ENDO 14G X 120MM DISP  C2201,27200000,CDM,,,272,RC,,,facility,inpatient,,,46,32.57,Aetna First Health,Commercial,,39.1,85,,,20.39,39.1,percent of total billed charges,
NEEDLE INSUFFLATION 14G   C2202,27200000,CDM,,,272,RC,,,facility,inpatient,,,46,32.57,Aetna First Health,Commercial,,39.1,85,,,20.39,39.1,percent of total billed charges,
SUPPLIES STERILE,27200000,CDM,,,272,RC,,,facility,inpatient,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
INA CANNULA NASAL SET PLUS O2 LFCAPNOLINE SMAR H  008180,27200000,CDM,,,272,RC,,,facility,inpatient,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
LINE FILTER SAMPLING ADULT O2 NASAL LONG TERM MICROSTREAM  MVANOH,27200000,CDM,,,272,RC,,,facility,inpatient,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
SNARE LARIAT HOT/COLD THIN WIRE  00711119,27200000,CDM,,,272,RC,,,facility,inpatient,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
SNARE MINI-HEX EXACTO 230CM LENGTH  00711115,27200000,CDM,,,272,RC,,,facility,inpatient,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
SUTURE VICRYL #2 DYD 4-27IN TP-1  J649G,27200000,CDM,,,272,RC,,,facility,inpatient,,,51,36.11,Aetna First Health,Commercial,,43.35,85,,,22.6,43.35,percent of total billed charges,
KIT ENDO W/VALVE & KEY   4005914,27200000,CDM,,,272,RC,,,facility,inpatient,,,52,36.82,Aetna First Health,Commercial,,44.2,85,,,23.05,44.2,percent of total billed charges,
NEEDLE NEPHROSTOMY 18GA X 20CM 2 PART TROCAR  G14255,27200000,CDM,,,272,RC,,,facility,inpatient,,,52,36.82,Aetna First Health,Commercial,,44.2,85,,,23.05,44.2,percent of total billed charges,
SUTURE ETHIBOND #5 DYD 30IN V-37  MB66G,27200000,CDM,,,272,RC,,,facility,inpatient,,,52,36.82,Aetna First Health,Commercial,,44.2,85,,,23.05,44.2,percent of total billed charges,
SYSTEM EVAC SMOKE LAPAROSCOPIC PLUMEPORT  PP010CS,27200000,CDM,,,272,RC,,,facility,inpatient,,,53,37.52,Aetna First Health,Commercial,,45.05,85,,,23.49,45.05,percent of total billed charges,
SPONGE HEMOSTAT 8X10CM ABSORBABLE SURGIFOAM STRL  1973,27200000,CDM,,,272,RC,,,facility,inpatient,,,54,38.23,Aetna First Health,Commercial,,45.9,85,,,23.93,45.9,percent of total billed charges,
TUBING INSUFFLATION NON-HEATED   WA95005A,27200000,CDM,,,272,RC,,,facility,inpatient,,,55,38.94,Aetna First Health,Commercial,,46.75,85,,,24.38,46.75,percent of total billed charges,
TUBING INSUFFLATION NON-HEATED W/FILTER  WA95005A,27200000,CDM,,,272,RC,,,facility,inpatient,,,55,38.94,Aetna First Health,Commercial,,46.75,85,,,24.38,46.75,percent of total billed charges,
CATHETER URETH 16FR 35CML 5ML FOLEY IC RADIOPAQUE  0196SI16,27200000,CDM,,,272,RC,,,facility,inpatient,,,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
DEVICE PORT CLOSURE-STANDARD 14FR 150MM  RSG-14F,27200000,CDM,,,272,RC,,,facility,inpatient,,,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
CATHETER 3DRC 6FR CORDIS   534-676T,27200000,CDM,,,272,RC,,,facility,inpatient,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
APPLICATOR FLEXTIP   AM0005,27200000,CDM,,,272,RC,,,facility,inpatient,,,58,41.06,Aetna First Health,Commercial,,49.3,85,,,25.71,49.3,percent of total billed charges,
PAD HEMOSTATIC THROMBIX   3101,27200000,CDM,,,272,RC,,,facility,inpatient,,,59,41.77,Aetna First Health,Commercial,,50.15,85,,,26.15,50.15,percent of total billed charges,
CATHETER ANGLED PIGTAIL 6FR   H74908641412,27200000,CDM,,,272,RC,,,facility,inpatient,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
DEVICE TOUGHY TORQUE LG BORE   MAP152,27200000,CDM,,,272,RC,,,facility,inpatient,,,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
PRESSURIZER CEMENT BONE SM PROXIMAL FEM CANAL W/O HUB  0206-545-000,27200000,CDM,,,272,RC,,,facility,inpatient,,,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
SUTURE ETHILON 4-0 DYD 18IN PS-2 BLK  1667H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
SUTURE ETHILON 5-0 DYD 18IN PS-2  1666G,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
POSITIONER HIP ABDUCTION MD   M60076EM,27200000,CDM,,,272,RC,,,facility,inpatient,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
SET IRRIGATION Y-TYPE TUR NONVENTED TUBING LF  6543-01,27200000,CDM,,,272,RC,,,facility,inpatient,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
TROCAR BLADED 5MM   CTB03,27200000,CDM,,,272,RC,,,facility,inpatient,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
BLADE SAW SAGITTAL LG BONE   BR2108-115,27200000,CDM,,,272,RC,,,facility,inpatient,,,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
CATHETER URETH 20FR 30ML FOLEY 3-WAY IC LATEX  0167SI20,27200000,CDM,,,272,RC,,,facility,inpatient,,,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
CATHETER URETH 22FR 30ML FOLEY 3-WAY IC LATEX  0167SI22,27200000,CDM,,,272,RC,,,facility,inpatient,,,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
DEVICE SECUREMENT STATLOCK IAB STABILIZATION STERILE LF  0684-00-0472,27200000,CDM,,,272,RC,,,facility,inpatient,,,66,46.73,Aetna First Health,Commercial,,56.1,85,,,29.25,56.1,percent of total billed charges,
BAND VASCULAR HEMOSTAT REG 24CM  3524,27200000,CDM,,,272,RC,,,facility,inpatient,,,67,47.44,Aetna First Health,Commercial,,56.95,85,,,29.69,56.95,percent of total billed charges,
VALVE HEMOSTASIS W/GW INSERT TOOL  8215,27200000,CDM,,,272,RC,,,facility,inpatient,,,67,47.44,Aetna First Health,Commercial,,56.95,85,,,29.69,56.95,percent of total billed charges,
APPLICATOR SURGICEL ENDOSCOPIC   3123SPEA,27200000,CDM,,,272,RC,,,facility,inpatient,,,69,48.85,Aetna First Health,Commercial,,58.65,85,,,30.58,58.65,percent of total billed charges,
DRESSING FOAM MEPILEX 4X8IN BORDER AG POST-OP  395890,27200000,CDM,,,272,RC,,,facility,inpatient,,,69,48.85,Aetna First Health,Commercial,,58.65,85,,,30.58,58.65,percent of total billed charges,
SYSTEM CO CLOSED INJECTION DELIVERY  93610,27200000,CDM,,,272,RC,,,facility,inpatient,,,69.5,49.21,Aetna First Health,Commercial,,59.08,85,,,30.8,59.08,percent of total billed charges,
FAN SPRAY TIP   0210-018-000,27200000,CDM,,,272,RC,,,facility,inpatient,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
SEAL CANNULA DA VINCI 12MM AND STAPLER  470380,27200000,CDM,,,272,RC,,,facility,inpatient,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
KIT MANIFOLD ACIST   BT-2000,27200000,CDM,,,272,RC,,,facility,inpatient,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
CABLE SURGICAL DISP   301-CG,27200000,CDM,,,272,RC,,,facility,inpatient,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
PENCIL SMOKE PLUMEPEN PRO 10FT   PLPRO4020,27200000,CDM,,,272,RC,,,facility,inpatient,,,73,51.68,Aetna First Health,Commercial,,62.05,85,,,32.35,62.05,percent of total billed charges,
CATHETER SLEEVE REPOSITIONING (ORDER IN MULT OF 5)  406501,27200000,CDM,,,272,RC,,,facility,inpatient,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
TROCAR 12MM X 150MM Z THRD LONG  CTF71,27200000,CDM,,,272,RC,,,facility,inpatient,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
CATHETER LCB 6FR   H749086411952,27200000,CDM,,,272,RC,,,facility,inpatient,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
BLADE SAW RECIPROCATING LG BONE  KM-277R,27200000,CDM,,,272,RC,,,facility,inpatient,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
CLIP LIGATION VAS-Q-CLIP LG   2232,27200000,CDM,,,272,RC,,,facility,inpatient,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
SUTURE MONOCRYL 4-0 18IN PS-2   Y496G,27200000,CDM,,,272,RC,,,facility,inpatient,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
SUTURE STRATAFIX SPIRAL PDS 2-0 12IN CT-1  SXPP1B410,27200000,CDM,,,272,RC,,,facility,inpatient,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
SUTURE VICRYL #1 DYD 36IN CTX   J371H,27200000,CDM,,,272,RC,,,facility,inpatient,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
TIP COVER ACCESSORY DA VINCI   400180,27200000,CDM,,,272,RC,,,facility,inpatient,,,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
CATHETER URETH 16FR 5ML FOLEY COUDE 2-WAY SILICONE  0170SI16,27200000,CDM,,,272,RC,,,facility,inpatient,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
SUTURE STRATAFIX PDS 1 CT 45IN   SXPP1A405,27200000,CDM,,,272,RC,,,facility,inpatient,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
CATHETER ANGIOGRAPHIC FL4.0 6FR EXPO  H74908641222,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
CATHETER CORONARY 5F PIG 145 IMPULSE  H74916391412,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
CATHETER FL5 6FR   H74908641242,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
CATHETER IM 6FR   H749086412012,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
SUTURE FIBERWIRE #2 W/NEEDLE   AR-7200,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
SUTURE FIBERWIRE #2 W/TPR NDL   AR-7206,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
TROCAR 12MM FIOS   CTF73,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
TROCAR BLADED 12X100MM   CTB73,27200000,CDM,,,272,RC,,,facility,inpatient,,,77,54.52,Aetna First Health,Commercial,,65.45,85,,,34.13,65.45,percent of total billed charges,
CATHETER ANGIOGRAPHIC FL3.5 6FR EXPO  H74908641212,27200000,CDM,,,272,RC,,,facility,inpatient,,,82,58.06,Aetna First Health,Commercial,,69.7,85,,,36.34,69.7,percent of total billed charges,
CATHETER ARMOD 6FR   H74908641892,27200000,CDM,,,272,RC,,,facility,inpatient,,,82,58.06,Aetna First Health,Commercial,,69.7,85,,,36.34,69.7,percent of total billed charges,
CATHETER CORONARY 6F FR4.0 IMPULSE  H74916599022,27200000,CDM,,,272,RC,,,facility,inpatient,,,82,58.06,Aetna First Health,Commercial,,69.7,85,,,36.34,69.7,percent of total billed charges,
CANISTER WOUND DRAINAGE PREVENA 45ML REPLACEMENT  PRE.1095.S,27200000,CDM,,,272,RC,,,facility,inpatient,,,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
PENCIL SMOKE PLUMEPEN ELITE 10FT  PLP2020,27200000,CDM,,,272,RC,,,facility,inpatient,,,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
BLADE SAW THK1.27MM THK1.37MM TOOTH OFFSET  BR4118-137-090,27200000,CDM,,,272,RC,,,facility,inpatient,,,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
PAD KNEE POSITIONING TRIANGLE   193-P,27200000,CDM,,,272,RC,,,facility,inpatient,,,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
PENCIL ELECTROSURGICAL SMOKE EVAC NON-STICK W/10FT TUBING  PLPUL2020,27200000,CDM,,,272,RC,,,facility,inpatient,,,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
CUSHION PRONEVIEW INSERT MD   D28505CE,27200000,CDM,,,272,RC,,,facility,inpatient,,,88,62.3,Aetna First Health,Commercial,,74.8,85,,,39,74.8,percent of total billed charges,
REDUCER 12-8MM DA VINCI   470381,27200000,CDM,,,272,RC,,,facility,inpatient,,,88,62.3,Aetna First Health,Commercial,,74.8,85,,,39,74.8,percent of total billed charges,
SUTURE PROLENE 6-0 DYD 24IN C-1  8726H,27200000,CDM,,,272,RC,,,facility,inpatient,,,44,31.15,Aetna First Health,Commercial,,37.4,85,,,19.5,37.4,percent of total billed charges,
ADHESIVE SKIN DERMABOND   DNX12,27200000,CDM,,,272,RC,,,facility,inpatient,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
CANNULA SUCTION IRRIGATOR 5MM X 44CM  60-6001-205,27200000,CDM,,,272,RC,,,facility,inpatient,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
SUTURE PROLENE 3-0 DYD 18IN PS-2  8687H,27200000,CDM,,,272,RC,,,facility,inpatient,,,31,21.95,Aetna First Health,Commercial,,26.35,85,,,13.74,26.35,percent of total billed charges,
FORCEPS BRONCH CAPTURA   G47742,27200000,CDM,,,272,RC,,,facility,inpatient,,,94,66.55,Aetna First Health,Commercial,,79.9,85,,,41.66,79.9,percent of total billed charges,
SUTURE STRATAFIX SYMMETRIC PDS 0  SXPP1A425,27200000,CDM,,,272,RC,,,facility,inpatient,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
SUTURE VICRYL 2-0 DYD 27IN CT-1  J339H,27200000,CDM,,,272,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
VACUUM EXTRACTION MITYONE MITYVAC M-STYLE  10067,27200000,CDM,,,272,RC,,,facility,inpatient,,,97,68.68,Aetna First Health,Commercial,,82.45,85,,,42.99,82.45,percent of total billed charges,
DRESSING MEPILEX AG 4X10IN POST-OP BORDER  498450,27200000,CDM,,,272,RC,,,facility,inpatient,,,98,69.38,Aetna First Health,Commercial,,83.3,85,,,43.43,83.3,percent of total billed charges,
SUTURE ETHIBOND 0 DYD 8-18IN CT-1  CX21D,27200000,CDM,,,272,RC,,,facility,inpatient,,,103,72.92,Aetna First Health,Commercial,,87.55,85,,,45.65,87.55,percent of total billed charges,
SUTURE VICRYL 0 DYD 8-18IN CT-1  J740D,27200000,CDM,,,272,RC,,,facility,inpatient,,,103,72.92,Aetna First Health,Commercial,,87.55,85,,,45.65,87.55,percent of total billed charges,
BLADE THIN 9 X 0.38 X 31.0MM PRECISION  2296-003-125,27200000,CDM,,,272,RC,,,facility,inpatient,,,104,73.63,Aetna First Health,Commercial,,88.4,85,,,46.09,88.4,percent of total billed charges,
KIT HAND CONTROL ANGIO TOUCH   AT-P65,27200000,CDM,,,272,RC,,,facility,inpatient,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
SYRINGE ENDO 60ML DIALATON W/GAUGE KIT  G27112,27200000,CDM,,,272,RC,,,facility,inpatient,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
KIT URINARY CATH 5CC 16FR ST TEMP SENSING  319516AM,27200000,CDM,,,272,RC,,,facility,inpatient,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
OBTURATOR 8MM BLADELESS OPTICAL DISP  470359,27200000,CDM,,,272,RC,,,facility,inpatient,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
TRAY FOLEY 16FR 5ML LATEX TEMPSENSOR  A319416AM,27200000,CDM,,,272,RC,,,facility,inpatient,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
PENCIL ELECTROSURGICAL 10FT SMOKE EVAC ROCKER SWITCH 3M  SEP6000,27200000,CDM,,,272,RC,,,facility,inpatient,,,107,75.76,Aetna First Health,Commercial,,90.95,85,,,47.42,90.95,percent of total billed charges,
TRAY FOLEY 16FR-5ML SILICONE URINE METER  A303416A,27200000,CDM,,,272,RC,,,facility,inpatient,,,107,75.76,Aetna First Health,Commercial,,90.95,85,,,47.42,90.95,percent of total billed charges,
TUBE FEEDING GASTRO MIC G 24FR W/ENFIT  8100-24,27200000,CDM,,,272,RC,,,facility,inpatient,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
TUBE FEEDING GASTRO MIC G 22FR W/ENFIT  8100-22,27200000,CDM,,,272,RC,,,facility,inpatient,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
CANNULA SUCTION IRRIGATOR 10MM X 32CM  60-6001-110,27200000,CDM,,,272,RC,,,facility,inpatient,,,113,80,Aetna First Health,Commercial,,96.05,85,,,50.08,96.05,percent of total billed charges,
SUTURE STRATAFIX SPIRAL PDS 3-0 15CM SH  SXPP1B420,27200000,CDM,,,272,RC,,,facility,inpatient,,,113,80,Aetna First Health,Commercial,,96.05,85,,,50.08,96.05,percent of total billed charges,
TRAY FOLEY 16FR-5ML SILICONE TEMP SENS  A319516AM,27200000,CDM,,,272,RC,,,facility,inpatient,,,113,80,Aetna First Health,Commercial,,96.05,85,,,50.08,96.05,percent of total billed charges,
CUFF TOURNIQUET 18IN 2 PORT 1 BLADDER QC REPROCESSED  60-7070-103,27200000,CDM,,,272,RC,,,facility,inpatient,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
SHEATH URETERAL ACCESS DUAL LUMEN FLEXI TIP 6/10  G17013,27200000,CDM,,,272,RC,,,facility,inpatient,,,115,81.42,Aetna First Health,Commercial,,97.75,85,,,50.97,97.75,percent of total billed charges,
HANDPIECE INTERPULSE W/RETRAC COAXIAL FAN SPRAY TIP ST  210-118-200,27200000,CDM,,,272,RC,,,facility,inpatient,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
MANIFOLD STANDARD 4-PORT   0702-020-000,27200000,CDM,,,272,RC,,,facility,inpatient,,,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
NEEDLE 3/8 CIRCLE CUTTING EDGE   1822-16DC,27200000,CDM,,,272,RC,,,facility,inpatient,,,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
DEVICE COMPRESSION PRELUDE SYNC EZ RADIAL  EZ-SML,27200000,CDM,,,272,RC,,,facility,inpatient,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
WALKER CAM NEXTEP CONTOUR MD   79-95075,27200000,CDM,,,272,RC,,,facility,inpatient,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
BLADE SAGITTAL MD   2108-115-000,27200000,CDM,,,272,RC,,,facility,inpatient,,,124,87.79,Aetna First Health,Commercial,,105.4,85,,,54.96,105.4,percent of total billed charges,
BULB & BLADDER INSUFFLATION STRL DISP  SBB-01-5,27200000,CDM,,,272,RC,,,facility,inpatient,,,124,87.79,Aetna First Health,Commercial,,105.4,85,,,54.96,105.4,percent of total billed charges,
IRRIGATOR SURGILAV 210-118 STRYKER  0210-118-000,27200000,CDM,,,272,RC,,,facility,inpatient,,,127,89.92,Aetna First Health,Commercial,,107.95,85,,,56.29,107.95,percent of total billed charges,
BLADE MD AGGRESSIVE 31X9MM STRYKER  2296-003-225,27200000,CDM,,,272,RC,,,facility,inpatient,,,131,92.75,Aetna First Health,Commercial,,111.35,85,,,58.06,111.35,percent of total billed charges,
INSERT CLAMP FOGARTY HYDROGRIP 33MM 1 HYDRAJAW 1 TRACTIONJAW  HYDRA33,27200000,CDM,,,272,RC,,,facility,inpatient,,,131,92.75,Aetna First Health,Commercial,,111.35,85,,,58.06,111.35,percent of total billed charges,
DEVICE SECURE STATLOCK PSI (EA=BX/20)  0684-00-0493,27200000,CDM,,,272,RC,,,facility,inpatient,,,66,46.73,Aetna First Health,Commercial,,56.1,85,,,29.25,56.1,percent of total billed charges,
SUTURE V-LOC 90 3-0 DYD 6IN CV-23  VLOCM0804,27200000,CDM,,,272,RC,,,facility,inpatient,,,132,93.46,Aetna First Health,Commercial,,112.2,85,,,58.5,112.2,percent of total billed charges,
SUTURE V-LOC 90 ABSORB CLOS 3-0 UD 9 CV-23  VLOCM1944,27200000,CDM,,,272,RC,,,facility,inpatient,,,132,93.46,Aetna First Health,Commercial,,112.2,85,,,58.5,112.2,percent of total billed charges,
MARKER ENDOSCOPIC SPOT   GIS-45,27200000,CDM,,,272,RC,,,facility,inpatient,,,133,94.16,Aetna First Health,Commercial,,113.05,85,,,58.95,113.05,percent of total billed charges,
SNARE ENDOSCOPIC MD OVAL 27MM   M00562671,27200000,CDM,,,272,RC,,,facility,inpatient,,,133,94.16,Aetna First Health,Commercial,,113.05,85,,,58.95,113.05,percent of total billed charges,
ELECTRODE L-HOOK SHAFT SUCTION/IRRIGATOR 5MM X 32CM  60-5274-132,27200000,CDM,,,272,RC,,,facility,inpatient,,,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
BLADE OSCILLATING AGGRESSIVE AVERAGE MD 25X9MM  2296-003-111,27200000,CDM,,,272,RC,,,facility,inpatient,,,136,96.29,Aetna First Health,Commercial,,115.6,85,,,60.28,115.6,percent of total billed charges,
LIGATURE ENDOPATH ENDOLOOP COATED 0 VICRYL 18IN  EJ10G,27200000,CDM,,,272,RC,,,facility,inpatient,,,136,96.29,Aetna First Health,Commercial,,115.6,85,,,60.28,115.6,percent of total billed charges,
GUIDEWIRE MICROPUNCTURE SET 5FR X10CM STD MINI STICK MAS  H965457561,27200000,CDM,,,272,RC,,,facility,inpatient,,,137,97,Aetna First Health,Commercial,,116.45,85,,,60.72,116.45,percent of total billed charges,
PACK ESSENTIA CYSTO PACK STD   EHCY62A,27200000,CDM,,,272,RC,,,facility,inpatient,,,137,97,Aetna First Health,Commercial,,116.45,85,,,60.72,116.45,percent of total billed charges,
PACK ESSENTIA CYSTO STD   EHCY62A,27200000,CDM,,,272,RC,,,facility,inpatient,,,137,97,Aetna First Health,Commercial,,116.45,85,,,60.72,116.45,percent of total billed charges,
PACK ESSENTIA CYSTO STD   EHCY62B,27200000,CDM,,,272,RC,,,facility,inpatient,,,137,97,Aetna First Health,Commercial,,116.45,85,,,60.72,116.45,percent of total billed charges,
KIT MANIFOLD MERIT   K09-11307D,27200000,CDM,,,272,RC,,,facility,inpatient,,,139,98.41,Aetna First Health,Commercial,,118.15,85,,,61.6,118.15,percent of total billed charges,
CATHETER GUIDING LAUNCHER 5FR AR 1.0  LA5AR10,27200000,CDM,,,272,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
CATHETER GUIDING LAUNCHER 6FR ALR 1-2  LA6ALR12,27200000,CDM,,,272,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
CATHETER SHORT AMPLATZ 6FR 100CM LT GUIDE WO SIDEHOLES  LA6SAL10,27200000,CDM,,,272,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
KIT INFLATION ENCORE ADVANTAGE 26  H74904527052,27200000,CDM,,,272,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
CUFF TOURNIQUET 3.5IN X 12IN 2-PORT DISP  5921-212-235,27200000,CDM,,,272,RC,,,facility,inpatient,,,143.5,101.6,Aetna First Health,Commercial,,121.98,85,,,63.6,121.98,percent of total billed charges,
CUFF TOURNIQUET 4IN X 18IN 2 PORT DISP  5921-218-235,27200000,CDM,,,272,RC,,,facility,inpatient,,,143.5,101.6,Aetna First Health,Commercial,,121.98,85,,,63.6,121.98,percent of total billed charges,
CUFF TOURNIQUET 4IN X 24IN 2 PORT DISP  5921-024-235,27200000,CDM,,,272,RC,,,facility,inpatient,,,143.5,101.6,Aetna First Health,Commercial,,121.98,85,,,63.6,121.98,percent of total billed charges,
CUFF TOURNIQUET 4IN X 30IN 2 PORT DISP  5921-030-235,27200000,CDM,,,272,RC,,,facility,inpatient,,,143.5,101.6,Aetna First Health,Commercial,,121.98,85,,,63.6,121.98,percent of total billed charges,
CUFF TOURNIQUET 2 PORT DISP 5.5 X 18IN DOUBLE  5921-018-245,27200000,CDM,,,272,RC,,,facility,inpatient,,,147,104.08,Aetna First Health,Commercial,,124.95,85,,,65.15,124.95,percent of total billed charges,
BLADE ARTO EXCALIBUR CURVED 40  AR-8400CEX,27200000,CDM,,,272,RC,,,facility,inpatient,,,149,105.49,Aetna First Health,Commercial,,126.65,85,,,66.04,126.65,percent of total billed charges,
DEVICE SLED PULL BACK IVUS   H749A70200,27200000,CDM,,,272,RC,,,facility,inpatient,,,150,106.2,Aetna First Health,Commercial,,127.5,85,,,66.48,127.5,percent of total billed charges,
SUTURE PROLENE 5-0 DYD 24IN C-1  8725H,27200000,CDM,,,272,RC,,,facility,inpatient,,,79,55.93,Aetna First Health,Commercial,,67.15,85,,,35.01,67.15,percent of total billed charges,
KIT GUIDEWIRE ACCESSORY W/CO-PILOT  1003330,27200000,CDM,,,272,RC,,,facility,inpatient,,,165,116.82,Aetna First Health,Commercial,,140.25,85,,,73.13,140.25,percent of total billed charges,
PACK ESSENTIA MINOR   ESMN46A1,27200000,CDM,,,272,RC,,,facility,inpatient,,,166,117.53,Aetna First Health,Commercial,,141.1,85,,,73.57,141.1,percent of total billed charges,
PACK ESSENTIA MINOR   ESMN46A2,27200000,CDM,,,272,RC,,,facility,inpatient,,,166,117.53,Aetna First Health,Commercial,,141.1,85,,,73.57,141.1,percent of total billed charges,
PACK ESSENTIA MINOR   ESMN46AB,27200000,CDM,,,272,RC,,,facility,inpatient,,,166,117.53,Aetna First Health,Commercial,,141.1,85,,,73.57,141.1,percent of total billed charges,
PACK ESSENTIA MINOR   ESMN46B,27200000,CDM,,,272,RC,,,facility,inpatient,,,166,117.53,Aetna First Health,Commercial,,141.1,85,,,73.57,141.1,percent of total billed charges,
BLADE SAGITTAL DUAL-CUT   4111-135-090,27200000,CDM,,,272,RC,,,facility,inpatient,,,176,124.61,Aetna First Health,Commercial,,149.6,85,,,78,149.6,percent of total billed charges,
NEEDLE ENDO INJECTION 25GA X 5.0MM CARR-LOCKE SS  00711811,27200000,CDM,,,272,RC,,,facility,inpatient,,,179,126.73,Aetna First Health,Commercial,,152.15,85,,,79.33,152.15,percent of total billed charges,
DRESSING VAC SIMPLACE MD TEGADERM/SPIRAL/SENSATRAC PAD  M8275040/10.S,27200000,CDM,,,272,RC,,,facility,inpatient,,,179,126.73,Aetna First Health,Commercial,,152.15,85,,,79.33,152.15,percent of total billed charges,
STAPLER SKIN SUBQ ABSORBABLE   2030,27200000,CDM,,,272,RC,,,facility,inpatient,,,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
RETRACTOR WOUND ALEXIS MD   C8402,27200000,CDM,,,272,RC,,,facility,inpatient,,,182,128.86,Aetna First Health,Commercial,,154.7,85,,,80.66,154.7,percent of total billed charges,
PACK LAPAROSCOPY SUPINE STD ESS  ESLS51A,27200000,CDM,,,272,RC,,,facility,inpatient,,,185,130.98,Aetna First Health,Commercial,,157.25,85,,,81.99,157.25,percent of total billed charges,
PACK LAPAROSCOPY SUPINE STD ESS  ESLS51B,27200000,CDM,,,272,RC,,,facility,inpatient,,,185,130.98,Aetna First Health,Commercial,,157.25,85,,,81.99,157.25,percent of total billed charges,
PACK C SEC PACK STD LAP ESS   ESCS35A,27200000,CDM,,,272,RC,,,facility,inpatient,,,187,132.4,Aetna First Health,Commercial,,158.95,85,,,82.88,158.95,percent of total billed charges,
PACK C SEC STD LAP ESS   ESCS35A,27200000,CDM,,,272,RC,,,facility,inpatient,,,187,132.4,Aetna First Health,Commercial,,158.95,85,,,82.88,158.95,percent of total billed charges,
PACK C SEC STD LAP ESS   ESCS35B,27200000,CDM,,,272,RC,,,facility,inpatient,,,187,132.4,Aetna First Health,Commercial,,158.95,85,,,82.88,158.95,percent of total billed charges,
PACK C SEC STD LAP ESS   ESCS35C,27200000,CDM,,,272,RC,,,facility,inpatient,,,187,132.4,Aetna First Health,Commercial,,158.95,85,,,82.88,158.95,percent of total billed charges,
PACK ESS LAPAROSCOPY LITHO STD   ESLL29A2,27200000,CDM,,,272,RC,,,facility,inpatient,,,187,132.4,Aetna First Health,Commercial,,158.95,85,,,82.88,158.95,percent of total billed charges,
SEAL CANNULA 5-8MM DA VINCI   470361,27200000,CDM,,,272,RC,,,facility,inpatient,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
BLADE SAW RECIPROCATING DOUBLE SIDED 12.5X70MM  0277-096-277,27200000,CDM,,,272,RC,,,facility,inpatient,,,197,139.48,Aetna First Health,Commercial,,167.45,85,,,87.31,167.45,percent of total billed charges,
TUBING ART PUMP SINGLE USE   AR-6410,27200000,CDM,,,272,RC,,,facility,inpatient,,,198,140.18,Aetna First Health,Commercial,,168.3,85,,,87.75,168.3,percent of total billed charges,
PACK HIP CUSTOM   SOP5BHPSJ11,27200000,CDM,,,272,RC,,,facility,inpatient,,,201,142.31,Aetna First Health,Commercial,,170.85,85,,,89.08,170.85,percent of total billed charges,
CATHETER 3PK EXPO 6FR   H749086413012,27200000,CDM,,,272,RC,,,facility,inpatient,,,202,143.02,Aetna First Health,Commercial,,171.7,85,,,89.53,171.7,percent of total billed charges,
CLIP SUTURE ABSORBABLE LAPRA-TY  XC200,27200000,CDM,,,272,RC,,,facility,inpatient,,,205,145.14,Aetna First Health,Commercial,,174.25,85,,,90.86,174.25,percent of total billed charges,
SUTURE PROLENE 7-0 DYD 24IN CC   8704H,27200000,CDM,,,272,RC,,,facility,inpatient,,,103,72.92,Aetna First Health,Commercial,,87.55,85,,,45.65,87.55,percent of total billed charges,
PACK ESSENTIA GYN MINOR STD   ESGN13A2,27200000,CDM,,,272,RC,,,facility,inpatient,,,207,146.56,Aetna First Health,Commercial,,175.95,85,,,91.74,175.95,percent of total billed charges,
SPONGE HEMOSTAT 4X8IN ABSORBABLE SURGICEL STRL  1952,27200000,CDM,,,272,RC,,,facility,inpatient,,,209,147.97,Aetna First Health,Commercial,,177.65,85,,,92.63,177.65,percent of total billed charges,
SPONGE HEMOSTAT 4X8IN ABSORBABLE SURGICEL STRL DISP  1952,27200000,CDM,,,272,RC,,,facility,inpatient,,,209,147.97,Aetna First Health,Commercial,,177.65,85,,,92.63,177.65,percent of total billed charges,
APPLIER LIGACLIP MCA MULTICLIP MD 11-1/2IN  MCM20,27200000,CDM,,,272,RC,,,facility,inpatient,,,211,149.39,Aetna First Health,Commercial,,179.35,85,,,93.52,179.35,percent of total billed charges,
MANIPULATOR UTERINE ELEVATOR MD 35MM CUP  UE-TVPRO-35,27200000,CDM,,,272,RC,,,facility,inpatient,,,211,149.39,Aetna First Health,Commercial,,179.35,85,,,93.52,179.35,percent of total billed charges,
MANIPULATOR UTERINE ELEVATOR SM 32MM CUP  UE-TVPRO-32,27200000,CDM,,,272,RC,,,facility,inpatient,,,211,149.39,Aetna First Health,Commercial,,179.35,85,,,93.52,179.35,percent of total billed charges,
SYSTEM WOUND DEBRIDEMENT   ISEPT-450-USA,27200000,CDM,,,272,RC,,,facility,inpatient,,,212,150.1,Aetna First Health,Commercial,,180.2,85,,,93.96,180.2,percent of total billed charges,
BIT DRILL SYNT 2.5MM TIP GUIDEWIRE 200MM  310.243,27200000,CDM,,,272,RC,,,facility,inpatient,,,223,157.88,Aetna First Health,Commercial,,189.55,85,,,98.83,189.55,percent of total billed charges,
"POSITIONER HAND ALUMINUM LG ""ALUMIHAND""  760",27200000,CDM,,,272,RC,,,facility,inpatient,,,113,80,Aetna First Health,Commercial,,96.05,85,,,50.08,96.05,percent of total billed charges,
CATHETER SWAN-GANZ 5FR 110CM DOUBLE LUMEN  110F5,27200000,CDM,,,272,RC,,,facility,inpatient,,,228,161.42,Aetna First Health,Commercial,,193.8,85,,,101.05,193.8,percent of total billed charges,
RELOAD STAPLE 30 MD   XR30B,27200000,CDM,,,272,RC,,,facility,inpatient,,,228,161.42,Aetna First Health,Commercial,,193.8,85,,,101.05,193.8,percent of total billed charges,
RETRACTOR PANNICULUS RETENTION SYSTEM  CZ-PRS-04,27200000,CDM,,,272,RC,,,facility,inpatient,,,228,161.42,Aetna First Health,Commercial,,193.8,85,,,101.05,193.8,percent of total billed charges,
SYSTEM RETRIEVAL UNIVERSAL INZII  CD003,27200000,CDM,,,272,RC,,,facility,inpatient,,,228,161.42,Aetna First Health,Commercial,,193.8,85,,,101.05,193.8,percent of total billed charges,
BIT DRILL SYNT 4.5MM QC 145MM 310.44,27200000,CDM,,,272,RC,,,facility,inpatient,,,235,166.38,Aetna First Health,Commercial,,199.75,85,,,104.15,199.75,percent of total billed charges,
HANDLE SUCTION/IRRIGATION   60-6010-002,27200000,CDM,,,272,RC,,,facility,inpatient,,,235,166.38,Aetna First Health,Commercial,,199.75,85,,,104.15,199.75,percent of total billed charges,
GUIDEWIRE SYSTEM WHOLEY .035IN X 145CM MODIFIED J TIP  WWIJ35145,27200000,CDM,,,272,RC,,,facility,inpatient,,,241,170.63,Aetna First Health,Commercial,,204.85,85,,,106.81,204.85,percent of total billed charges,
DRAIN CHANNEL ROUND 10FR FULL-FLUTED LF  072186,27200000,CDM,,,272,RC,,,facility,inpatient,,,242,171.34,Aetna First Health,Commercial,,205.7,85,,,107.25,205.7,percent of total billed charges,
DRAIN FLAT HBLS FULL PERF 7MM LF  0070430,27200000,CDM,,,272,RC,,,facility,inpatient,,,242,171.34,Aetna First Health,Commercial,,205.7,85,,,107.25,205.7,percent of total billed charges,
BIT DRILL SYNT 2.5MM QC 110MM   310.25,27200000,CDM,,,272,RC,,,facility,inpatient,,,244,172.75,Aetna First Health,Commercial,,207.4,85,,,108.14,207.4,percent of total billed charges,
POUCH RETRIEVAL 10MM   CD001,27200000,CDM,,,272,RC,,,facility,inpatient,,,244,172.75,Aetna First Health,Commercial,,207.4,85,,,108.14,207.4,percent of total billed charges,
CATHETER 6FR IKARI LT 3.5 GUIDING (BX/1)  40-6370,27200000,CDM,,,272,RC,,,facility,inpatient,,,245,173.46,Aetna First Health,Commercial,,208.25,85,,,108.58,208.25,percent of total billed charges,
BIT DRILL 3.6MM X 122MM AO FITTING  45-35020,27200000,CDM,,,272,RC,,,facility,inpatient,,,245,173.46,Aetna First Health,Commercial,,208.25,85,,,108.58,208.25,percent of total billed charges,
RETRACTOR WOUND ALEXIS LG   C8403,27200000,CDM,,,272,RC,,,facility,inpatient,,,246,174.17,Aetna First Health,Commercial,,209.1,85,,,109.03,209.1,percent of total billed charges,
PACK ESSENTIA TOTAL JOINT STD   ESJS73B2,27200000,CDM,,,272,RC,,,facility,inpatient,,,247,174.88,Aetna First Health,Commercial,,209.95,85,,,109.47,209.95,percent of total billed charges,
PACK ESSENTIA TOTAL JOINT STD   ESJS73D,27200000,CDM,,,272,RC,,,facility,inpatient,,,247,174.88,Aetna First Health,Commercial,,209.95,85,,,109.47,209.95,percent of total billed charges,
BIT DRILL SYNT 3.2MM QC 145 MM 310.31,27200000,CDM,,,272,RC,,,facility,inpatient,,,254,179.83,Aetna First Health,Commercial,,215.9,85,,,112.57,215.9,percent of total billed charges,
BIT DRILL SYNT 3.2MM QC 145MM   310.31,27200000,CDM,,,272,RC,,,facility,inpatient,,,254,179.83,Aetna First Health,Commercial,,215.9,85,,,112.57,215.9,percent of total billed charges,
BIT DRILL SYNT 3.5MM QC 110MM   310.35,27200000,CDM,,,272,RC,,,facility,inpatient,,,257,181.96,Aetna First Health,Commercial,,218.45,85,,,113.9,218.45,percent of total billed charges,
BIT DRILL 2.6MM X 122MM WL70MMAO-SHAFT  45-35010,27200000,CDM,,,272,RC,,,facility,inpatient,,,260,184.08,Aetna First Health,Commercial,,221,85,,,115.23,221,percent of total billed charges,
PIN DRILL 3.2MM X 75MM TROCAR HEADLESS  00590102000,27200000,CDM,,,272,RC,,,facility,inpatient,,,264,186.91,Aetna First Health,Commercial,,224.4,85,,,117,224.4,percent of total billed charges,
BIT DRILL SYNT 2MM QC 125MM   310.21,27200000,CDM,,,272,RC,,,facility,inpatient,,,272,192.58,Aetna First Health,Commercial,,231.2,85,,,120.55,231.2,percent of total billed charges,
SUTURE RETRIEVER HEWSON   71111579,27200000,CDM,,,272,RC,,,facility,inpatient,,,291,206.03,Aetna First Health,Commercial,,247.35,85,,,128.97,247.35,percent of total billed charges,
KIT PEG MIC-KEY PULL METHOD 24FR W/ENFIT  8180-24,27200000,CDM,,,272,RC,,,facility,inpatient,,,293,207.44,Aetna First Health,Commercial,,249.05,85,,,129.86,249.05,percent of total billed charges,
TROCAR FIOS 5X100 Z-THREAD   CTF03,27200000,CDM,,,272,RC,,,facility,inpatient,,,293,207.44,Aetna First Health,Commercial,,249.05,85,,,129.86,249.05,percent of total billed charges,
TUBE SET AIRSEAL 3 LUMEN FILTERED IFS  ASM-EVAC1,27200000,CDM,,,272,RC,,,facility,inpatient,,,299,211.69,Aetna First Health,Commercial,,254.15,85,,,132.52,254.15,percent of total billed charges,
RELOAD CUTTER LINEAR PROXIMATE STANDARD BLUE 75MM  TCR75,27200000,CDM,,,272,RC,,,facility,inpatient,,,300,212.4,Aetna First Health,Commercial,,255,85,,,132.96,255,percent of total billed charges,
BLADE ART 4.0 TORPEDO   AR-8400TD,27200000,CDM,,,272,RC,,,facility,inpatient,,,303,214.52,Aetna First Health,Commercial,,257.55,85,,,134.29,257.55,percent of total billed charges,
TROCAR 12X120MM OPTICAL BLADELESS  IAS12-120LPI,27200000,CDM,,,272,RC,,,facility,inpatient,,,307,217.36,Aetna First Health,Commercial,,260.95,85,,,136.06,260.95,percent of total billed charges,
BASKET ROTH NET FOREIGN BODY   00711050,27200000,CDM,,,272,RC,,,facility,inpatient,,,308,218.06,Aetna First Health,Commercial,,261.8,85,,,136.51,261.8,percent of total billed charges,
SPONGE HEMOSTAT 2X3IN ABSORBABLE SURGICEL STRL  1953S,27200000,CDM,,,272,RC,,,facility,inpatient,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
BIT DRILL BIO RINGLOC 3.2MM X 30MM  31-323230,27200000,CDM,,,272,RC,,,facility,inpatient,,,312,220.9,Aetna First Health,Commercial,,265.2,85,,,138.28,265.2,percent of total billed charges,
CANNULA AIRSEAL 8MM CAP AND OBTURATOR  IAS8-DV,27200000,CDM,,,272,RC,,,facility,inpatient,,,323,228.68,Aetna First Health,Commercial,,274.55,85,,,143.15,274.55,percent of total billed charges,
TUBE SET AIRSEAL BIFURCATED FILTERED  ASM-EVAC1-BI,27200000,CDM,,,272,RC,,,facility,inpatient,,,323,228.68,Aetna First Health,Commercial,,274.55,85,,,143.15,274.55,percent of total billed charges,
PACK ESSENTIA TOTAL JOINT STD   ESJS73B2,27200000,CDM,,,272,RC,,,facility,inpatient,,,328,232.22,Aetna First Health,Commercial,,278.8,85,,,145.37,278.8,percent of total billed charges,
CATHETER DIAGNOSTIC 5FR MPA1 IMPULSE  H749163911172,27200000,CDM,,,272,RC,,,facility,inpatient,,,336,237.89,Aetna First Health,Commercial,,285.6,85,,,148.92,285.6,percent of total billed charges,
BLADE OSTEOTOME SHORT 12MM   47998602122,27200000,CDM,,,272,RC,,,facility,inpatient,,,336,237.89,Aetna First Health,Commercial,,285.6,85,,,148.92,285.6,percent of total billed charges,
CARTRIDGE CEMENT MIX SYSTEM STRYKER  0606-563-000,27200000,CDM,,,272,RC,,,facility,inpatient,,,340,240.72,Aetna First Health,Commercial,,289,85,,,150.69,289,percent of total billed charges,
DEVICE FEM-O-STOP GOLD HEMOSTASIS ASSIST  C11165,27200000,CDM,,,272,RC,,,facility,inpatient,,,342,242.14,Aetna First Health,Commercial,,290.7,85,,,151.57,290.7,percent of total billed charges,
BIT DRILL SYNT 2.8MM QC 165MM   310.288,27200000,CDM,,,272,RC,,,facility,inpatient,,,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
BIT DRILL SYNT 3.5MM QC 195MM   310.37,27200000,CDM,,,272,RC,,,facility,inpatient,,,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
ROD REAMING SYNT 2.5MM W/BALL TIP 950MM STRL  351.706S,27200000,CDM,,,272,RC,,,facility,inpatient,,,346,244.97,Aetna First Health,Commercial,,294.1,85,,,153.35,294.1,percent of total billed charges,
MARKER DELIVERY KIT   SDMDK1000,27200000,CDM,,,272,RC,,,facility,inpatient,,,355,251.34,Aetna First Health,Commercial,,301.75,85,,,157.34,301.75,percent of total billed charges,
HEMOSTAT ARISTA 1GM   SM0005-USA,27200000,CDM,,,272,RC,,,facility,inpatient,,,358,253.46,Aetna First Health,Commercial,,304.3,85,,,158.67,304.3,percent of total billed charges,
CLIP HEMOSTASIS INSTINCT PLUS DISP  G58010,27200000,CDM,,,272,RC,,,facility,inpatient,,,360,254.88,Aetna First Health,Commercial,,306,85,,,159.55,306,percent of total billed charges,
DEVICE COMPRESSION PRELUDE SYNC EZ RADIAL SML  EZ-SML,27200000,CDM,,,272,RC,,,facility,inpatient,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
BIT DRILL SYNT 4.3MM QC 180MM   310.431,27200000,CDM,,,272,RC,,,facility,inpatient,,,373,264.08,Aetna First Health,Commercial,,317.05,85,,,165.31,317.05,percent of total billed charges,
CATHETER FLOW DIRECTED PACING 5FR  401762,27200000,CDM,,,272,RC,,,facility,inpatient,,,380,269.04,Aetna First Health,Commercial,,323,85,,,168.42,323,percent of total billed charges,
STAPLER LINEAR RELOADABLE STANDARD BLUE 30X3.5MM  TX30B,27200000,CDM,,,272,RC,,,facility,inpatient,,,387,274,Aetna First Health,Commercial,,328.95,85,,,171.52,328.95,percent of total billed charges,
BIT DRILL SYNT 2.5MM W/STOP CALIB QC 250/95MM  03.113.023,27200000,CDM,,,272,RC,,,facility,inpatient,,,395,279.66,Aetna First Health,Commercial,,335.75,85,,,175.06,335.75,percent of total billed charges,
CANISTER 500ML W/GEL INFO VAC   M8275063/10.S,27200000,CDM,,,272,RC,,,facility,inpatient,,,395,279.66,Aetna First Health,Commercial,,335.75,85,,,175.06,335.75,percent of total billed charges,
BIT DRILL SYNT 2.7MM 3-FLUTED QC 125MM  315.28,27200000,CDM,,,272,RC,,,facility,inpatient,,,396,280.37,Aetna First Health,Commercial,,336.6,85,,,175.51,336.6,percent of total billed charges,
TROCAR SLEEVE THORACIC   TT012,27200000,CDM,,,272,RC,,,facility,inpatient,,,199,140.89,Aetna First Health,Commercial,,169.15,85,,,88.2,169.15,percent of total billed charges,
BIT DRILL AO DIA 2.0MM X 135MM SCALED VARIAX 2  703690,27200000,CDM,,,272,RC,,,facility,inpatient,,,417,295.24,Aetna First Health,Commercial,,354.45,85,,,184.81,354.45,percent of total billed charges,
BIT DRILL AO DIA 2.6MM X 135MM SCALED  703691,27200000,CDM,,,272,RC,,,facility,inpatient,,,417,295.24,Aetna First Health,Commercial,,354.45,85,,,184.81,354.45,percent of total billed charges,
DRILL BIT AO VARIAX 3.5 X122MM SCALED  703694,27200000,CDM,,,272,RC,,,facility,inpatient,,,417,295.24,Aetna First Health,Commercial,,354.45,85,,,184.81,354.45,percent of total billed charges,
DRAIN CHEST OASIS 2000ML WATERSEAL  3600-100,27200000,CDM,,,272,RC,,,facility,inpatient,,,210,148.68,Aetna First Health,Commercial,,178.5,85,,,93.07,178.5,percent of total billed charges,
AGENT SURGIFLO HEMOSTATIC GELATIN MATRIX 8ML  2991,27200000,CDM,,,272,RC,,,facility,inpatient,,,421,298.07,Aetna First Health,Commercial,,357.85,85,,,186.59,357.85,percent of total billed charges,
BALLOON COR RX 2.75 X 15MM NC EMERGE  H7493926715270,27200000,CDM,,,272,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.75 X 8MM NC EMERGE  H7493926708270,27200000,CDM,,,272,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.50 X 8MM NC EMERGE  H7493926708350,27200000,CDM,,,272,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
FORCEPS ROBOT XI PROGRASP 8MM   471093,27200000,CDM,,,272,RC,,,facility,inpatient,,,450,318.6,Aetna First Health,Commercial,,382.5,85,,,199.44,382.5,percent of total billed charges,
RELOAD STAPLER GRAY   ECR45M,27200000,CDM,,,272,RC,,,facility,inpatient,,,471,333.47,Aetna First Health,Commercial,,400.35,85,,,208.75,400.35,percent of total billed charges,
RELOAD STAPLER ECHILON 45MM 1.0MM WHITE  GST45W,27200000,CDM,,,272,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
RELOAD STAPLER ECHILON 45MM 1.5MM BLUE  GST45B,27200000,CDM,,,272,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
SUPPLIES STERILE,27200000,CDM,,,272,RC,,,facility,inpatient,,,476,337.01,Aetna First Health,Commercial,,404.6,85,,,210.96,404.6,percent of total billed charges,
BIT DRILL NCB 4.3 X 195MM   0200024002,27200000,CDM,,,272,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
BIT DRILL SYNT 4.2MM 3-FLUTED QC FOR TIB AND FEM NAIL-EX  03.010.104,27200000,CDM,,,272,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
DEVICE SPECIMEN RETRIEVAL SYSTEM INZII 12/15MM  CD004,27200000,CDM,,,272,RC,,,facility,inpatient,,,495,350.46,Aetna First Health,Commercial,,420.75,85,,,219.38,420.75,percent of total billed charges,
POWDER SURGICEL 3GR   3013SP,27200000,CDM,,,272,RC,,,facility,inpatient,,,499,353.29,Aetna First Health,Commercial,,424.15,85,,,221.16,424.15,percent of total billed charges,
FORCEPS ROBOT XI BIPOLAR FENE   471205,27200000,CDM,,,272,RC,,,facility,inpatient,,,500,354,Aetna First Health,Commercial,,425,85,,,221.6,425,percent of total billed charges,
STAPLER SUREFORM 45 SPU   480445,27200000,CDM,,,272,RC,,,facility,inpatient,,,500,354,Aetna First Health,Commercial,,425,85,,,221.6,425,percent of total billed charges,
BALLOON ESOPHAGEAL DILATION HERCULES 12-13.5-15MM  G31926,27200000,CDM,,,272,RC,,,facility,inpatient,,,504,356.83,Aetna First Health,Commercial,,428.4,85,,,223.37,428.4,percent of total billed charges,
STAPLER INTERNAL ENTACT SEPTAL   601-00100,27200000,CDM,,,272,RC,,,facility,inpatient,,,510,361.08,Aetna First Health,Commercial,,433.5,85,,,226.03,433.5,percent of total billed charges,
CLIP ENDO 5MM APPLIER LIGAMAX   EL5ML,27200000,CDM,,,272,RC,,,facility,inpatient,,,516,365.33,Aetna First Health,Commercial,,438.6,85,,,228.69,438.6,percent of total billed charges,
DRIVER NEEDLE MEGA SUTURECUT ROBOT XI  471309,27200000,CDM,,,272,RC,,,facility,inpatient,,,525,371.7,Aetna First Health,Commercial,,446.25,85,,,232.68,446.25,percent of total billed charges,
BIT DRILL SYNT 2.8MM 100MM CALIBRATION  324.214,27200000,CDM,,,272,RC,,,facility,inpatient,,,528,373.82,Aetna First Health,Commercial,,448.8,85,,,234.01,448.8,percent of total billed charges,
STAPLER ENDOPATH PROXIMATE STANDARD BLUE 60MM  TX60B,27200000,CDM,,,272,RC,,,facility,inpatient,,,535,378.78,Aetna First Health,Commercial,,454.75,85,,,237.11,454.75,percent of total billed charges,
DEVICE M2A CAPSULE DELIVERY   00711144,27200000,CDM,,,272,RC,,,facility,inpatient,,,540,382.32,Aetna First Health,Commercial,,459,85,,,239.33,459,percent of total billed charges,
CUFF TOURNIQUET 4IN X 44IN 2 PORT DISP  5921-044-235,27200000,CDM,,,272,RC,,,facility,inpatient,,,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
BIT DRILL SYNT 1.5MM MINI QC 96MM W/DEPTH MARK  310.507,27200000,CDM,,,272,RC,,,facility,inpatient,,,544,385.15,Aetna First Health,Commercial,,462.4,85,,,241.1,462.4,percent of total billed charges,
FORCEPS ROBOT DA VINCI XI LF TENACULUM 8MM  470207,27200000,CDM,,,272,RC,,,facility,inpatient,,,550,389.4,Aetna First Health,Commercial,,467.5,85,,,243.76,467.5,percent of total billed charges,
GRASPER DA VINCI FENESTRATED TIP UP 8MM  470347,27200000,CDM,,,272,RC,,,facility,inpatient,,,550,389.4,Aetna First Health,Commercial,,467.5,85,,,243.76,467.5,percent of total billed charges,
SHAFT REAMER MOD HALL 450MM STERILE  0227-3000S,27200000,CDM,,,272,RC,,,facility,inpatient,,,551,390.11,Aetna First Health,Commercial,,468.35,85,,,244.2,468.35,percent of total billed charges,
SPONGE HEMOSTAT 4X8IN ABSORBABLE SURGICEL STRL  1952S,27200000,CDM,,,272,RC,,,facility,inpatient,,,552,390.82,Aetna First Health,Commercial,,469.2,85,,,244.65,469.2,percent of total billed charges,
FIBER LASER DORNIER SINGLEFLEX SLIM 200C  HOL200SBX,27200000,CDM,,,272,RC,,,facility,inpatient,,,563,398.6,Aetna First Health,Commercial,,478.55,85,,,249.52,478.55,percent of total billed charges,
RETRACTOR ALEXIS LAPAROSCOPIC SYSTEM SM  C8501,27200000,CDM,,,272,RC,,,facility,inpatient,,,563,398.6,Aetna First Health,Commercial,,478.55,85,,,249.52,478.55,percent of total billed charges,
EXTRACTOR NCIRCLE TIPLESS STONE 2CM  G18777,27200000,CDM,,,272,RC,,,facility,inpatient,,,566,400.73,Aetna First Health,Commercial,,481.1,85,,,250.85,481.1,percent of total billed charges,
EXTRACTOR NCIRCLE TIPLESS STONE  G18778,27200000,CDM,,,272,RC,,,facility,inpatient,,,566,400.73,Aetna First Health,Commercial,,481.1,85,,,250.85,481.1,percent of total billed charges,
BIT DRILL 4.2 X 130MM FREEHAND   2351-4213S,27200000,CDM,,,272,RC,,,facility,inpatient,,,573,405.68,Aetna First Health,Commercial,,487.05,85,,,253.95,487.05,percent of total billed charges,
DRILL IMN STRYKER 4.2 X 185MM   2351-4218S,27200000,CDM,,,272,RC,,,facility,inpatient,,,573,405.68,Aetna First Health,Commercial,,487.05,85,,,253.95,487.05,percent of total billed charges,
DRILL LCK 4.2 X 360MM INSTRUMENT SYS  2351-4236S,27200000,CDM,,,272,RC,,,facility,inpatient,,,573,405.68,Aetna First Health,Commercial,,487.05,85,,,253.95,487.05,percent of total billed charges,
RELOAD SUREFORM 60 2.5 WHITE 6-ROW  48360W,27200000,CDM,,,272,RC,,,facility,inpatient,,,575,407.1,Aetna First Health,Commercial,,488.75,85,,,254.84,488.75,percent of total billed charges,
PROTECTOR TISSUE ALEXIS SM/MD FLEXIBLE ORTHO  HR104,27200000,CDM,,,272,RC,,,facility,inpatient,,,585,414.18,Aetna First Health,Commercial,,497.25,85,,,259.27,497.25,percent of total billed charges,
BIT DRILL MINI CANN 1.9MM   IS1112,27200000,CDM,,,272,RC,,,facility,inpatient,,,597,422.68,Aetna First Health,Commercial,,507.45,85,,,264.59,507.45,percent of total billed charges,
CUTTER ENDOPATH LINEAR PROXIMATE STANDARD BLUE 75MM  TLC75,27200000,CDM,,,272,RC,,,facility,inpatient,,,601,425.51,Aetna First Health,Commercial,,510.85,85,,,266.36,510.85,percent of total billed charges,
APPLIER ENDOCLIP DISP 10MM   ER320,27200000,CDM,,,272,RC,,,facility,inpatient,,,610,431.88,Aetna First Health,Commercial,,518.5,85,,,270.35,518.5,percent of total billed charges,
STAPLER ILS CURVED 25MM DETACHABLE HEAD  ECS25B,27200000,CDM,,,272,RC,,,facility,inpatient,,,636,450.29,Aetna First Health,Commercial,,540.6,85,,,281.88,540.6,percent of total billed charges,
TUBE T-TUBE 16FR SILICONE LF  SU130-1240,27200000,CDM,,,272,RC,,,facility,inpatient,,,638,451.7,Aetna First Health,Commercial,,542.3,85,,,282.76,542.3,percent of total billed charges,
BIT DRILL SYNT 4.2MM 4-FLUTED QC 330MM 100MM CALIB  03.010.061,27200000,CDM,,,272,RC,,,facility,inpatient,,,657.5,465.51,Aetna First Health,Commercial,,558.88,85,,,291.4,558.88,percent of total billed charges,
BATTERY PACK FOR POWERED DRIVER STRL  05.000.007.01S,27200000,CDM,,,272,RC,,,facility,inpatient,,,665,470.82,Aetna First Health,Commercial,,565.25,85,,,294.73,565.25,percent of total billed charges,
BIT DRILL SYNT 2MM W/DEPTH MARK QC 140MM  323.062,27200000,CDM,,,272,RC,,,facility,inpatient,,,676,478.61,Aetna First Health,Commercial,,574.6,85,,,299.6,574.6,percent of total billed charges,
SCISSORS DA VINCI CURVED MONOPOLAR 8MM  470179,27200000,CDM,,,272,RC,,,facility,inpatient,,,720,509.76,Aetna First Health,Commercial,,612,85,,,319.1,612,percent of total billed charges,
TUBE FEEDING JEJUNAL MIC 16FR W/ENFIT  8200-16,27200000,CDM,,,272,RC,,,facility,inpatient,,,390,276.12,Aetna First Health,Commercial,,331.5,85,,,172.85,331.5,percent of total billed charges,
BIT DRILL SYNT 5MM CANN   310.632,27200000,CDM,,,272,RC,,,facility,inpatient,,,819,579.85,Aetna First Health,Commercial,,696.15,85,,,362.98,696.15,percent of total billed charges,
SEALER ENSEAL X1 STRAIGHT 5MM X 37CM ARTICULATING  NSLX137S,27200000,CDM,,,272,RC,,,facility,inpatient,,,821,581.27,Aetna First Health,Commercial,,697.85,85,,,363.87,697.85,percent of total billed charges,
STAPLER ECHELON FLEX 45 ENDOSCOPIC LINEAR CUTTER  EC45A,27200000,CDM,,,272,RC,,,facility,inpatient,,,828,586.22,Aetna First Health,Commercial,,703.8,85,,,366.97,703.8,percent of total billed charges,
CANISTER MAX INDIGO W/TUBING FILTER  IAPS2,27200000,CDM,,,272,RC,,,facility,inpatient,,,833,589.76,Aetna First Health,Commercial,,708.05,85,,,369.19,708.05,percent of total billed charges,
BIT DRILL COMP RVS 2.7MM DIA   405889,27200000,CDM,,,272,RC,,,facility,inpatient,,,420,297.36,Aetna First Health,Commercial,,357,85,,,186.14,357,percent of total billed charges,
STAPLER ECHELON FLEX 60 LONG   LONG60A,27200000,CDM,,,272,RC,,,facility,inpatient,,,845,598.26,Aetna First Health,Commercial,,718.25,85,,,374.5,718.25,percent of total billed charges,
CATHETER TWIN PASS   5200,27200000,CDM,,,272,RC,,,facility,inpatient,,,848,600.38,Aetna First Health,Commercial,,720.8,85,,,375.83,720.8,percent of total billed charges,
BIT DRILL CANNULATED 2.7MM FOR 4.0MM ASNIS III W AO COUPLING  702449,27200000,CDM,,,272,RC,,,facility,inpatient,,,858,607.46,Aetna First Health,Commercial,,729.3,85,,,380.27,729.3,percent of total billed charges,
STAPLER ECHELON 25MM CIRCULAR POWERED  CDH25P,27200000,CDM,,,272,RC,,,facility,inpatient,,,864,611.71,Aetna First Health,Commercial,,734.4,85,,,382.92,734.4,percent of total billed charges,
STAPLER ECHELON 29MM CIRCULAR POWERED  CDH29P,27200000,CDM,,,272,RC,,,facility,inpatient,,,864,611.71,Aetna First Health,Commercial,,734.4,85,,,382.92,734.4,percent of total billed charges,
PACK ESSENTIA TOTAL JOINT STD   ESJS73B2,27200000,CDM,,,272,RC,,,facility,inpatient,,,301,213.11,Aetna First Health,Commercial,,255.85,85,,,133.4,255.85,percent of total billed charges,
CATHETER GUIDE LINER 6F 150CM   5571,27200000,CDM,,,272,RC,,,facility,inpatient,,,995,704.46,Aetna First Health,Commercial,,845.75,85,,,440.98,845.75,percent of total billed charges,
RELOAD SUREFORM 45 2.5 WHITE 6-ROW  48345W,27200000,CDM,,,272,RC,,,facility,inpatient,,,500,354,Aetna First Health,Commercial,,425,85,,,221.6,425,percent of total billed charges,
SHAFT REAMER MOD TRINKLE BIXCUT 8X510MM  0227-8510S,27200000,CDM,,,272,RC,,,facility,inpatient,,,1019,721.45,Aetna First Health,Commercial,,866.15,85,,,451.62,866.15,percent of total billed charges,
NEEDLE DRIVER ROBOT XI LG   471006,27200000,CDM,,,272,RC,,,facility,inpatient,,,510,361.08,Aetna First Health,Commercial,,433.5,85,,,226.03,433.5,percent of total billed charges,
SEALER ENSEAL CURVED 5MM X 37CM ARTICULATING  NSLX137C,27200000,CDM,,,272,RC,,,facility,inpatient,,,1020,722.16,Aetna First Health,Commercial,,867,85,,,452.06,867,percent of total billed charges,
BIT DRILL SYNT 5MM LG QC 300MM   310.63,27200000,CDM,,,272,RC,,,facility,inpatient,,,1025,725.7,Aetna First Health,Commercial,,871.25,85,,,454.28,871.25,percent of total billed charges,
BIT DRILL SYNT 2.7MM CANN   310.67,27200000,CDM,,,272,RC,,,facility,inpatient,,,1037,734.2,Aetna First Health,Commercial,,881.45,85,,,459.6,881.45,percent of total billed charges,
STAPLER SUREFORM 60 SPU   480460,27200000,CDM,,,272,RC,,,facility,inpatient,,,1060,750.48,Aetna First Health,Commercial,,901,85,,,469.79,901,percent of total billed charges,
CATHETER TURNPIKE 135CM   5642,27200000,CDM,,,272,RC,,,facility,inpatient,,,1069,756.85,Aetna First Health,Commercial,,908.65,85,,,473.78,908.65,percent of total billed charges,
SEALER ENSEAL LG JAW 12MMX20CM OPEN  NSLX120L,27200000,CDM,,,272,RC,,,facility,inpatient,,,1094,774.55,Aetna First Health,Commercial,,929.9,85,,,484.86,929.9,percent of total billed charges,
CAPSULE VIDEO PILLCAM SB3 12 HR  FGS-0499,27200000,CDM,,,272,RC,,,facility,inpatient,,,1105,782.34,Aetna First Health,Commercial,,939.25,85,,,489.74,939.25,percent of total billed charges,
SYSTEM WOUND PREVENA INCISION MGMT13CM COMPLETE  PRE1101US,27200000,CDM,,,272,RC,,,facility,inpatient,,,1114,788.71,Aetna First Health,Commercial,,946.9,85,,,493.72,946.9,percent of total billed charges,
SEALER AQUAMANTYS 6.0 BIPOLAR (ORDER IN MULT OF 5)  23-112-1,27200000,CDM,,,272,RC,,,facility,inpatient,,,1125,796.5,Aetna First Health,Commercial,,956.25,85,,,498.6,956.25,percent of total billed charges,
RELOAD SUREFORM 60 3.5 BLUE 6-ROW  48360B,27200000,CDM,,,272,RC,,,facility,inpatient,,,575,407.1,Aetna First Health,Commercial,,488.75,85,,,254.84,488.75,percent of total billed charges,
STAPLER BOWEL CONTOUR (GREEN)   GCS40G,27200000,CDM,,,272,RC,,,facility,inpatient,,,1209,855.97,Aetna First Health,Commercial,,1027.65,85,,,535.83,1027.65,percent of total billed charges,
UNIT PREVENA INCISION MGMT 125 SYSTEM COMPLETE  PRE1001US.S,27200000,CDM,,,272,RC,,,facility,inpatient,,,1238,876.5,Aetna First Health,Commercial,,1052.3,85,,,548.68,1052.3,percent of total billed charges,
SEALER VESSEL XI EXTEND   480422,27200000,CDM,,,272,RC,,,facility,inpatient,,,1250,885,Aetna First Health,Commercial,,1062.5,85,,,554,1062.5,percent of total billed charges,
PROBE LITHOTRIPSY 11.3FR SINGLE USE SHOCKPULSE  SPL-PDBX376,27200000,CDM,,,272,RC,,,facility,inpatient,,,1290,913.32,Aetna First Health,Commercial,,1096.5,85,,,571.73,1096.5,percent of total billed charges,
RELOAD STAPLER LINEAR 60MM WHITE  GST60W,27200000,CDM,,,272,RC,,,facility,inpatient,,,510,361.08,Aetna First Health,Commercial,,433.5,85,,,226.03,433.5,percent of total billed charges,
PACK ESSENTIA TOTAL JOINT STD   ESJS73B2,27200000,CDM,,,272,RC,,,facility,inpatient,,,274,193.99,Aetna First Health,Commercial,,232.9,85,,,121.44,232.9,percent of total billed charges,
CATHETER IABP 40CC 7FR FOPTIC   0684-00-0470-01,27200000,CDM,,,272,RC,,,facility,inpatient,,,1969,1394.05,Aetna First Health,Commercial,,1673.65,85,,,872.66,1673.65,percent of total billed charges,
CATHETER IABP SENSATION 34CC 7FR OPTIC  0684-00-0469-01,27200000,CDM,,,272,RC,,,facility,inpatient,,,1969,1394.05,Aetna First Health,Commercial,,1673.65,85,,,872.66,1673.65,percent of total billed charges,
RELOAD STAPLER ECHILON 60MM BLUE 1.5MM  GST60B,27200000,CDM,,,272,RC,,,facility,inpatient,,,510,361.08,Aetna First Health,Commercial,,433.5,85,,,226.03,433.5,percent of total billed charges,
CATHETER FOPTIC IAB 50CC 8FR   0684-00-0576-01,27200000,CDM,,,272,RC,,,facility,inpatient,,,2082,1474.06,Aetna First Health,Commercial,,1769.7,85,,,922.74,1769.7,percent of total billed charges,
PACK ESSENTIA TOTAL JOINT STD   ESJS73B2,27200000,CDM,,,272,RC,,,facility,inpatient,,,287.5,203.55,Aetna First Health,Commercial,,244.38,85,,,127.42,244.38,percent of total billed charges,
ELECTRODE RESECTION LOOP 24FR 12* WITH CABLE MD  WA22602S,27200000,CDM,,,272,RC,,,facility,inpatient,,,1150,814.2,Aetna First Health,Commercial,,977.5,85,,,509.68,977.5,percent of total billed charges,
PACK ESSENTIA TOTAL JOINT STD   ESJS73B2,27200000,CDM,,,272,RC,,,facility,inpatient,,,279.4,197.82,Aetna First Health,Commercial,,237.49,85,,,123.83,237.49,percent of total billed charges,
BLADE SURGICAL CARBON STEEL RIBBACK STERILE #15  371115,27200000,CDM,,,272,RC,,,facility,inpatient,,,2,1.42,Aetna First Health,Commercial,,1.7,85,,,0.89,1.7,percent of total billed charges,
BANDAGE COMPRESSION ELASTIC SELF CLOSE 2IN X 5YD STRL  REB3112,27200000,CDM,,,272,RC,,,facility,inpatient,,,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
BANDAGE COMPRESSION ELASTIC SELF CLOSE 4IN X 5.5YD STRL  REB3114,27200000,CDM,,,272,RC,,,facility,inpatient,,,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
CATHETER URETH 14FR INTERMITTENT RED RUBBER  277714,27200000,CDM,,,272,RC,,,facility,inpatient,,,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
CATHETER URETH 16FR INTERMITTENT RED RUBBER  277716,27200000,CDM,,,272,RC,,,facility,inpatient,,,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NEEDLE SPINAL 20G X 3.5IN QUINCKE  333335,27200000,CDM,,,272,RC,,,facility,inpatient,,,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
ADAPTER CATHETER URETH PLASTIC DISP  140000,27200000,CDM,,,272,RC,,,facility,inpatient,,,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
NEEDLE SPINAL 18G X 3.5IN QUINCKE  333350,27200000,CDM,,,272,RC,,,facility,inpatient,,,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
NEEDLE SPINAL 25G X 3-1/2IN SPINOCAN QUINCKE  333313,27200000,CDM,,,272,RC,,,facility,inpatient,,,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
INSTRUMENT SUCTION FRAZIER W/VENT 12FR  0033120,27200000,CDM,,,272,RC,,,facility,inpatient,,,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
"SUTURE 0 COATED VICRYL PLUS VIOLET 1X27"" CT-2  VCP334H",27200000,CDM,,,272,RC,,,facility,inpatient,,,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
SUTURE 3-0 COATED VICRYL PLUS UNDYD 1X27IN SH  VCP416H,27200000,CDM,,,272,RC,,,facility,inpatient,,,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
SUPPLIES STERILE,27200000,CDM,,,272,RC,,,facility,inpatient,,,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
BANDAGE ESMARK 4IN X 9FT LF   V18410000,27200000,CDM,,,272,RC,,,facility,inpatient,,,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
CAP K-WIRE .062IN SCANLAN   301-0120,27200000,CDM,,,272,RC,,,facility,inpatient,,,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
SUTURE 2-0 COATED VICRYL PLUS UNDYD 1X27IN CP-2  VCP869H,27200000,CDM,,,272,RC,,,facility,inpatient,,,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
SUTURE MONOCRYL 4-0 27IN   Y415H,27200000,CDM,,,272,RC,,,facility,inpatient,,,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
SUTURE VICRYL 0 DYD 27IN CT-2   J334H,27200000,CDM,,,272,RC,,,facility,inpatient,,,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
SUTURE SILK 2-0 BRAIDED 18IN FS  685G,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE ETHIBOND 0 DYD 30IN SH   X834H,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE ETHILON 2-0 DYD 30IN KS   628H,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE SILK 0 18IN FSL 30MM   678G,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE SILK 0 DYD 13-24IN   SA76G,27200000,CDM,,,272,RC,,,facility,inpatient,,,8,5.66,Aetna First Health,Commercial,,6.8,85,,,3.55,6.8,percent of total billed charges,
SUTURE ETHILON 4-0 DYD 18IN PS-2 NON-ABSORB POLYAMIDE  1667ZH,27200000,CDM,,,272,RC,,,facility,both,,,13,9.2,Aetna First Health,Commercial,,11.05,85,,,5.76,11.05,percent of total billed charges,
PACK ESSENTIA MINOR   ESMN46B,27200000,CDM,,,272,RC,,,facility,both,,,166,117.53,Aetna First Health,Commercial,,141.1,85,,,73.57,141.1,percent of total billed charges,
EPIDURAL TRAY,27208012,CDM,,,272,RC,,,facility,both,,,103,72.92,Aetna First Health,Commercial,,87.55,85,,,45.65,87.55,percent of total billed charges,
EPIDURAL TRAY,27208012,CDM,,,272,RC,,,facility,inpatient,,,100,70.8,Aetna First Health,Commercial,,85,85,,,44.32,85,percent of total billed charges,
TRACH MASK SUPPLIES,27209000,CDM,,,272,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
TRACH MASK SUPPLIES,27209000,CDM,,,272,RC,,,facility,inpatient,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
TRACHEAL TUBE GUIDE,27209008,CDM,,,272,RC,,,facility,both,,,159,112.57,Aetna First Health,Commercial,,135.15,85,,,70.47,135.15,percent of total billed charges,
LARYNG VID GLIDESCP STAT SZ 4,27209012,CDM,,,272,RC,,,facility,both,,,58,41.06,Aetna First Health,Commercial,,49.3,85,,,25.71,49.3,percent of total billed charges,
LARYNG VID GLIDESCP STAT SZ 4,27209012,CDM,,,272,RC,,,facility,both,,,56,39.65,Aetna First Health,Commercial,,47.6,85,,,24.82,47.6,percent of total billed charges,
"TRAY, C.T. BIOPSY    6919",27209104,CDM,,,272,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
"TRAY, C.T. BIOPSY    6919",27209104,CDM,,,272,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
CIRCUIT W/ METANEB,27280094,CDM,,,272,RC,,,facility,both,,,237,167.8,Aetna First Health,Commercial,,201.45,85,,,105.04,201.45,percent of total billed charges,
MULTIPURPOSE CATHETER MACLOC 10 FR,27291003,CDM,,,272,RC,,,facility,both,,,317,224.44,Aetna First Health,Commercial,,269.45,85,,,140.49,269.45,percent of total billed charges,
MULTIPURPOSE CATHETER MACLOC 10 FR,27291003,CDM,,,272,RC,,,facility,inpatient,,,308,218.06,Aetna First Health,Commercial,,261.8,85,,,136.51,261.8,percent of total billed charges,
DILATOR 10 FR.,27291008,CDM,,,272,RC,,,facility,both,,,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
NEEDLE SPINAL 22GX5 IN. QUINKE,27291009,CDM,,,272,RC,,,facility,both,,,132,93.46,Aetna First Health,Commercial,,112.2,85,,,58.5,112.2,percent of total billed charges,
NEEDLE SPINAL 22G X 7 IN QUINCKE,27291017,CDM,,,272,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
GLIDEWIRE RADIFOCUS STRAIGHT STIFF .035 X 150CM,27291019,CDM,,,272,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
COVER TRANSDUCER CIV-FLEX 14 X 91.5 CM,27291020,CDM,,,272,RC,,,facility,both,,,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
COVER TRANSDUCER CIV-FLEX 14 X 91.5 CM,27291020,CDM,,,272,RC,,,facility,both,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
COVER TRANSDUCER CIV-FLEX 14 X 91.5 CM,27291020,CDM,,,272,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
NEEDLE QUICK CORE BIOPSY  QC-18-9.0-10T,27291021,CDM,,,272,RC,,,facility,both,,,167,118.24,Aetna First Health,Commercial,,141.95,85,,,74.01,141.95,percent of total billed charges,
NEEDLE BIOPSY CELERO VACUUM,27291022,CDM,,,272,RC,,,facility,both,,,464,328.51,Aetna First Health,Commercial,,394.4,85,,,205.64,394.4,percent of total billed charges,
MARKER-SECURMARK FOR CELERO,27291023,CDM,C1819,CPT,278,RC,,,facility,both,,,385,272.58,Aetna First Health,Commercial,,327.25,85,,,170.63,327.25,percent of total billed charges,
NEEDLE COAXIAL ACHIEVE,27291024,CDM,,,272,RC,,,facility,both,,,73,51.68,Aetna First Health,Commercial,,62.05,85,,,32.35,62.05,percent of total billed charges,
NEEDLE YUEH CENTESIS 5.0-19-7.0 YUEH,27291025,CDM,,,272,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,,66.3,85,,,34.57,66.3,percent of total billed charges,
NEEDLE YUEH CENTESIS 5.0-19-7.0 YUEH,27291025,CDM,,,272,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
NEEDLE YUEH CENTESIS 5.0-19-7.0 YUEH,27291025,CDM,,,272,RC,,,facility,inpatient,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
NEEDLE YUEH CENTESIS 5.0-19-10.0 YUEH,27291026,CDM,,,272,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,,66.3,85,,,34.57,66.3,percent of total billed charges,
NEEDLE YUEH CENTESIS 5.0-19-10.0 YUEH,27291026,CDM,,,272,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
NEEDLE YUEH CENTESIS 5.0-19-10.0 YUEH,27291026,CDM,,,272,RC,,,facility,inpatient,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
NEEDLE YUEH CENTESIS 8.0-16-7.0-YUEH,27291027,CDM,,,272,RC,,,facility,both,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
NEEDLE YUEH CENTESIS 8.0-16-7.0-YUEH,27291027,CDM,,,272,RC,,,facility,inpatient,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
NEEDLE GUIDE COVER KIT W/CLIP,27291028,CDM,,,272,RC,,,facility,both,,,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
NEEDLE QUICK CORE BIOPSY QC-20-9.0-10T,27291030,CDM,,,272,RC,,,facility,both,,,171,121.07,Aetna First Health,Commercial,,145.35,85,,,75.79,145.35,percent of total billed charges,
SET QUICK CORE BIOPSY QCS-18-9.0-20T,27291031,CDM,,,272,RC,,,facility,both,,,218,154.34,Aetna First Health,Commercial,,185.3,85,,,96.62,185.3,percent of total billed charges,
CATHETER H/S 5FR ZINNATI,27291033,CDM,,,272,RC,,,facility,both,,,71,50.27,Aetna First Health,Commercial,,60.35,85,,,31.47,60.35,percent of total billed charges,
SET QUICK CORE BIOPSY QCS-18-9.0-10T,27291034,CDM,,,272,RC,,,facility,both,,,213,150.8,Aetna First Health,Commercial,,181.05,85,,,94.4,181.05,percent of total billed charges,
MARKER COIL ULTRASOUND ENHANCED,27291036,CDM,C1819,CPT,278,RC,,,facility,both,,,271,191.87,Aetna First Health,Commercial,,230.35,85,,,120.11,230.35,percent of total billed charges,
NEEDLE YUEH CENTESIS DTVN 5.0-19-15.0,27291038,CDM,,,272,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,,66.3,85,,,34.57,66.3,percent of total billed charges,
NEEDLE YUEH CENTESIS DTVN 5.0-19-15.0,27291038,CDM,,,272,RC,,,facility,inpatient,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
SET QUICK CORE BIOPSY QCS-20-9.0-20T,27291049,CDM,,,272,RC,,,facility,both,,,207,146.56,Aetna First Health,Commercial,,175.95,85,,,91.74,175.95,percent of total billed charges,
SET QUICK CORE BIOPSY QCS-18-9.0-20T,27291053,CDM,,,272,RC,,,facility,both,,,218,154.34,Aetna First Health,Commercial,,185.3,85,,,96.62,185.3,percent of total billed charges,
DRAIN SET CATHETER 10.2FR,27291054,CDM,,,272,RC,,,facility,both,,,582,412.06,Aetna First Health,Commercial,,494.7,85,,,257.94,494.7,percent of total billed charges,
DRAIN SET CATHETER 10.2FR,27291054,CDM,,,272,RC,,,facility,inpatient,,,565,400.02,Aetna First Health,Commercial,,480.25,85,,,250.41,480.25,percent of total billed charges,
DRAIN SET CATHETER 12FR,27291055,CDM,,,272,RC,,,facility,both,,,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
DRAIN SET CATHETER 12FR,27291055,CDM,,,272,RC,,,facility,inpatient,,,583,412.76,Aetna First Health,Commercial,,495.55,85,,,258.39,495.55,percent of total billed charges,
NEEDLE BONE BIOPSY MURPHY M2 OSTEO-SITE 13G  10CM,27291056,CDM,,,272,RC,,,facility,both,,,387,274,Aetna First Health,Commercial,,328.95,85,,,171.52,328.95,percent of total billed charges,
NEEDLE BONE BIOPSY MURPHY M2 OSTEO-SITE 11G 10CM,27291058,CDM,,,272,RC,,,facility,both,,,376,266.21,Aetna First Health,Commercial,,319.6,85,,,166.64,319.6,percent of total billed charges,
NEEDLE SET BONE BIOPSY MURPHY M2 OSTEO-SITE DBBN-11-15.0-M2-S,27291059,CDM,,,272,RC,,,facility,both,,,384,271.87,Aetna First Health,Commercial,,326.4,85,,,170.19,326.4,percent of total billed charges,
SET QUICK CORE BIOPSY QCS-20-9.0-10T,27291062,CDM,,,272,RC,,,facility,both,,,207,146.56,Aetna First Health,Commercial,,175.95,85,,,91.74,175.95,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 18G X 9CM,27291067,CDM,,,272,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 18G X 15CM,27291068,CDM,,,272,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 20G X 9CM,27291069,CDM,,,272,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,,109.65,85,,,57.17,109.65,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 20G X 15CM,27291070,CDM,,,272,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,,106.25,85,,,55.4,106.25,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 18G X 10CM,27291071,CDM,,,272,RC,,,facility,both,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 20G X 10CM,27291072,CDM,,,272,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,,109.65,85,,,57.17,109.65,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 20G X 16CM,27291073,CDM,,,272,RC,,,facility,both,,,126,89.21,Aetna First Health,Commercial,,107.1,85,,,55.84,107.1,percent of total billed charges,
NEEDLEGUIDE MONOPTY 17G X 7.8CM,27291074,CDM,,,272,RC,,,facility,both,,,52,36.82,Aetna First Health,Commercial,,44.2,85,,,23.05,44.2,percent of total billed charges,
NEEDLEGUIDE MONOPTY 17G X 7.8CM,27291074,CDM,,,272,RC,,,facility,inpatient,,,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
NEEDLEGUIDE MONOPTY 17G X 13.8CM,27291075,CDM,,,272,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
NEEDLEGUIDE MONOPTY 17G X 13.8CM,27291075,CDM,,,272,RC,,,facility,inpatient,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
NEEDLEGUIDE MONOPTY 19G X 7.8CM,27291076,CDM,,,272,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
NEEDLEGUIDE MONOPTY 19G X 7.8CM,27291076,CDM,,,272,RC,,,facility,inpatient,,,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
NEEDLEGUIDE MONOPTY 19G X 13.8CM,27291077,CDM,,,272,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
NEEDLEGUIDE MONOPTY 19G X 13.8CM,27291077,CDM,,,272,RC,,,facility,inpatient,,,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
EVACUATOR BULB FOR SABER SYSTEM,27291078,CDM,,,272,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EVACUATOR BULB FOR SABER SYSTEM,27291078,CDM,,,272,RC,,,facility,inpatient,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
CONNECTOR LUER ADAPTOR FOR SABER SYSTEM,27291079,CDM,,,272,RC,,,facility,both,,,25,17.7,Aetna First Health,Commercial,,21.25,85,,,11.08,21.25,percent of total billed charges,
CONNECTOR LUER ADAPTOR FOR SABER SYSTEM,27291079,CDM,,,272,RC,,,facility,inpatient,,,24,16.99,Aetna First Health,Commercial,,20.4,85,,,10.64,20.4,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 18,27291080,CDM,,,272,RC,,,facility,both,,,129,91.33,Aetna First Health,Commercial,,109.65,85,,,57.17,109.65,percent of total billed charges,
HANDPIECE 9G BIOPSY DEVICE,27291087,CDM,,,272,RC,,,facility,both,,,723,511.88,Aetna First Health,Commercial,,614.55,85,,,320.43,614.55,percent of total billed charges,
NEEDLE GUIDE,27291088,CDM,,,272,RC,,,facility,both,,,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
GUIDE NEEDLE NG09-L,27291095,CDM,,,272,RC,,,facility,both,,,38,26.9,Aetna First Health,Commercial,,32.3,85,,,16.84,32.3,percent of total billed charges,
NEEDLE GUIDE CLOSED,27291096,CDM,,,272,RC,,,facility,both,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
GELACTOGRAPHY INFUSION,27291097,CDM,,,272,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,,77.35,85,,,40.33,77.35,percent of total billed charges,
NEEDLE SPINAL 22 GA X 3.5 IN,27291099,CDM,,,272,RC,,,facility,both,,,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
NEEDLE SPINAL 22 GA X 3.5 IN,27291099,CDM,,,272,RC,,,facility,inpatient,,,27,19.12,Aetna First Health,Commercial,,22.95,85,,,11.97,22.95,percent of total billed charges,
NEEDLE SPINAL 18 GA X 3.5 IN,27291109,CDM,,,272,RC,,,facility,both,,,27,19.12,Aetna First Health,Commercial,,22.95,85,,,11.97,22.95,percent of total billed charges,
NEEDLE SPINAL 20 GA X 3.5 IN,27291110,CDM,,,272,RC,,,facility,both,,,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
NEEDLE SPINAL 20 GA X 3.5 IN,27291110,CDM,,,272,RC,,,facility,inpatient,,,27,19.12,Aetna First Health,Commercial,,22.95,85,,,11.97,22.95,percent of total billed charges,
NEEDLE SPINAL 22 GA X 3.5 IN,27291111,CDM,,,272,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
NEEDLE SPINAL 25 GA X 3.5 IN,27291112,CDM,,,272,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,,22.1,85,,,11.52,22.1,percent of total billed charges,
TRAY SAFE-T-BIOPSY CUSTOM (LAB),27291117,CDM,,,272,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,,37.4,85,,,19.5,37.4,percent of total billed charges,
TRAY SAFE-T BIOPSY WITHOUT NEEDLE,27291118,CDM,,,272,RC,,,facility,both,,,78,55.22,Aetna First Health,Commercial,,66.3,85,,,34.57,66.3,percent of total billed charges,
TRAY SAFE-T BIOPSY WITHOUT NEEDLE,27291118,CDM,,,272,RC,,,facility,inpatient,,,76,53.81,Aetna First Health,Commercial,,64.6,85,,,33.68,64.6,percent of total billed charges,
STOPCOCK 3 WAY,27291120,CDM,,,272,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
STOPCOCK 3 WAY,27291120,CDM,,,272,RC,,,facility,inpatient,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
TRAY SAFE-T BIOPSY WITHOUT NEEDLE,27291121,CDM,,,272,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,,37.4,85,,,19.5,37.4,percent of total billed charges,
TRAY SAFE-T BIOPSY WITHOUT NEEDLE,27291121,CDM,,,272,RC,,,facility,inpatient,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
NEEDLE SPINAL 22 GA X 3.5 IN,27291132,CDM,,,272,RC,,,facility,inpatient,,,24,16.99,Aetna First Health,Commercial,,20.4,85,,,10.64,20.4,percent of total billed charges,
NEEDLE SPINAL 22 GA X 3.5 IN,27291132,CDM,,,272,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
NEEDLE MONOPTY CORE BIOPSY 14G,27291138,CDM,,,272,RC,,,facility,both,,,125,88.5,Aetna First Health,Commercial,,106.25,85,,,55.4,106.25,percent of total billed charges,
NEEDLE ONE1STEP CENTESIS,27291139,CDM,C1729,CPT,272,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,,83.3,85,,,43.43,83.3,percent of total billed charges,
NEEDLE ONE1STEP CENTESIS,27291139,CDM,C1729,CPT,272,RC,,,facility,inpatient,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
SMARK FIRST SITE MARKER,27291140,CDM,C1819,CPT,272,RC,,,facility,both,,,291,206.03,Aetna First Health,Commercial,,247.35,85,,,128.97,247.35,percent of total billed charges,
SMARK SECOND SITE MARKER,27291141,CDM,C1819,CPT,272,RC,,,facility,both,,,291,206.03,Aetna First Health,Commercial,,247.35,85,,,128.97,247.35,percent of total billed charges,
THERMAL VENT T,27309002,CDM,,,271,RC,,,facility,both,,,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
VALVE CONTROL BLEEDBACK CO-PILOT .096IN  1003331,27800000,CDM,,,278,RC,,,facility,inpatient,,,184,130.27,Aetna First Health,Commercial,,156.4,85,,,81.55,156.4,percent of total billed charges,
SLEEVE SHOULDER POSITIONING HUMERAL FRACTURE 15MM  113583,27800000,CDM,,,278,RC,,,facility,inpatient,,,522,369.58,Aetna First Health,Commercial,,443.7,85,,,231.35,443.7,percent of total billed charges,
SCREW STRY TI T2 LAG 6.5 X 100MM  1897-6100S,27800000,CDM,,,278,RC,,,facility,inpatient,,,533,377.36,Aetna First Health,Commercial,,453.05,85,,,236.23,453.05,percent of total billed charges,
PIN COMP REV SHLDR 9IN STEINMANN  405800,27800000,CDM,,,278,RC,,,facility,inpatient,,,332,235.06,Aetna First Health,Commercial,,282.2,85,,,147.14,282.2,percent of total billed charges,
GRAFT BONE CHIPS CANC 15CC OSTEOTECH 00035  T00035,27800000,CDM,,,278,RC,,,facility,inpatient,,,693,490.64,Aetna First Health,Commercial,,589.05,85,,,307.14,589.05,percent of total billed charges,
BIT DRILL COMP RVS 3.2MM   405883,27800000,CDM,,,278,RC,,,facility,inpatient,,,360,254.88,Aetna First Health,Commercial,,306,85,,,159.55,306,percent of total billed charges,
SCREW STRY HEADLESS 2.5 X 26MM   IH2526,27800000,CDM,,,278,RC,,,facility,inpatient,,,795,562.86,Aetna First Health,Commercial,,675.75,85,,,352.34,675.75,percent of total billed charges,
SCREW STRY HEADLESS 2.5 X 32MM   IH2532,27800000,CDM,,,278,RC,,,facility,inpatient,,,795,562.86,Aetna First Health,Commercial,,675.75,85,,,352.34,675.75,percent of total billed charges,
INSERT TIBIAL 2.5 X 10.0MM   96-2121,27800000,CDM,,,278,RC,,,facility,inpatient,,,1000,708,Aetna First Health,Commercial,,850,85,,,443.2,850,percent of total billed charges,
PORT GELPORT HAND ACCESS 120MM   C8XX2,27800000,CDM,,,278,RC,,,facility,inpatient,,,1250,885,Aetna First Health,Commercial,,1062.5,85,,,554,1062.5,percent of total billed charges,
AUGMENT TIBIAL BIO 71X5MM VANGUARD 360  185223,27800000,CDM,,,278,RC,,,facility,inpatient,,,1814,1284.31,Aetna First Health,Commercial,,1541.9,85,,,803.96,1541.9,percent of total billed charges,
SHUNT PRUITT F3 CAROTID W/T-PORT 9FR X 31  E2012-10,27800000,CDM,,,278,RC,,,facility,inpatient,,,1998,1414.58,Aetna First Health,Commercial,,1698.3,85,,,885.51,1698.3,percent of total billed charges,
IMPLANT PATELLA  ITOTAL IPOLY XE-35MM X 7MM  PAT-021-3507-000101,27800000,CDM,,,278,RC,,,facility,inpatient,,,3027,2143.12,Aetna First Health,Commercial,,2572.95,85,,,1341.57,2572.95,percent of total billed charges,
NAIL STRY T2 ALPHA TIBIAL 10MM X 285MM  2341-1028S,27800000,CDM,,,278,RC,,,facility,inpatient,,,3098,2193.38,Aetna First Health,Commercial,,2633.3,85,,,1373.03,2633.3,percent of total billed charges,
COUPLER LEGION OFFSET 2MM   71424223,27800000,CDM,,,278,RC,,,facility,inpatient,,,3480,2463.84,Aetna First Health,Commercial,,2958,85,,,1542.34,2958,percent of total billed charges,
PLATE BONE NCB PP PROX FEM LT 324MM  0203263115,27800000,CDM,,,278,RC,,,facility,inpatient,,,3528,2497.82,Aetna First Health,Commercial,,2998.8,85,,,1563.61,2998.8,percent of total billed charges,
STEM BIO CEMENTED BOWED 18 X 150MM OSS  150372,27800000,CDM,,,278,RC,,,facility,inpatient,,,3819,2703.85,Aetna First Health,Commercial,,3246.15,85,,,1692.58,3246.15,percent of total billed charges,
NAIL STRY GAMMA LONG LT 10 X 440MM X 125 DEG STRL  8525-0440S,27800000,CDM,,,278,RC,,,facility,inpatient,,,4078,2887.22,Aetna First Health,Commercial,,3466.3,85,,,1807.37,3466.3,percent of total billed charges,
NAIL STRY GAMMA LONG RT 10 X 320MM X 125 DEG STRL  8425-0320S,27800000,CDM,,,278,RC,,,facility,inpatient,,,4078,2887.22,Aetna First Health,Commercial,,3466.3,85,,,1807.37,3466.3,percent of total billed charges,
NAIL STRY GAMMA LONG RT 11 X 360MM X 125 DEG STRL  8425-1360S,27800000,CDM,,,278,RC,,,facility,inpatient,,,4078,2887.22,Aetna First Health,Commercial,,3466.3,85,,,1807.37,3466.3,percent of total billed charges,
BEARING HIP BIO E1 28MM X 38MM ACTIVE ARTICULATION  EP-200144,27800000,CDM,,,278,RC,,,facility,inpatient,,,4242,3003.34,Aetna First Health,Commercial,,3605.7,85,,,1880.05,3605.7,percent of total billed charges,
BEARING TIBIAL BIO SSK PSC 20X71 75 VANGUARD  183890,27800000,CDM,,,278,RC,,,facility,inpatient,,,4473,3166.88,Aetna First Health,Commercial,,3802.05,85,,,1982.43,3802.05,percent of total billed charges,
BEARING TIBIAL ZIMM SSK PSC 12X71/75 VANGUARD  183882,27800000,CDM,,,278,RC,,,facility,inpatient,,,4473,3166.88,Aetna First Health,Commercial,,3802.05,85,,,1982.43,3802.05,percent of total billed charges,
TIBIAL BEARING BIO SSK PS 14X63/67 VANGUARD  185064,27800000,CDM,,,278,RC,,,facility,inpatient,,,4473,3166.88,Aetna First Health,Commercial,,3802.05,85,,,1982.43,3802.05,percent of total billed charges,
STEM RADIAL EVOLVE 7.5MM STD ELBOW  496S075,27800000,CDM,,,278,RC,,,facility,inpatient,,,4884,3457.87,Aetna First Health,Commercial,,4151.4,85,,,2164.59,4151.4,percent of total billed charges,
STEM HUMERAL FRACTURE 12MM X122MM PPS  12-113562,27800000,CDM,,,278,RC,,,facility,inpatient,,,5170,3660.36,Aetna First Health,Commercial,,4394.5,85,,,2291.34,4394.5,percent of total billed charges,
STEM ECHO POR FMRL NC 13 X 145   192013,27800000,CDM,,,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
INSERT TIBIAL TC3 RP S2.5 10.0  96-2331,27800000,CDM,,,278,RC,,,facility,inpatient,,,5943,4207.64,Aetna First Health,Commercial,,5051.55,85,,,2633.94,5051.55,percent of total billed charges,
PLATE SYNT 3.5/4.5MM VA-LCP PROX FEM LG 8H 291MM RT  02.221.090,27800000,CDM,,,278,RC,,,facility,inpatient,,,6562,4645.9,Aetna First Health,Commercial,,5577.7,85,,,2908.28,5577.7,percent of total billed charges,
HEAD RADIAL EVOLVE 22MM STD ELBOW  496H022,27800000,CDM,,,278,RC,,,facility,inpatient,,,6639,4700.41,Aetna First Health,Commercial,,5643.15,85,,,2942.4,5643.15,percent of total billed charges,
SCREW LEGION DISTAL FEM WEDGE SZ 6 5MM  71421667,27800000,CDM,,,278,RC,,,facility,inpatient,,,3443,2437.64,Aetna First Health,Commercial,,2926.55,85,,,1525.94,2926.55,percent of total billed charges,
STEM DISTAL ARCOS REVISION 13MM X 198MM  11-300913,27800000,CDM,,,278,RC,,,facility,inpatient,,,7095,5023.26,Aetna First Health,Commercial,,6030.75,85,,,3144.5,6030.75,percent of total billed charges,
STEM DISTAL BIO ARCOS 13X150MM SPL TPR  11-300813,27800000,CDM,,,278,RC,,,facility,inpatient,,,7095,5023.26,Aetna First Health,Commercial,,6030.75,85,,,3144.5,6030.75,percent of total billed charges,
STEM DISTAL BIO ARCOS 20X150MM SPL TPR  11-300820,27800000,CDM,,,278,RC,,,facility,inpatient,,,7095,5023.26,Aetna First Health,Commercial,,6030.75,85,,,3144.5,6030.75,percent of total billed charges,
PLATE TIBIAL OSS NON-MOD LONG 71MM  161043,27800000,CDM,,,278,RC,,,facility,inpatient,,,8977,6355.72,Aetna First Health,Commercial,,7630.45,85,,,3978.61,7630.45,percent of total billed charges,
COMPONENT FEM BIO 67.5MM RT VANGUARD 360  185265,27800000,CDM,,,278,RC,,,facility,inpatient,,,13673,9680.48,Aetna First Health,Commercial,,11622.05,85,,,6059.87,11622.05,percent of total billed charges,
SYSTEM OSS 5CM RESURFACING FEMORAL RT  150352,27800000,CDM,,,278,RC,,,facility,inpatient,,,15644,11075.95,Aetna First Health,Commercial,,13297.4,85,,,6933.42,13297.4,percent of total billed charges,
INSERT ART GENESIS II JOURNEY SZ 3-4 11MM LOCK  71934382,27800000,CDM,,,278,RC,,,facility,inpatient,,,23559,16679.77,Aetna First Health,Commercial,,20025.15,85,,,10441.35,20025.15,percent of total billed charges,
INSERT ART GENESIS II JOURNEY SZ 3-4 13MM LOCK  71934383,27800000,CDM,,,278,RC,,,facility,inpatient,,,23559,16679.77,Aetna First Health,Commercial,,20025.15,85,,,10441.35,20025.15,percent of total billed charges,
OR LEVEL 1,36000001,CDM,,,360,RC,,,facility,both,,,2756,1951.25,Aetna First Health,Commercial,,2342.6,85,,,1221.46,2342.6,percent of total billed charges,
OR LEVEL 2,36000002,CDM,,,360,RC,,,facility,both,,,5570,3943.56,Aetna First Health,Commercial,,4734.5,85,,,2468.62,4734.5,percent of total billed charges,
OR LEVEL 3,36000003,CDM,,,360,RC,,,facility,both,,,6565,4648.02,Aetna First Health,Commercial,,5580.25,85,,,2909.61,5580.25,percent of total billed charges,
OR LEVEL 4,36000004,CDM,,,360,RC,,,facility,both,,,7257,5137.96,Aetna First Health,Commercial,,6168.45,85,,,3216.3,6168.45,percent of total billed charges,
OR LEVEL 5,36000005,CDM,,,360,RC,,,facility,both,,,7733,5474.96,Aetna First Health,Commercial,,6573.05,85,,,3427.27,6573.05,percent of total billed charges,
OR LEVEL 6,36000006,CDM,,,360,RC,,,facility,both,,,8920,6315.36,Aetna First Health,Commercial,,7582,85,,,3953.34,7582,percent of total billed charges,
LEVEL 1 ADDITIONAL PROCEDURE,36000080,CDM,,,360,RC,,,facility,both,,,1930,1366.44,Aetna First Health,Commercial,,1640.5,85,,,855.38,1640.5,percent of total billed charges,
LEVEL 2 ADDITIONAL PROCEDURE,36000081,CDM,,,360,RC,,,facility,both,,,4456,3154.85,Aetna First Health,Commercial,,3787.6,85,,,1974.9,3787.6,percent of total billed charges,
LEVEL 3 ADDITIONAL PROCEDURE,36000082,CDM,,,360,RC,,,facility,both,,,5580,3950.64,Aetna First Health,Commercial,,4743,85,,,2473.06,4743,percent of total billed charges,
LEVEL 4 ADDITIONAL PROCEDURE,36000083,CDM,,,360,RC,,,facility,both,,,6220,4403.76,Aetna First Health,Commercial,,5287,85,,,2756.7,5287,percent of total billed charges,
LEVEL 5 ADDITIONAL PROCEDURE,36000084,CDM,,,360,RC,,,facility,both,,,5850,4141.8,Aetna First Health,Commercial,,4972.5,85,,,2592.72,4972.5,percent of total billed charges,
LEVEL 6 ADDITIONAL PROCEDURE,36000085,CDM,,,360,RC,,,facility,both,,,7414,5249.11,Aetna First Health,Commercial,,6301.9,85,,,3285.88,6301.9,percent of total billed charges,
OR TIME,36000086,CDM,,,360,RC,,,facility,both,,,74,52.39,Aetna First Health,Commercial,,62.9,85,,,32.8,62.9,percent of total billed charges,
OR PACKAGE - FLAT FEE,36007441,CDM,,,360,RC,,,facility,both,,,4700,3327.6,Aetna First Health,Commercial,,3995,85,,,2083.04,3995,percent of total billed charges,
OXYGEN TIME,37000008,CDM,,,270,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,,22.1,85,,,11.52,22.1,percent of total billed charges,
ANESTHESIA LEVEL - G3,37000017,CDM,,,370,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
ANESTHESIA LEVEL - MAC,37000018,CDM,,,370,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
ANESTHESIA LEVEL - REGIONAL,37000025,CDM,,,370,RC,,,facility,both,,,39,27.61,Aetna First Health,Commercial,,33.15,85,,,17.28,33.15,percent of total billed charges,
METERED DOSE INHALER TX,41000000,CDM,94640,CPT,410,RC,,,facility,both,,,156,110.45,Aetna First Health,Commercial,,132.6,85,,,69.14,132.6,percent of total billed charges,
Hydromorphone PF 500 MG/50ML Solution 50 mL Vial,63600000,CDM,J1170,CPT,636,RC,17478054050,NDC,facility,both,1,ML,229.5,162.49,Aetna First Health,Commercial,,195.08,85,,,101.71,195.08,percent of total billed charges,
Hydromorphone PF 500 MG/50ML Solution 50 mL Vial,63600000,CDM,J1170,CPT,636,RC,00703001801,NDC,facility,both,1,ML,232.88,164.88,Aetna First Health,Commercial,,197.95,85,,,103.21,197.95,percent of total billed charges,
Hydromorphone PF 500 MG/50ML Solution 50 mL Vial,63600000,CDM,J1170,CPT,636,RC,00409263450,NDC,facility,both,1,ML,275.63,195.15,Aetna First Health,Commercial,,234.29,85,,,122.16,234.29,percent of total billed charges,
perphenazine 16 MG Tablet 100 Each Bottle,63600000,CDM,Q0175,CPT,636,RC,00781104901,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorproMAZINE 50 MG Tablet 1 Each Blister,63600000,CDM,Q0171,CPT,636,RC,51079013001,NDC,facility,both,0.2,EA,6.45,4.57,Aetna First Health,Commercial,,5.48,85,,,2.86,5.48,percent of total billed charges,
chlorproMAZINE 50 MG Tablet 100 Each Bottle,63600000,CDM,Q0171,CPT,636,RC,00832030200,NDC,facility,both,0.2,EA,3.77,2.67,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
chlorproMAZINE 50 MG Tablet 100 Each Box,63600000,CDM,Q0171,CPT,636,RC,51079013020,NDC,facility,both,0.2,EA,6.46,4.57,Aetna First Health,Commercial,,5.49,85,,,2.86,5.49,percent of total billed charges,
azithromycin 600 MG Tablet 30 Each Bottle,63600000,CDM,Q0144,CPT,636,RC,50111078910,NDC,facility,both,0.41667,EA,6.72,4.76,Aetna First Health,Commercial,,5.71,85,,,2.98,5.71,percent of total billed charges,
azithromycin 600 MG Tablet 30 Each Bottle,63600000,CDM,Q0144,CPT,636,RC,64679096201,NDC,facility,both,0.41667,EA,6.72,4.76,Aetna First Health,Commercial,,5.71,85,,,2.98,5.71,percent of total billed charges,
azithromycin 600 MG Tablet 30 Each Bottle,63600000,CDM,Q0144,CPT,636,RC,51224022230,NDC,facility,both,0.41667,EA,6.72,4.76,Aetna First Health,Commercial,,5.71,85,,,2.98,5.71,percent of total billed charges,
azaTHIOprine 100 MG Recon Soln 1 Each Vial,63600000,CDM,J7501,CPT,636,RC,00143956601,NDC,facility,both,1,EA,662.5,469.05,Aetna First Health,Commercial,,563.12,85,,,293.62,563.12,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,71288042710,NDC,facility,both,1,EA,157.5,111.51,Aetna First Health,Commercial,,133.88,85,,,69.8,133.88,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,16729027503,NDC,facility,both,1,EA,161.08,114.04,Aetna First Health,Commercial,,136.92,85,,,71.39,136.92,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,00781315894,NDC,facility,both,1,EA,168.75,119.48,Aetna First Health,Commercial,,143.44,85,,,74.79,143.44,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,00781315895,NDC,facility,both,1,EA,168.75,119.48,Aetna First Health,Commercial,,143.44,85,,,74.79,143.44,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,00781915895,NDC,facility,both,1,EA,168.75,119.48,Aetna First Health,Commercial,,143.44,85,,,74.79,143.44,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,00781915894,NDC,facility,both,1,EA,168.75,119.48,Aetna First Health,Commercial,,143.44,85,,,74.79,143.44,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,55150021010,NDC,facility,both,1,EA,225,159.3,Aetna First Health,Commercial,,191.25,85,,,99.72,191.25,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,67457025600,NDC,facility,both,1,EA,225,159.3,Aetna First Health,Commercial,,191.25,85,,,99.72,191.25,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,67457025610,NDC,facility,both,1,EA,225,159.3,Aetna First Health,Commercial,,191.25,85,,,99.72,191.25,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,63323056210,NDC,facility,both,1,EA,326.25,230.98,Aetna First Health,Commercial,,277.31,85,,,144.59,277.31,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,70860040210,NDC,facility,both,1,EA,326.25,230.98,Aetna First Health,Commercial,,277.31,85,,,144.59,277.31,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,70860040241,NDC,facility,both,1,EA,326.25,230.98,Aetna First Health,Commercial,,277.31,85,,,144.59,277.31,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,55111065237,NDC,facility,both,1,EA,506.25,358.42,Aetna First Health,Commercial,,430.31,85,,,224.37,430.31,percent of total billed charges,
bivalirudin 250 MG Recon Soln 1 Each Vial,63600000,CDM,J0583,CPT,636,RC,55111065207,NDC,facility,both,1,EA,618.75,438.08,Aetna First Health,Commercial,,525.94,85,,,274.23,525.94,percent of total billed charges,
cabergoline 0.5 MG Tablet 8 Each Bottle,63600000,CDM,J8515,CPT,636,RC,59762100501,NDC,facility,both,1,EA,20.47,14.49,Aetna First Health,Commercial,,17.4,85,,,9.07,17.4,percent of total billed charges,
cefUROXime 750 MG Recon Soln 1 Each Vial,63600000,CDM,J0697,CPT,636,RC,00143997922,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
cefUROXime 750 MG Recon Soln 1 Each Vial,63600000,CDM,J0697,CPT,636,RC,25021011810,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
cefUROXime 750 MG Recon Soln 1 Each Vial,63600000,CDM,J0697,CPT,636,RC,24987035210,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
DTaP-IPV-Hib vaccine Recon Susp 1 Each Vial,63600000,CDM,90698,CPT,636,RC,49281051005,NDC,facility,both,1,EA,254.82,180.41,Aetna First Health,Commercial,,216.6,85,,,112.94,216.6,percent of total billed charges,
DTaP-IPV-Hib vaccine Recon Susp 1 Each Vial,63600000,CDM,90698,CPT,636,RC,49281051105,NDC,facility,both,1,EA,274.86,194.6,Aetna First Health,Commercial,,233.63,85,,,121.82,233.63,percent of total billed charges,
everolimus 0.25 MG Tablet 60 Each Bottle,63600000,CDM,J7527,CPT,636,RC,00054047021,NDC,facility,both,1,EA,27.75,19.65,Aetna First Health,Commercial,,23.59,85,,,12.3,23.59,percent of total billed charges,
everolimus 0.25 MG Tablet 60 Each Box,63600000,CDM,J7527,CPT,636,RC,67877071831,NDC,facility,both,1,EA,14.58,10.32,Aetna First Health,Commercial,,12.39,85,,,6.46,12.39,percent of total billed charges,
gefitinib 250 MG Tablet 30 Each Bottle,63600000,CDM,J8565,CPT,636,RC,00310048230,NDC,facility,both,1,EA,198.55,140.57,Aetna First Health,Commercial,,168.77,85,,,88,168.77,percent of total billed charges,
melphalan 2 MG Tablet 28 Each Bottle,63600000,CDM,J8600,CPT,636,RC,54868433903,NDC,facility,both,1,EA,23.12,16.37,Aetna First Health,Commercial,,19.65,85,,,10.25,19.65,percent of total billed charges,
melphalan 2 MG Tablet 50 Each Bottle,63600000,CDM,J8600,CPT,636,RC,47781020050,NDC,facility,both,1,EA,32.06,22.7,Aetna First Health,Commercial,,27.25,85,,,14.21,27.25,percent of total billed charges,
melphalan 2 MG Tablet 50 Each Bottle,63600000,CDM,J8600,CPT,636,RC,52609000105,NDC,facility,both,1,EA,35.61,25.21,Aetna First Health,Commercial,,30.27,85,,,15.78,30.27,percent of total billed charges,
mycophenolate sodium 360 MG Tablet Delayed Release 1 Each Blister,63600000,CDM,J7518,CPT,636,RC,68084091895,NDC,facility,both,1,EA,26.63,18.85,Aetna First Health,Commercial,,22.64,85,,,11.8,22.64,percent of total billed charges,
mycophenolate sodium 360 MG Tablet Delayed Release 30 Each Box,63600000,CDM,J7518,CPT,636,RC,68084091825,NDC,facility,both,1,EA,26.63,18.85,Aetna First Health,Commercial,,22.64,85,,,11.8,22.64,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,63323030478,NDC,facility,both,1,EA,146.25,103.54,Aetna First Health,Commercial,,124.31,85,,,64.82,124.31,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,64679067902,NDC,facility,both,1,EA,153,108.32,Aetna First Health,Commercial,,130.05,85,,,67.81,130.05,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,64679067901,NDC,facility,both,1,EA,153,108.32,Aetna First Health,Commercial,,130.05,85,,,67.81,130.05,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,61990015001,NDC,facility,both,1,EA,164.03,116.13,Aetna First Health,Commercial,,139.43,85,,,72.7,139.43,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,25021018199,NDC,facility,both,1,EA,196.16,138.88,Aetna First Health,Commercial,,166.74,85,,,86.94,166.74,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,60505077300,NDC,facility,both,1,EA,264.11,186.99,Aetna First Health,Commercial,,224.49,85,,,117.05,224.49,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,44567080401,NDC,facility,both,1,EA,267.77,189.58,Aetna First Health,Commercial,,227.6,85,,,118.68,227.6,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,39822013907,NDC,facility,both,1,EA,270,191.16,Aetna First Health,Commercial,,229.5,85,,,119.66,229.5,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,70860012399,NDC,facility,both,1,EA,328.12,232.31,Aetna First Health,Commercial,,278.9,85,,,145.42,278.9,percent of total billed charges,
piperacillin-tazobactam 40.5 (36-4.5) g Recon Soln 1 Each Vial,63600000,CDM,J2543,CPT,636,RC,63323030474,NDC,facility,both,1,EA,330.23,233.8,Aetna First Health,Commercial,,280.7,85,,,146.36,280.7,percent of total billed charges,
pralidoxime 1 g Recon Soln 1 Each Vial,63600000,CDM,J2730,CPT,636,RC,60977014127,NDC,facility,both,1,EA,195.08,138.12,Aetna First Health,Commercial,,165.82,85,,,86.46,165.82,percent of total billed charges,
pralidoxime 1 g Recon Soln 1 Each Vial,63600000,CDM,J2730,CPT,636,RC,60977014101,NDC,facility,both,1,EA,195.08,138.12,Aetna First Health,Commercial,,165.82,85,,,86.46,165.82,percent of total billed charges,
prochlorperazine 5 MG Tablet 1 Each Blister,63600000,CDM,Q0164,CPT,636,RC,51079054101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 5 MG Tablet 1 Each Blister,63600000,CDM,Q0164,CPT,636,RC,50268068411,NDC,facility,both,1,EA,3.89,2.75,Aetna First Health,Commercial,,3.31,85,,,1.72,3.31,percent of total billed charges,
prochlorperazine 5 MG Tablet 100 Each Bottle,63600000,CDM,Q0164,CPT,636,RC,00093964301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 5 MG Tablet 100 Each Bottle,63600000,CDM,Q0164,CPT,636,RC,59746011306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 5 MG Tablet 100 Each Bottle,63600000,CDM,Q0164,CPT,636,RC,60219203801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 5 MG Tablet 100 Each Bottle,63600000,CDM,Q0164,CPT,636,RC,00781502001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 5 MG Tablet 100 Each Bottle,63600000,CDM,Q0164,CPT,636,RC,70954068810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 5 MG Tablet 100 Each Box,63600000,CDM,Q0164,CPT,636,RC,51079054120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prochlorperazine 5 MG Tablet 50 Each Box,63600000,CDM,Q0164,CPT,636,RC,50268068415,NDC,facility,both,1,EA,3.87,2.74,Aetna First Health,Commercial,,3.29,85,,,1.72,3.29,percent of total billed charges,
cromolyn 20 MG/2ML Nebulization Solution 2 mL Plas Cont,63600000,CDM,J7631,CPT,636,RC,00172640649,NDC,facility,both,1,ML,11.68,8.27,Aetna First Health,Commercial,,9.93,85,,,5.18,9.93,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,63600000,CDM,,,636,RC,00338002303,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 250 mL Flex Cont,63600000,CDM,,,636,RC,00338002302,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
dextrose 10% 10 % Solution 500 mL Flex Cont,63600000,CDM,,,636,RC,00409793003,NDC,facility,both,1,ML,36,25.49,Aetna First Health,Commercial,,30.6,85,,,15.96,30.6,percent of total billed charges,
HYDROmorphone PF 50 MG/5ML Solution 5 mL Vial,63600000,CDM,J1170,CPT,636,RC,00409263405,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
HYDROmorphone PF 50 MG/5ML Solution 5 mL Vial,63600000,CDM,J1170,CPT,636,RC,00409263425,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
HYDROmorphone PF 50 MG/5ML Solution 5 mL Ampule,63600000,CDM,J1170,CPT,636,RC,17478054005,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
paricalcitol 5 MCG/ML Solution 1 mL Vial,63600000,CDM,J2501,CPT,636,RC,00074165801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
DOCEtaxel 20 MG/ML Concentrate 1 mL Vial,63600000,CDM,J9171,CPT,636,RC,72485021401,NDC,facility,both,1,ML,75,53.1,Aetna First Health,Commercial,,63.75,85,,,33.24,63.75,percent of total billed charges,
plasma protein fraction 5% 5 % Solution 250 mL Vial,63600000,CDM,P9043,CPT,636,RC,13533061325,NDC,facility,both,1,ML,94.5,66.91,Aetna First Health,Commercial,,80.32,85,,,41.88,80.32,percent of total billed charges,
DOCEtaxel 20 MG/ML Concentrate 1 mL Vial,63600000,CDM,J9171,CPT,636,RC,43598025811,NDC,facility,both,1,ML,198.75,140.72,Aetna First Health,Commercial,,168.94,85,,,88.09,168.94,percent of total billed charges,
HYDROmorphone PF 50 MG/5ML Solution 50 mL Vial,63600000,CDM,J1170,CPT,636,RC,17478054050,NDC,facility,both,1,ML,229.5,162.49,Aetna First Health,Commercial,,195.08,85,,,101.71,195.08,percent of total billed charges,
HYDROmorphone PF 50 MG/5ML Solution 50 mL Vial,63600000,CDM,J1170,CPT,636,RC,00703001801,NDC,facility,both,1,ML,232.88,164.88,Aetna First Health,Commercial,,197.95,85,,,103.21,197.95,percent of total billed charges,
tacrolimus 5 MG/ML Solution 1 mL Ampule,63600000,CDM,J7525,CPT,636,RC,00469301601,NDC,facility,both,1,ML,656.14,464.55,Aetna First Health,Commercial,,557.72,85,,,290.8,557.72,percent of total billed charges,
HYDROmorphone PF 50 MG/5ML Solution 5 mL Vial,63600000,CDM,J1170,CPT,636,RC,00703011303,NDC,facility,both,1.04,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
HYDROmorphone PF 50 MG/5ML Solution 5 mL Vial,63600000,CDM,J1170,CPT,636,RC,00703011301,NDC,facility,both,1.04,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
Hydromorphone PF 500 MG/50ML Solution 1 mL Vial,63600000,CDM,J1170,CPT,636,RC,00703011003,NDC,facility,both,1.2,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
methylene blue 10 mg in NS 1% Solution 100 mL Bag,63600000,CDM,Q9968,CPT,636,RC,88887800007,NDC,facility,both,100,ML,175.5,124.25,Aetna First Health,Commercial,,149.17,85,,,77.78,149.17,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,,,facility,both,0.16667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 120-12 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,,,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sorbitol 70 % Solution 30 mL Cup,63700001,CDM,,,250,RC,,,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aloe vera Gel 170 g Tube,63700001,CDM,,,250,RC,,,facility,both,1,GR,2.55,1.81,Aetna First Health,Commercial,,2.17,85,,,1.13,2.17,percent of total billed charges,
Alum & Mag Hydroxide-Simeth 1200-1200-120 MG/30ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,,,facility,both,1,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,,,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,,,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phytonadione 0.25 mL Syringe,63700001,CDM,,,250,RC,,,facility,both,1,ML,27.48,19.46,Aetna First Health,Commercial,,23.36,85,,,12.18,23.36,percent of total billed charges,
phytonadione 1 mL Syringe,63700001,CDM,,,250,RC,,,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
vancomycin Solution 10 mL Bottle,63700001,CDM,,,250,RC,,,facility,both,1,ML,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
tobramycin Solution 15 mL Bottle,63700001,CDM,,,250,RC,,,facility,both,1,ML,225,159.3,Aetna First Health,Commercial,,191.25,85,,,99.72,191.25,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904198261,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50580050110,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50580060002,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904677361,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50580045811,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,71399801401,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
strong iodine 5 % Solution 14 mL Bottle,63700001,CDM,,,250,RC,48433023015,NDC,facility,both,0.00714,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Biotene Dry Mouth Liquid 473 mL Bottle,63700001,CDM,,,250,RC,48582000330,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
fluticasone furoate-vilanterol 100-25 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,66993013597,NDC,facility,both,0.01667,EA,16.63,11.77,Aetna First Health,Commercial,,14.14,85,,,7.37,14.14,percent of total billed charges,
fluticasone furoate-vilanterol 100-25 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00173085910,NDC,facility,both,0.01667,EA,27.15,19.22,Aetna First Health,Commercial,,23.08,85,,,12.03,23.08,percent of total billed charges,
fluticasone-salmeterol 100-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,66993058497,NDC,facility,both,0.01667,EA,5.94,4.21,Aetna First Health,Commercial,,5.05,85,,,2.63,5.05,percent of total billed charges,
fluticasone-salmeterol 100-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00378932032,NDC,facility,both,0.01667,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
fluticasone-salmeterol 250-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00054032756,NDC,facility,both,0.01667,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
fluticasone-salmeterol 250-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00378932132,NDC,facility,both,0.01667,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
fluticasone-salmeterol 250-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00173069600,NDC,facility,both,0.01667,EA,13.05,9.24,Aetna First Health,Commercial,,11.09,85,,,5.78,11.09,percent of total billed charges,
fluticasone-salmeterol 500-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,66993058697,NDC,facility,both,0.01667,EA,10.21,7.23,Aetna First Health,Commercial,,8.68,85,,,4.53,8.68,percent of total billed charges,
fluticasone-vilanterol 200-25 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,66993013697,NDC,facility,both,0.01667,EA,16.63,11.77,Aetna First Health,Commercial,,14.14,85,,,7.37,14.14,percent of total billed charges,
fluticasone-vilanterol 200-25 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00173088210,NDC,facility,both,0.01667,EA,27.15,19.22,Aetna First Health,Commercial,,23.08,85,,,12.03,23.08,percent of total billed charges,
budesonide-formoterol 80-4.5 MCG/ACT Aerosol 10.2 g Inhaler,63700001,CDM,,,250,RC,00186037220,NDC,facility,both,0.01667,GR,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
budesonide-formoterol 160-4.5 MCG/ACT Aerosol 10.2 g Inhaler,63700001,CDM,,,250,RC,00310737020,NDC,facility,both,0.01667,GR,5.21,3.69,Aetna First Health,Commercial,,4.43,85,,,2.31,4.43,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,33261076801,NDC,facility,both,0.01667,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,57896033905,NDC,facility,both,0.01667,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,46122055705,NDC,facility,both,0.01667,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
mineral oil heavy Oil 473 mL Bottle,63700001,CDM,,,250,RC,10939074444,NDC,facility,both,0.03171,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
mineral oil heavy Oil 473 mL Bottle,63700001,CDM,,,250,RC,46122039516,NDC,facility,both,0.03171,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
mineral oil heavy Oil 473 mL Bottle,63700001,CDM,,,250,RC,63868093816,NDC,facility,both,0.03171,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mineral oil heavy Oil 473 mL Bottle,63700001,CDM,,,250,RC,00869083143,NDC,facility,both,0.03171,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nirmatrelvir-ritonavir EUA 300/100 20 x 150 MG & 10 x 100MG tablet therapy pack 30 Each Box,63700001,CDM,,,250,RC,00069532130,NDC,facility,both,0.03333,EA,162.17,114.82,Aetna First Health,Commercial,,137.84,85,,,71.87,137.84,percent of total billed charges,
fluticasone-umeclidin-vilant 200-62.5-25 MCG/ACT Aerosol Powder Breath Activated 28 Each Disp Pack,63700001,CDM,,,250,RC,00173089314,NDC,facility,both,0.03571,EA,43.78,31,Aetna First Health,Commercial,,37.21,85,,,19.4,37.21,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.1-20 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00378728785,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.1-20 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00378728753,NDC,facility,both,0.03571,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-35 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,16714036301,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-35 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,68462056584,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-35 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,70700012184,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-35 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,52544024828,NDC,facility,both,0.03571,EA,3.07,2.17,Aetna First Health,Commercial,,2.61,85,,,1.36,2.61,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-35 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00555901858,NDC,facility,both,0.03571,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
norgestimate-ethinyl estradiol 0.25-35 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,69238155106,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.25-35 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,65862077628,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.25-35 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,70700011984,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.25-35 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,52544024728,NDC,facility,both,0.03571,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
norgestrel-ethinyl estradiol 0.3-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00555904979,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestrel-ethinyl estradiol 0.3-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00555904958,NDC,facility,both,0.03571,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
norgestrel-ethinyl estradiol 0.3-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,52544084728,NDC,facility,both,0.03571,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,59762330403,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,68462063945,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,68462063925,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,47781045704,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,47781045766,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,70756001402,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,59651065804,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,59651065825,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,72888013932,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,70756001405,NDC,facility,both,0.04,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,00071041813,NDC,facility,both,0.04,EA,4.8,3.4,Aetna First Health,Commercial,,4.08,85,,,2.13,4.08,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,43598043611,NDC,facility,both,0.04,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 25 Each Bottle,63700001,CDM,,,250,RC,43598043635,NDC,facility,both,0.04,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
norethindrone-ethinyl estradiol 1-20 MG-MCG Tablet 21 Each Disp Pack,63700001,CDM,,,250,RC,51862000701,NDC,facility,both,0.04762,EA,3.58,2.53,Aetna First Health,Commercial,,3.04,85,,,1.59,3.04,percent of total billed charges,
nirmatrelvir-ritonavir (renal) EUA 150/100 10 x 150 MG & 10 x 100MG tablet therapy pack 20 Each Box,63700001,CDM,,,250,RC,00069531720,NDC,facility,both,0.05,EA,243.25,172.22,Aetna First Health,Commercial,,206.76,85,,,107.81,206.76,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Syringe,63700001,CDM,,,250,RC,08888800637,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,00113030234,NDC,facility,both,0.06329,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,00536128636,NDC,facility,both,0.06329,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
fluticasone-umeclidin-vilant 200-62.5-25 MCG/ACT Aerosol Powder Breath Activated 28 Each Disp Pack,63700001,CDM,,,250,RC,00173089314,NDC,facility,both,0.07143,EA,87.57,62,Aetna First Health,Commercial,,74.43,85,,,38.81,74.43,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,68180067801,NDC,facility,both,0.08333,ML,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,27241013909,NDC,facility,both,0.08333,ML,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,70710116506,NDC,facility,both,0.08333,ML,20.48,14.5,Aetna First Health,Commercial,,17.41,85,,,9.08,17.41,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,47781038426,NDC,facility,both,0.08333,ML,29.24,20.7,Aetna First Health,Commercial,,24.85,85,,,12.96,24.85,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,42291056760,NDC,facility,both,0.08333,ML,29.24,20.7,Aetna First Health,Commercial,,24.85,85,,,12.96,24.85,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,69238127306,NDC,facility,both,0.08333,ML,29.24,20.7,Aetna First Health,Commercial,,24.85,85,,,12.96,24.85,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,00004082205,NDC,facility,both,0.08333,ML,44.29,31.36,Aetna First Health,Commercial,,37.65,85,,,19.63,37.65,percent of total billed charges,
lisinopril 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084006211,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687033311,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079098301,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084006201,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739035010,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084019801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904648661,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687033301,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904679961,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,08888800179,NDC,facility,both,0.15,ML,5.78,4.09,Aetna First Health,Commercial,,4.91,85,,,2.56,4.91,percent of total billed charges,
clonazePAM 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687055511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00054353244,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,65162068784,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00121077001,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,50383036315,NDC,facility,both,0.33333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,00121090315,NDC,facility,both,0.33333,ML,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,00121090340,NDC,facility,both,0.33333,ML,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,00121495015,NDC,facility,both,0.33333,ML,6.55,4.64,Aetna First Health,Commercial,,5.57,85,,,2.9,5.57,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,00121495040,NDC,facility,both,0.33333,ML,6.55,4.64,Aetna First Health,Commercial,,5.57,85,,,2.9,5.57,percent of total billed charges,
carvedilol 6.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079093001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084085411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584033911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079030001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687012411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228212810,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300013601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001023800,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378004501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093031901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68682000710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084074895,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68094006559,NDC,facility,both,0.5,EA,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
guanFACINE 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687071011,NDC,facility,both,0.5,EA,4.84,3.43,Aetna First Health,Commercial,,4.11,85,,,2.15,4.11,percent of total billed charges,
hydrocortisone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687051111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687058211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268051711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268050511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084096611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687042411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687055011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292000101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sodium bicarbonate 650 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333083125,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium bicarbonate 650 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333082725,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904655561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687045401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904686961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505265400,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mineral oil heavy Oil 30 mL Cup,63700001,CDM,,,250,RC,17856083201,NDC,facility,both,0.5,ML,1.51,1.07,Aetna First Health,Commercial,,1.28,85,,,0.67,1.28,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,08888800785,NDC,facility,both,0.5,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
benzocaine-menthol 6-10 MG Lozenge 18 Each Box,63700001,CDM,,,250,RC,78112001106,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
benzocaine-menthol 6-10 MG Lozenge 18 Each Box,63700001,CDM,,,250,RC,78112001266,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
budesonide (Inhalation) 180 MCG/ACT Aerosol Powder Breath Activated 1 Each Inhaler,63700001,CDM,,,250,RC,00186091612,NDC,facility,both,1,EA,295.48,209.2,Aetna First Health,Commercial,,251.16,85,,,130.96,251.16,percent of total billed charges,
carvedilol 6.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084026211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079088201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079029901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584065711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687011311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac 1.3 % Patch 5 Each Package,63700001,CDM,,,250,RC,59762041101,NDC,facility,both,1,EA,26.11,18.49,Aetna First Health,Commercial,,22.19,85,,,11.57,22.19,percent of total billed charges,
diclofenac 1.3 % Patch 5 Each Package,63700001,CDM,,,250,RC,59762070701,NDC,facility,both,1,EA,26.11,18.49,Aetna First Health,Commercial,,22.19,85,,,11.57,22.19,percent of total billed charges,
diclofenac 1.3 % Patch 5 Each Package,63700001,CDM,,,250,RC,82347040504,NDC,facility,both,1,EA,35.71,25.28,Aetna First Health,Commercial,,30.35,85,,,15.83,30.35,percent of total billed charges,
diclofenac 1.3 % Patch 5 Each Package,63700001,CDM,,,250,RC,00093372750,NDC,facility,both,1,EA,37.59,26.61,Aetna First Health,Commercial,,31.95,85,,,16.66,31.95,percent of total billed charges,
fluticasone furoate-vilanterol 100-25 MCG/ACT Aerosol Powder Breath Activated 28 Each Disp Pack,63700001,CDM,,,250,RC,00173085914,NDC,facility,both,1,EA,196.11,138.85,Aetna First Health,Commercial,,166.69,85,,,86.92,166.69,percent of total billed charges,
fluticasone-salmeterol 100-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00173069500,NDC,facility,both,1,EA,195,138.06,Aetna First Health,Commercial,,165.75,85,,,86.42,165.75,percent of total billed charges,
fluticasone-salmeterol 100-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00054032656,NDC,facility,both,1,EA,374.88,265.42,Aetna First Health,Commercial,,318.65,85,,,166.15,318.65,percent of total billed charges,
fluticasone-salmeterol 250-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,66993058597,NDC,facility,both,1,EA,145.58,103.07,Aetna First Health,Commercial,,123.74,85,,,64.52,123.74,percent of total billed charges,
fluticasone-salmeterol 500-50 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00173069700,NDC,facility,both,1,EA,647.63,458.52,Aetna First Health,Commercial,,550.49,85,,,287.03,550.49,percent of total billed charges,
fluticasone-vilanterol 200-25 MCG/ACT Aerosol Powder Breath Activated 28 Each Disp Pack,63700001,CDM,,,250,RC,00173088214,NDC,facility,both,1,EA,196.11,138.85,Aetna First Health,Commercial,,166.69,85,,,86.92,166.69,percent of total billed charges,
guanFACINE 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084074811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228282011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729018201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315015501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084046911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.1-20 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,70700011884,NDC,facility,both,1,EA,19.6,13.88,Aetna First Health,Commercial,,16.66,85,,,8.69,16.66,percent of total billed charges,
lisinopril 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084019811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079098320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084034711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
melatonin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904518261,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333051610,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,10006070031,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,20555003601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68094011061,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50035061501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079021701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mometasone 110 MCG/ACT Aerosol Powder Breath Activated 1 Each Inhaler,63700001,CDM,,,250,RC,00085146102,NDC,facility,both,1,EA,221.74,156.99,Aetna First Health,Commercial,,188.48,85,,,98.28,188.48,percent of total billed charges,
mometasone 110 MCG/ACT Aerosol Powder Breath Activated 1 Each Inhaler,63700001,CDM,,,250,RC,78206011501,NDC,facility,both,1,EA,372.16,263.49,Aetna First Health,Commercial,,316.34,85,,,164.94,316.34,percent of total billed charges,
mometasone 220 MCG/ACT Aerosol Powder Breath Activated 1 Each Inhaler,63700001,CDM,,,250,RC,00085134106,NDC,facility,both,1,EA,92.45,65.45,Aetna First Health,Commercial,,78.58,85,,,40.97,78.58,percent of total billed charges,
mometasone 220 MCG/ACT Aerosol Powder Breath Activated 1 Each Inhaler,63700001,CDM,,,250,RC,78206011403,NDC,facility,both,1,EA,155.2,109.88,Aetna First Health,Commercial,,131.92,85,,,68.78,131.92,percent of total billed charges,
mometasone 220 MCG/ACT Aerosol Powder Breath Activated 1 Each Inhaler,63700001,CDM,,,250,RC,00085134107,NDC,facility,both,1,EA,239.44,169.52,Aetna First Health,Commercial,,203.52,85,,,106.12,203.52,percent of total billed charges,
mometasone 220 MCG/ACT Aerosol Powder Breath Activated 1 Each Inhaler,63700001,CDM,,,250,RC,78206011404,NDC,facility,both,1,EA,401.88,284.53,Aetna First Health,Commercial,,341.6,85,,,178.11,341.6,percent of total billed charges,
norgestrel-ethinyl estradiol 0.3-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,51862056401,NDC,facility,both,1,EA,80.16,56.75,Aetna First Health,Commercial,,68.14,85,,,35.53,68.14,percent of total billed charges,
oxyCODONE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084035411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406055223,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pancrelipase (lip-prot-amyl) 12000 UNIT Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00032004770,NDC,facility,both,1,EA,13.34,9.44,Aetna First Health,Commercial,,11.34,85,,,5.91,11.34,percent of total billed charges,
pancrelipase (lip-prot-amyl) 12000 UNIT Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00032121201,NDC,facility,both,1,EA,14.54,10.29,Aetna First Health,Commercial,,12.36,85,,,6.44,12.36,percent of total billed charges,
tiotropium 18 MCG capsule 5 Each Box,63700001,CDM,,,250,RC,00597007575,NDC,facility,both,1,EA,405.64,287.19,Aetna First Health,Commercial,,344.79,85,,,179.78,344.79,percent of total billed charges,
umeclidinium 62.5 MCG/ACT Aerosol Powder Breath Activated 7 Each Disp Pack,63700001,CDM,,,250,RC,00173087306,NDC,facility,both,1,EA,93.81,66.42,Aetna First Health,Commercial,,79.74,85,,,41.58,79.74,percent of total billed charges,
umeclidinium-vilanterol 62.5-25 MCG/ACT Aerosol Powder Breath Activated 14 Each Disp Pack,63700001,CDM,,,250,RC,00173086906,NDC,facility,both,1,EA,142.64,100.99,Aetna First Health,Commercial,,121.24,85,,,63.22,121.24,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,45802037635,NDC,facility,both,1,GM,15.42,10.92,Aetna First Health,Commercial,,13.11,85,,,6.83,13.11,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,68308015215,NDC,facility,both,1,GM,28.02,19.84,Aetna First Health,Commercial,,23.82,85,,,12.42,23.82,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,68382037001,NDC,facility,both,1,GM,28.02,19.84,Aetna First Health,Commercial,,23.82,85,,,12.42,23.82,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,42806018615,NDC,facility,both,1,GM,28.02,19.84,Aetna First Health,Commercial,,23.82,85,,,12.42,23.82,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,00832046515,NDC,facility,both,1,GM,43.62,30.88,Aetna First Health,Commercial,,37.08,85,,,19.33,37.08,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,43386053001,NDC,facility,both,1,GM,59.82,42.35,Aetna First Health,Commercial,,50.85,85,,,26.51,50.85,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,39822301501,NDC,facility,both,1,GM,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,16714076901,NDC,facility,both,1,GM,69.42,49.15,Aetna First Health,Commercial,,59.01,85,,,30.77,59.01,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,00574200815,NDC,facility,both,1,GM,77.58,54.93,Aetna First Health,Commercial,,65.94,85,,,34.38,65.94,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,42543005261,NDC,facility,both,1,GM,77.58,54.93,Aetna First Health,Commercial,,65.94,85,,,34.38,65.94,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 15 g Bottle,63700001,CDM,,,250,RC,69315030615,NDC,facility,both,1,GM,77.58,54.93,Aetna First Health,Commercial,,65.94,85,,,34.38,65.94,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 30 g Bottle,63700001,CDM,,,250,RC,00832046530,NDC,facility,both,1,GM,85.32,60.41,Aetna First Health,Commercial,,72.52,85,,,37.81,72.52,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 60 g Bottle,63700001,CDM,,,250,RC,68308015260,NDC,facility,both,1,GM,88.08,62.36,Aetna First Health,Commercial,,74.87,85,,,39.04,74.87,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 30 g Bottle,63700001,CDM,,,250,RC,68308015230,NDC,facility,both,1,GM,117,82.84,Aetna First Health,Commercial,,99.45,85,,,51.85,99.45,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 30 g Bottle,63700001,CDM,,,250,RC,16714076902,NDC,facility,both,1,GM,141.48,100.17,Aetna First Health,Commercial,,120.26,85,,,62.7,120.26,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 30 g Bottle,63700001,CDM,,,250,RC,00574200830,NDC,facility,both,1,GM,155.28,109.94,Aetna First Health,Commercial,,131.99,85,,,68.82,131.99,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 30 g Bottle,63700001,CDM,,,250,RC,42543005262,NDC,facility,both,1,GM,155.28,109.94,Aetna First Health,Commercial,,131.99,85,,,68.82,131.99,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 30 g Bottle,63700001,CDM,,,250,RC,39822301503,NDC,facility,both,1,GM,159.48,112.91,Aetna First Health,Commercial,,135.56,85,,,70.68,135.56,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 60 g Bottle,63700001,CDM,,,250,RC,39822301506,NDC,facility,both,1,GM,199.92,141.54,Aetna First Health,Commercial,,169.93,85,,,88.6,169.93,percent of total billed charges,
nystatin 100000 UNIT/GM Powder 60 g Bottle,63700001,CDM,,,250,RC,00574200802,NDC,facility,both,1,GM,277.2,196.26,Aetna First Health,Commercial,,235.62,85,,,122.86,235.62,percent of total billed charges,
collagenase 250 UNIT/GM Ointment 30 g Tube,63700001,CDM,,,250,RC,00064501030,NDC,facility,both,1,GM,743.04,526.07,Aetna First Health,Commercial,,631.58,85,,,329.32,631.58,percent of total billed charges,
hydrocortisone 1 % Cream 28 g Tube,63700001,CDM,,,250,RC,00472034356,NDC,facility,both,1,GR,1.97,1.39,Aetna First Health,Commercial,,1.67,85,,,0.87,1.67,percent of total billed charges,
hydrocortisone 1 % Cream 28 g Tube,63700001,CDM,,,250,RC,61269034356,NDC,facility,both,1,GR,1.97,1.39,Aetna First Health,Commercial,,1.67,85,,,0.87,1.67,percent of total billed charges,
hydrocortisone 1 % Cream 28 g Tube,63700001,CDM,,,250,RC,00904762331,NDC,facility,both,1,GR,2.14,1.52,Aetna First Health,Commercial,,1.82,85,,,0.95,1.82,percent of total billed charges,
hydrocortisone 1 % Cream 28 g Tube,63700001,CDM,,,250,RC,00536127780,NDC,facility,both,1,GR,2.14,1.52,Aetna First Health,Commercial,,1.82,85,,,0.95,1.82,percent of total billed charges,
povidone-iodine 10 % Ointment 28.35 g Tube,63700001,CDM,,,250,RC,00904110231,NDC,facility,both,1,GR,2.25,1.59,Aetna First Health,Commercial,,1.91,85,,,1,1.91,percent of total billed charges,
diphenhydrAMINE-zinc acetate 2-0.1 % Cream 28 g Tube,63700001,CDM,,,250,RC,00904535431,NDC,facility,both,1,GR,2.65,1.88,Aetna First Health,Commercial,,2.25,85,,,1.17,2.25,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00904516838,NDC,facility,both,1,GR,3.03,2.15,Aetna First Health,Commercial,,2.58,85,,,1.34,2.58,percent of total billed charges,
trolamine salicylate 10 % Cream 85 g Tube,63700001,CDM,,,250,RC,45802035653,NDC,facility,both,1,GR,3.06,2.17,Aetna First Health,Commercial,,2.6,85,,,1.36,2.6,percent of total billed charges,
diphenhydrAMINE-zinc acetate 2-0.1 % Cream 28.4 g Tube,63700001,CDM,,,250,RC,49348085472,NDC,facility,both,1,GR,3.11,2.2,Aetna First Health,Commercial,,2.64,85,,,1.38,2.64,percent of total billed charges,
diphenhydrAMINE-zinc acetate 2-0.1 % Cream 28.4 g Tube,63700001,CDM,,,250,RC,24385021003,NDC,facility,both,1,GR,3.11,2.2,Aetna First Health,Commercial,,2.64,85,,,1.38,2.64,percent of total billed charges,
hydrocortisone 1 % Cream 28 g Tube,63700001,CDM,,,250,RC,45802043803,NDC,facility,both,1,GR,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
menthol-methyl salicylate 10-15 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167006003,NDC,facility,both,1,GR,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
menthol-methyl salicylate 10-30 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167006003,NDC,facility,both,1,GR,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
menthol-methyl salicylate 10-30 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167006006,NDC,facility,both,1,GR,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
hydrocortisone 1 % Cream 28.4 g Tube,63700001,CDM,,,250,RC,00603053550,NDC,facility,both,1,GR,3.45,2.44,Aetna First Health,Commercial,,2.93,85,,,1.53,2.93,percent of total billed charges,
menthol-methyl salicylate 10-30 % Cream 35.4 g Tube,63700001,CDM,,,250,RC,41167000885,NDC,facility,both,1,GR,3.66,2.59,Aetna First Health,Commercial,,3.11,85,,,1.62,3.11,percent of total billed charges,
phenylephrine-mineral oil-pet 0.25-14-74.9 % Ointment 57 g Tube,63700001,CDM,,,250,RC,00904635602,NDC,facility,both,1,GR,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
phenylephrine-mineral oil-pet 0.25-14-74.9 % Ointment 57 g Tube,63700001,CDM,,,250,RC,00904672602,NDC,facility,both,1,GR,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
phenylephrine-mineral oil-pet 0.25-14-74.9 % Ointment 57 g Tube,63700001,CDM,,,250,RC,00536128806,NDC,facility,both,1,GR,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
diphenhydrAMINE-zinc acetate 2-0.1 % Cream 28.4 g Tube,63700001,CDM,,,250,RC,51672206602,NDC,facility,both,1,GR,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
trolamine salicylate 10 % Cream 85 g Tube,63700001,CDM,,,250,RC,24385016553,NDC,facility,both,1,GR,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
menthol-methyl salicylate 10-15 % Cream 35.4 g Tube,63700001,CDM,,,250,RC,41167000883,NDC,facility,both,1,GR,3.98,2.82,Aetna First Health,Commercial,,3.38,85,,,1.76,3.38,percent of total billed charges,
menthol-methyl salicylate 10-30 % Cream 35.4 g Tube,63700001,CDM,,,250,RC,41167000883,NDC,facility,both,1,GR,3.98,2.82,Aetna First Health,Commercial,,3.38,85,,,1.76,3.38,percent of total billed charges,
saline Gel 14.1 g Tube,63700001,CDM,,,250,RC,00225052547,NDC,facility,both,1,GR,3.98,2.82,Aetna First Health,Commercial,,3.38,85,,,1.76,3.38,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00536108691,NDC,facility,both,1,GR,4.13,2.92,Aetna First Health,Commercial,,3.51,85,,,1.83,3.51,percent of total billed charges,
menthol-methyl salicylate 10-15 % Cream 85 g Tube,63700001,CDM,,,250,RC,45802017453,NDC,facility,both,1,GR,4.34,3.07,Aetna First Health,Commercial,,3.69,85,,,1.92,3.69,percent of total billed charges,
glucose 40 % Gel 37.5 g Tube,63700001,CDM,,,250,RC,00574006915,NDC,facility,both,1,GR,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
glucose 40 % Gel 37.5 g Tube,63700001,CDM,,,250,RC,00574007015,NDC,facility,both,1,GR,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
menthol-zinc oxide 0.44-20.625 % Ointment 113 g Tube,63700001,CDM,,,250,RC,10135070104,NDC,facility,both,1,GR,4.92,3.48,Aetna First Health,Commercial,,4.18,85,,,2.18,4.18,percent of total billed charges,
zinc oxide 13 % Cream 57 g Tube,63700001,CDM,,,250,RC,74300000300,NDC,facility,both,1,GR,4.96,3.51,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
white petrolatum Gel 368 g Jar,63700001,CDM,,,250,RC,24385009227,NDC,facility,both,1,GR,4.97,3.52,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
white petrolatum Gel 368 g Jar,63700001,CDM,,,250,RC,46122071427,NDC,facility,both,1,GR,4.97,3.52,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,24357070106,NDC,facility,both,1,GR,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
menthol-zinc oxide 0.44-20.625 % Ointment 113 g Tube,63700001,CDM,,,250,RC,64980032212,NDC,facility,both,1,GR,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
trolamine salicylate 10 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167073003,NDC,facility,both,1,GR,5.36,3.79,Aetna First Health,Commercial,,4.56,85,,,2.38,4.56,percent of total billed charges,
aloe vera Gel 340 g Bottle,63700001,CDM,,,250,RC,71661000120,NDC,facility,both,1,GR,5.61,3.97,Aetna First Health,Commercial,,4.77,85,,,2.49,4.77,percent of total billed charges,
hydrocortisone 1 % Ointment 28.35 g Tube,63700001,CDM,,,250,RC,00168018131,NDC,facility,both,1,GR,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
clotrimazole 1 % Cream 45 g Tube,63700001,CDM,,,250,RC,00472022041,NDC,facility,both,1,GR,6.01,4.26,Aetna First Health,Commercial,,5.11,85,,,2.66,5.11,percent of total billed charges,
clotrimazole 1 % Cream 45 g Tube,63700001,CDM,,,250,RC,00472022063,NDC,facility,both,1,GR,6.01,4.26,Aetna First Health,Commercial,,5.11,85,,,2.66,5.11,percent of total billed charges,
emollient Cream 113 g Tube,63700001,CDM,,,250,RC,45334030004,NDC,facility,both,1,GR,6.1,4.32,Aetna First Health,Commercial,,5.18,85,,,2.7,5.18,percent of total billed charges,
menthol-methyl salicylate 10-30 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167000891,NDC,facility,both,1,GR,6.12,4.33,Aetna First Health,Commercial,,5.2,85,,,2.71,5.2,percent of total billed charges,
trolamine salicylate 10 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167005703,NDC,facility,both,1,GR,6.12,4.33,Aetna First Health,Commercial,,5.2,85,,,2.71,5.2,percent of total billed charges,
zinc oxide 40 % Paste 57 g Tube,63700001,CDM,,,250,RC,74300000070,NDC,facility,both,1,GR,6.33,4.48,Aetna First Health,Commercial,,5.38,85,,,2.81,5.38,percent of total billed charges,
phenylephrine-mineral oil-pet 0.25-14-74.9 % Ointment 57 g Tube,63700001,CDM,,,250,RC,46122010346,NDC,facility,both,1,GR,6.41,4.54,Aetna First Health,Commercial,,5.45,85,,,2.84,5.45,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,43199004050,NDC,facility,both,1,GR,6.75,4.78,Aetna First Health,Commercial,,5.74,85,,,2.99,5.74,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,52565012207,NDC,facility,both,1,GR,6.75,4.78,Aetna First Health,Commercial,,5.74,85,,,2.99,5.74,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,43199004005,NDC,facility,both,1,GR,6.75,4.78,Aetna First Health,Commercial,,5.74,85,,,2.99,5.74,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,47781057047,NDC,facility,both,1,GR,6.75,4.78,Aetna First Health,Commercial,,5.74,85,,,2.99,5.74,percent of total billed charges,
capsaicin 0.075 % Cream 57 g Tube,63700001,CDM,,,250,RC,00536111825,NDC,facility,both,1,GR,7.01,4.96,Aetna First Health,Commercial,,5.96,85,,,3.11,5.96,percent of total billed charges,
emollient Ointment 50 g Tube,63700001,CDM,,,250,RC,72140045231,NDC,facility,both,1,GR,7.35,5.2,Aetna First Health,Commercial,,6.25,85,,,3.26,6.25,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00904648838,NDC,facility,both,1,GR,8.09,5.73,Aetna First Health,Commercial,,6.88,85,,,3.59,6.88,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,63736014308,NDC,facility,both,1,GR,8.33,5.9,Aetna First Health,Commercial,,7.08,85,,,3.69,7.08,percent of total billed charges,
Biotene OralBalance Dry Mouth Gel 42 g Tube,63700001,CDM,,,250,RC,48582051201,NDC,facility,both,1,GR,8.44,5.98,Aetna First Health,Commercial,,7.17,85,,,3.74,7.17,percent of total billed charges,
benzocaine-menthol-zinc (dental) 20-0.26-0.15 % Gel 11.9 g Tube,63700001,CDM,,,250,RC,10310028313,NDC,facility,both,1,GR,8.82,6.24,Aetna First Health,Commercial,,7.5,85,,,3.91,7.5,percent of total billed charges,
emollient Ointment 80 g Jar,63700001,CDM,,,250,RC,72140003711,NDC,facility,both,1,GR,8.88,6.29,Aetna First Health,Commercial,,7.55,85,,,3.94,7.55,percent of total billed charges,
hydrophor Ointment 80 g Jar,63700001,CDM,,,250,RC,72140003711,NDC,facility,both,1,GR,8.88,6.29,Aetna First Health,Commercial,,7.55,85,,,3.94,7.55,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00574402535,NDC,facility,both,1,GR,8.97,6.35,Aetna First Health,Commercial,,7.62,85,,,3.98,7.62,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,42291007615,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
hydrocortisone 1 % Cream 30 g Tube,63700001,CDM,,,250,RC,68001047646,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,46122075737,NDC,facility,both,1,GR,10.03,7.1,Aetna First Health,Commercial,,8.53,85,,,4.45,8.53,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00078047397,NDC,facility,both,1,GR,10.1,7.15,Aetna First Health,Commercial,,8.58,85,,,4.48,8.58,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,10119002239,NDC,facility,both,1,GR,10.23,7.24,Aetna First Health,Commercial,,8.7,85,,,4.53,8.7,percent of total billed charges,
capsaicin 0.025 % Cream 60 g Tube,63700001,CDM,,,250,RC,00536252525,NDC,facility,both,1,GR,10.44,7.39,Aetna First Health,Commercial,,8.87,85,,,4.63,8.87,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,17478006235,NDC,facility,both,1,GR,10.48,7.42,Aetna First Health,Commercial,,8.91,85,,,4.64,8.91,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,00496088205,NDC,facility,both,1,GR,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,00496088206,NDC,facility,both,1,GR,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,39328002405,NDC,facility,both,1,GR,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,39328002455,NDC,facility,both,1,GR,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
clotrimazole 2 % Cream 21 g Tube,63700001,CDM,,,250,RC,51672206200,NDC,facility,both,1,GR,10.71,7.58,Aetna First Health,Commercial,,9.1,85,,,4.75,9.1,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00065051801,NDC,facility,both,1,GR,10.73,7.6,Aetna First Health,Commercial,,9.12,85,,,4.76,9.12,percent of total billed charges,
clotrimazole 2 % Cream 21 g Tube,63700001,CDM,,,250,RC,87701045401,NDC,facility,both,1,GR,10.96,7.76,Aetna First Health,Commercial,,9.32,85,,,4.86,9.32,percent of total billed charges,
hydrocortisone 2.5 % Cream 28.35 g Tube,63700001,CDM,,,250,RC,51672300302,NDC,facility,both,1,GR,11.57,8.19,Aetna First Health,Commercial,,9.83,85,,,5.13,9.83,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,00168000415,NDC,facility,both,1,GR,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,52565005615,NDC,facility,both,1,GR,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
menthol-methyl salicylate 10-15 % Cream 85 g Tube,63700001,CDM,,,250,RC,00536134957,NDC,facility,both,1,GR,12.58,8.91,Aetna First Health,Commercial,,10.69,85,,,5.58,10.69,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00023024004,NDC,facility,both,1,GR,12.87,9.11,Aetna First Health,Commercial,,10.94,85,,,5.7,10.94,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,45802006435,NDC,facility,both,1,GR,12.96,9.18,Aetna First Health,Commercial,,11.02,85,,,5.74,11.02,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,00603786274,NDC,facility,both,1,GR,13.32,9.43,Aetna First Health,Commercial,,11.32,85,,,5.9,11.32,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00065050935,NDC,facility,both,1,GR,13.72,9.71,Aetna First Health,Commercial,,11.66,85,,,6.08,11.66,percent of total billed charges,
clobetasol 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,42291007630,NDC,facility,both,1,GR,13.8,9.77,Aetna First Health,Commercial,,11.73,85,,,6.12,11.73,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,24357070105,NDC,facility,both,1,GR,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,33342032915,NDC,facility,both,1,GR,14.4,10.2,Aetna First Health,Commercial,,12.24,85,,,6.38,12.24,percent of total billed charges,
ammonium lactate 12 % Lotion 227 g Bottle,63700001,CDM,,,250,RC,45802052555,NDC,facility,both,1,GR,14.64,10.37,Aetna First Health,Commercial,,12.44,85,,,6.49,12.44,percent of total billed charges,
artificial tears Ointment 3.5 g Tube,63700001,CDM,,,250,RC,00023031204,NDC,facility,both,1,GR,14.65,10.37,Aetna First Health,Commercial,,12.45,85,,,6.49,12.45,percent of total billed charges,
ammonium lactate 12 % Lotion 225 g Bottle,63700001,CDM,,,250,RC,00245002322,NDC,facility,both,1,GR,15.19,10.75,Aetna First Health,Commercial,,12.91,85,,,6.73,12.91,percent of total billed charges,
hydrocortisone 2.5 % Cream 28 g Tube,63700001,CDM,,,250,RC,45802000403,NDC,facility,both,1,GR,15.23,10.78,Aetna First Health,Commercial,,12.95,85,,,6.75,12.95,percent of total billed charges,
ammonium lactate 12 % Lotion 225 g Bottle,63700001,CDM,,,250,RC,71399014008,NDC,facility,both,1,GR,15.3,10.83,Aetna First Health,Commercial,,13,85,,,6.78,13,percent of total billed charges,
miconazole 2 % Ointment 71 g Tube,63700001,CDM,,,250,RC,53329017110,NDC,facility,both,1,GR,15.9,11.26,Aetna First Health,Commercial,,13.52,85,,,7.05,13.52,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00713022815,NDC,facility,both,1,GR,15.9,11.26,Aetna First Health,Commercial,,13.52,85,,,7.05,13.52,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 30 g Tube,63700001,CDM,,,250,RC,00713022531,NDC,facility,both,1,GR,16.08,11.38,Aetna First Health,Commercial,,13.67,85,,,7.13,13.67,percent of total billed charges,
hydrocortisone 1 % Cream 28.4 g Tube,63700001,CDM,,,250,RC,00316018601,NDC,facility,both,1,GR,16.13,11.42,Aetna First Health,Commercial,,13.71,85,,,7.15,13.71,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,51672128201,NDC,facility,both,1,GR,16.5,11.68,Aetna First Health,Commercial,,14.02,85,,,7.31,14.02,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,67877025115,NDC,facility,both,1,GR,16.98,12.02,Aetna First Health,Commercial,,14.43,85,,,7.53,14.43,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 15 g Tube,63700001,CDM,,,250,RC,33342033315,NDC,facility,both,1,GR,17.34,12.28,Aetna First Health,Commercial,,14.74,85,,,7.69,14.74,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 15 g Tube,63700001,CDM,,,250,RC,51672128401,NDC,facility,both,1,GR,17.34,12.28,Aetna First Health,Commercial,,14.74,85,,,7.69,14.74,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 15 g Tube,63700001,CDM,,,250,RC,52565001415,NDC,facility,both,1,GR,17.34,12.28,Aetna First Health,Commercial,,14.74,85,,,7.69,14.74,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,69238153205,NDC,facility,both,1,GR,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
lidocaine 4 % Cream 5 g Tube,63700001,CDM,,,250,RC,47781057036,NDC,facility,both,1,GR,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 15 g Tube,63700001,CDM,,,250,RC,45802005535,NDC,facility,both,1,GR,18.06,12.79,Aetna First Health,Commercial,,15.35,85,,,8,15.35,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00168000615,NDC,facility,both,1,GR,18.6,13.17,Aetna First Health,Commercial,,15.81,85,,,8.24,15.81,percent of total billed charges,
clobetasol 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,42291007730,NDC,facility,both,1,GR,18.96,13.42,Aetna First Health,Commercial,,16.12,85,,,8.4,16.12,percent of total billed charges,
menthol-methyl salicylate 10-30 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167000881,NDC,facility,both,1,GR,19.04,13.48,Aetna First Health,Commercial,,16.18,85,,,8.44,16.18,percent of total billed charges,
trolamine salicylate 10 % Cream 85 g Tube,63700001,CDM,,,250,RC,41167005723,NDC,facility,both,1,GR,19.04,13.48,Aetna First Health,Commercial,,16.18,85,,,8.44,16.18,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,52565000707,NDC,facility,both,1,GR,19.8,14.02,Aetna First Health,Commercial,,16.83,85,,,8.78,16.83,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,21922001604,NDC,facility,both,1,GR,19.98,14.15,Aetna First Health,Commercial,,16.98,85,,,8.86,16.98,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,51672125901,NDC,facility,both,1,GR,19.98,14.15,Aetna First Health,Commercial,,16.98,85,,,8.86,16.98,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,21922001704,NDC,facility,both,1,GR,19.98,14.15,Aetna First Health,Commercial,,16.98,85,,,8.86,16.98,percent of total billed charges,
hydrocortisone 1 % Cream 28.4 g Tube,63700001,CDM,,,250,RC,00472032126,NDC,facility,both,1,GR,21.58,15.28,Aetna First Health,Commercial,,18.34,85,,,9.56,18.34,percent of total billed charges,
benzocaine-menthol 20-0.5 % Aerosol 85 g Can,63700001,CDM,,,250,RC,16864068003,NDC,facility,both,1,GR,22.1,15.65,Aetna First Health,Commercial,,18.78,85,,,9.79,18.78,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 80 g Tube,63700001,CDM,,,250,RC,00713022580,NDC,facility,both,1,GR,23.68,16.77,Aetna First Health,Commercial,,20.13,85,,,10.49,20.13,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 30 g Tube,63700001,CDM,,,250,RC,52565005630,NDC,facility,both,1,GR,24,16.99,Aetna First Health,Commercial,,20.4,85,,,10.64,20.4,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,00115146860,NDC,facility,both,1,GR,24.12,17.08,Aetna First Health,Commercial,,20.5,85,,,10.69,20.5,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,00115146853,NDC,facility,both,1,GR,24.12,17.08,Aetna First Health,Commercial,,20.5,85,,,10.69,20.5,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,00781705805,NDC,facility,both,1,GR,24.12,17.08,Aetna First Health,Commercial,,20.5,85,,,10.69,20.5,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 30 g Tube,63700001,CDM,,,250,RC,67877025130,NDC,facility,both,1,GR,24.36,17.25,Aetna First Health,Commercial,,20.71,85,,,10.8,20.71,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 30 g Tube,63700001,CDM,,,250,RC,51672128202,NDC,facility,both,1,GR,25.2,17.84,Aetna First Health,Commercial,,21.42,85,,,11.17,21.42,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 80 g Tube,63700001,CDM,,,250,RC,33342032980,NDC,facility,both,1,GR,25.6,18.12,Aetna First Health,Commercial,,21.76,85,,,11.35,21.76,percent of total billed charges,
fluticasone 110 MCG/ACT Aerosol 12 g Inhaler,63700001,CDM,,,250,RC,00173071920,NDC,facility,both,1,GR,26.1,18.48,Aetna First Health,Commercial,,22.18,85,,,11.57,22.18,percent of total billed charges,
hydrocortisone 1 % Ointment 28.35 g Tube,63700001,CDM,,,250,RC,00168002031,NDC,facility,both,1,GR,26.31,18.63,Aetna First Health,Commercial,,22.36,85,,,11.66,22.36,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,13668056901,NDC,facility,both,1,GR,28.02,19.84,Aetna First Health,Commercial,,23.82,85,,,12.42,23.82,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 80 g Tube,63700001,CDM,,,250,RC,00168000480,NDC,facility,both,1,GR,28.16,19.94,Aetna First Health,Commercial,,23.94,85,,,12.48,23.94,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,00591207026,NDC,facility,both,1,GR,28.34,20.06,Aetna First Health,Commercial,,24.09,85,,,12.56,24.09,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,00591207072,NDC,facility,both,1,GR,28.34,20.06,Aetna First Health,Commercial,,24.09,85,,,12.56,24.09,percent of total billed charges,
clotrimazole 2 % Cream 21 g Tube,63700001,CDM,,,250,RC,24385011009,NDC,facility,both,1,GR,29.23,20.69,Aetna First Health,Commercial,,24.85,85,,,12.95,24.85,percent of total billed charges,
lidocaine 4 % Cream 15 g Tube,63700001,CDM,,,250,RC,39328002415,NDC,facility,both,1,GR,31.5,22.3,Aetna First Health,Commercial,,26.78,85,,,13.96,26.78,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 80 g Tube,63700001,CDM,,,250,RC,45802006436,NDC,facility,both,1,GR,31.68,22.43,Aetna First Health,Commercial,,26.93,85,,,14.04,26.93,percent of total billed charges,
triamcinolone acetonide 0.5 % Cream 15 g Tube,63700001,CDM,,,250,RC,45802006535,NDC,facility,both,1,GR,32.76,23.19,Aetna First Health,Commercial,,27.85,85,,,14.52,27.85,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,62332058204,NDC,facility,both,1,GR,33.04,23.39,Aetna First Health,Commercial,,28.08,85,,,14.64,28.08,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,00168035755,NDC,facility,both,1,GR,33.06,23.41,Aetna First Health,Commercial,,28.1,85,,,14.65,28.1,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 5 g Tube,63700001,CDM,,,250,RC,00168035705,NDC,facility,both,1,GR,33.06,23.41,Aetna First Health,Commercial,,28.1,85,,,14.65,28.1,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 80 g Tube,63700001,CDM,,,250,RC,67877025180,NDC,facility,both,1,GR,35.2,24.92,Aetna First Health,Commercial,,29.92,85,,,15.6,29.92,percent of total billed charges,
triamcinolone acetonide 0.5 % Cream 15 g Tube,63700001,CDM,,,250,RC,00168000215,NDC,facility,both,1,GR,37.02,26.21,Aetna First Health,Commercial,,31.47,85,,,16.41,31.47,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 80 g Tube,63700001,CDM,,,250,RC,33342033380,NDC,facility,both,1,GR,39.68,28.09,Aetna First Health,Commercial,,33.73,85,,,17.59,33.73,percent of total billed charges,
clobetasol 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,21922001605,NDC,facility,both,1,GR,39.96,28.29,Aetna First Health,Commercial,,33.97,85,,,17.71,33.97,percent of total billed charges,
clobetasol 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,51672125902,NDC,facility,both,1,GR,39.96,28.29,Aetna First Health,Commercial,,33.97,85,,,17.71,33.97,percent of total billed charges,
clobetasol 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,21922001705,NDC,facility,both,1,GR,39.96,28.29,Aetna First Health,Commercial,,33.97,85,,,17.71,33.97,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 16 g Bottle,63700001,CDM,,,250,RC,60505084703,NDC,facility,both,1,GR,40,28.32,Aetna First Health,Commercial,,34,85,,,17.73,34,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,51672125801,NDC,facility,both,1,GR,40.02,28.33,Aetna First Health,Commercial,,34.02,85,,,17.74,34.02,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,52565005115,NDC,facility,both,1,GR,40.02,28.33,Aetna First Health,Commercial,,34.02,85,,,17.74,34.02,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,64980044115,NDC,facility,both,1,GR,40.02,28.33,Aetna First Health,Commercial,,34.02,85,,,17.74,34.02,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 80 g Tube,63700001,CDM,,,250,RC,45802005536,NDC,facility,both,1,GR,40.96,29,Aetna First Health,Commercial,,34.82,85,,,18.15,34.82,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 80 g Tube,63700001,CDM,,,250,RC,00713022880,NDC,facility,both,1,GR,40.96,29,Aetna First Health,Commercial,,34.82,85,,,18.15,34.82,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,52565000814,NDC,facility,both,1,GR,41.96,29.71,Aetna First Health,Commercial,,35.67,85,,,18.6,35.67,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 16 g Bottle,63700001,CDM,,,250,RC,60432026415,NDC,facility,both,1,GR,44.03,31.17,Aetna First Health,Commercial,,37.43,85,,,19.51,37.43,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,65162091838,NDC,facility,both,1,GR,44.94,31.82,Aetna First Health,Commercial,,38.2,85,,,19.92,38.2,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,52565003915,NDC,facility,both,1,GR,46.14,32.67,Aetna First Health,Commercial,,39.22,85,,,20.45,39.22,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 80 g Tube,63700001,CDM,,,250,RC,00168000680,NDC,facility,both,1,GR,46.4,32.85,Aetna First Health,Commercial,,39.44,85,,,20.56,39.44,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,43386009660,NDC,facility,both,1,GR,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,67877047379,NDC,facility,both,1,GR,48.06,34.03,Aetna First Health,Commercial,,40.85,85,,,21.3,40.85,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 16 g Bottle,63700001,CDM,,,250,RC,50383070016,NDC,facility,both,1,GR,52.16,36.93,Aetna First Health,Commercial,,44.34,85,,,23.12,44.34,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 16 g Bottle,63700001,CDM,,,250,RC,00054327099,NDC,facility,both,1,GR,54.59,38.65,Aetna First Health,Commercial,,46.4,85,,,24.19,46.4,percent of total billed charges,
white petrolatum Gel 368 g Jar,63700001,CDM,,,250,RC,00521234500,NDC,facility,both,1,GR,55.2,39.08,Aetna First Health,Commercial,,46.92,85,,,24.46,46.92,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,64380078932,NDC,facility,both,1,GR,59.96,42.45,Aetna First Health,Commercial,,50.97,85,,,26.57,50.97,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,00168035730,NDC,facility,both,1,GR,60.36,42.73,Aetna First Health,Commercial,,51.31,85,,,26.75,51.31,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,00574204230,NDC,facility,both,1,GR,60.36,42.73,Aetna First Health,Commercial,,51.31,85,,,26.75,51.31,percent of total billed charges,
gabapentin 6 %-ketamine 8 %-ketoprofen 10 % 6-8-10 % 15 g Jar,63700001,CDM,,,250,RC,08888800046,NDC,facility,both,1,GR,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,00168016315,NDC,facility,both,1,GR,64.62,45.75,Aetna First Health,Commercial,,54.93,85,,,28.64,54.93,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 16 g Bottle,63700001,CDM,,,250,RC,60505082901,NDC,facility,both,1,GR,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
hydrocortisone (perianal) 2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,64980030130,NDC,facility,both,1,GR,79.56,56.33,Aetna First Health,Commercial,,67.63,85,,,35.26,67.63,percent of total billed charges,
hydrocortisone (perianal) 2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,64980032430,NDC,facility,both,1,GR,79.56,56.33,Aetna First Health,Commercial,,67.63,85,,,35.26,67.63,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,50383093335,NDC,facility,both,1,GR,79.81,56.51,Aetna First Health,Commercial,,67.84,85,,,35.37,67.84,percent of total billed charges,
clobetasol 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,51672125802,NDC,facility,both,1,GR,80.04,56.67,Aetna First Health,Commercial,,68.03,85,,,35.47,68.03,percent of total billed charges,
ammonium lactate 12 % Lotion 225 g Bottle,63700001,CDM,,,250,RC,45802041954,NDC,facility,both,1,GR,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,69680012035,NDC,facility,both,1,GR,86.76,61.43,Aetna First Health,Commercial,,73.75,85,,,38.45,73.75,percent of total billed charges,
tiotropium bromide-olodaterol 2.5-2.5 MCG/ACT Aerosol Solution 4 g Inhaler,63700001,CDM,,,250,RC,00597015570,NDC,facility,both,1,GR,93.75,66.38,Aetna First Health,Commercial,,79.69,85,,,41.55,79.69,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00713065615,NDC,facility,both,1,GR,96,67.97,Aetna First Health,Commercial,,81.6,85,,,42.55,81.6,percent of total billed charges,
clobetasol 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,70700010916,NDC,facility,both,1,GR,99.6,70.52,Aetna First Health,Commercial,,84.66,85,,,44.14,84.66,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,51672302009,NDC,facility,both,1,GR,99.94,70.76,Aetna First Health,Commercial,,84.95,85,,,44.29,84.95,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,50383026815,NDC,facility,both,1,GR,100.02,70.81,Aetna First Health,Commercial,,85.02,85,,,44.33,85.02,percent of total billed charges,
hydrocortisone (perianal) 2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,62559043130,NDC,facility,both,1,GR,103.95,73.6,Aetna First Health,Commercial,,88.36,85,,,46.07,88.36,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,68462041820,NDC,facility,both,1,GR,110.29,78.09,Aetna First Health,Commercial,,93.75,85,,,48.88,93.75,percent of total billed charges,
fluocinonide 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,51672138602,NDC,facility,both,1,GR,116.04,82.16,Aetna First Health,Commercial,,98.63,85,,,51.43,98.63,percent of total billed charges,
permethrin 5 % Cream 60 g Tube,63700001,CDM,,,250,RC,21922002107,NDC,facility,both,1,GR,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
clobetasol 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,00168016330,NDC,facility,both,1,GR,129.24,91.5,Aetna First Health,Commercial,,109.85,85,,,57.28,109.85,percent of total billed charges,
ammonium lactate 12 % Lotion 225 g Bottle,63700001,CDM,,,250,RC,51672130005,NDC,facility,both,1,GR,136.8,96.85,Aetna First Health,Commercial,,116.28,85,,,60.63,116.28,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,50383066730,NDC,facility,both,1,GR,138.24,97.87,Aetna First Health,Commercial,,117.5,85,,,61.27,117.5,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,68462053017,NDC,facility,both,1,GR,149.22,105.65,Aetna First Health,Commercial,,126.84,85,,,66.13,126.84,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00168016215,NDC,facility,both,1,GR,154.68,109.51,Aetna First Health,Commercial,,131.48,85,,,68.55,131.48,percent of total billed charges,
clobetasol 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,50383026730,NDC,facility,both,1,GR,195,138.06,Aetna First Health,Commercial,,165.75,85,,,86.42,165.75,percent of total billed charges,
clobetasol 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,50383026830,NDC,facility,both,1,GR,204,144.43,Aetna First Health,Commercial,,173.4,85,,,90.41,173.4,percent of total billed charges,
budesonide-formoterol 80-4.5 MCG/ACT Aerosol 10.2 g Inhaler,63700001,CDM,,,250,RC,00186037220,NDC,facility,both,1,GR,256.21,181.4,Aetna First Health,Commercial,,217.78,85,,,113.55,217.78,percent of total billed charges,
clobetasol 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,16714078201,NDC,facility,both,1,GR,261.78,185.34,Aetna First Health,Commercial,,222.51,85,,,116.02,222.51,percent of total billed charges,
budesonide-formoterol 80-4.5 MCG/ACT Aerosol 6.9 g Inhaler,63700001,CDM,,,250,RC,00186037228,NDC,facility,both,1,GR,269.05,190.49,Aetna First Health,Commercial,,228.69,85,,,119.24,228.69,percent of total billed charges,
budesonide-formoterol 80-4.5 MCG/ACT Aerosol 10.2 g Inhaler,63700001,CDM,,,250,RC,00310737220,NDC,facility,both,1,GR,273.46,193.61,Aetna First Health,Commercial,,232.44,85,,,121.2,232.44,percent of total billed charges,
fluticasone-salmeterol 115-21 MCG/ACT Aerosol 8 g Inhaler,63700001,CDM,,,250,RC,00173071622,NDC,facility,both,1,GR,273.55,193.67,Aetna First Health,Commercial,,232.52,85,,,121.24,232.52,percent of total billed charges,
hydrocortisone (perianal) 2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,69315030230,NDC,facility,both,1,GR,279.96,198.21,Aetna First Health,Commercial,,237.97,85,,,124.08,237.97,percent of total billed charges,
metroNIDAZOLE 0.75 % Cream 45 g Tube,63700001,CDM,,,250,RC,00168032346,NDC,facility,both,1,GR,285.48,202.12,Aetna First Health,Commercial,,242.66,85,,,126.52,242.66,percent of total billed charges,
metroNIDAZOLE 0.75 % Cream 45 g Tube,63700001,CDM,,,250,RC,66993096045,NDC,facility,both,1,GR,285.48,202.12,Aetna First Health,Commercial,,242.66,85,,,126.52,242.66,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,16714073001,NDC,facility,both,1,GR,286.02,202.5,Aetna First Health,Commercial,,243.12,85,,,126.76,243.12,percent of total billed charges,
fluocinonide 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,00093026230,NDC,facility,both,1,GR,291.48,206.37,Aetna First Health,Commercial,,247.76,85,,,129.18,247.76,percent of total billed charges,
fluocinonide 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,51672125302,NDC,facility,both,1,GR,291.48,206.37,Aetna First Health,Commercial,,247.76,85,,,129.18,247.76,percent of total billed charges,
budesonide-formoterol 160-4.5 MCG/ACT Aerosol 6 g Inhaler,63700001,CDM,,,250,RC,00186037028,NDC,facility,both,1,GR,309.5,219.13,Aetna First Health,Commercial,,263.08,85,,,137.17,263.08,percent of total billed charges,
budesonide-formoterol 160-4.5 MCG/ACT Aerosol 10.2 g Inhaler,63700001,CDM,,,250,RC,00310737020,NDC,facility,both,1,GR,312.58,221.31,Aetna First Health,Commercial,,265.69,85,,,138.54,265.69,percent of total billed charges,
lidocaine-prilocaine 2.5-2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,62332058231,NDC,facility,both,1,GR,318.72,225.65,Aetna First Health,Commercial,,270.91,85,,,141.26,270.91,percent of total billed charges,
fluticasone 220 MCG/ACT Aerosol 12 g Inhaler,63700001,CDM,,,250,RC,66993008096,NDC,facility,both,1,GR,345.57,244.66,Aetna First Health,Commercial,,293.73,85,,,153.16,293.73,percent of total billed charges,
metroNIDAZOLE 0.75 % Gel 45 g Tube,63700001,CDM,,,250,RC,51672411606,NDC,facility,both,1,GR,392.04,277.56,Aetna First Health,Commercial,,333.23,85,,,173.75,333.23,percent of total billed charges,
metroNIDAZOLE 0.75 % Gel 45 g Tube,63700001,CDM,,,250,RC,00115147446,NDC,facility,both,1,GR,392.04,277.56,Aetna First Health,Commercial,,333.23,85,,,173.75,333.23,percent of total billed charges,
permethrin 5 % Cream 60 g Tube,63700001,CDM,,,250,RC,00472024260,NDC,facility,both,1,GR,396,280.37,Aetna First Health,Commercial,,336.6,85,,,175.51,336.6,percent of total billed charges,
permethrin 5 % Cream 60 g Tube,63700001,CDM,,,250,RC,45802026937,NDC,facility,both,1,GR,396,280.37,Aetna First Health,Commercial,,336.6,85,,,175.51,336.6,percent of total billed charges,
permethrin 5 % Cream 60 g Tube,63700001,CDM,,,250,RC,40085021560,NDC,facility,both,1,GR,396,280.37,Aetna First Health,Commercial,,336.6,85,,,175.51,336.6,percent of total billed charges,
permethrin 5 % Cream 60 g Tube,63700001,CDM,,,250,RC,40085061560,NDC,facility,both,1,GR,396,280.37,Aetna First Health,Commercial,,336.6,85,,,175.51,336.6,percent of total billed charges,
permethrin 5 % Cream 60 g Tube,63700001,CDM,,,250,RC,16714089701,NDC,facility,both,1,GR,396,280.37,Aetna First Health,Commercial,,336.6,85,,,175.51,336.6,percent of total billed charges,
fluticasone-salmeterol 230-21 MCG/ACT Aerosol 8 g Inhaler,63700001,CDM,,,250,RC,00173071722,NDC,facility,both,1,GR,405.7,287.24,Aetna First Health,Commercial,,344.84,85,,,179.81,344.84,percent of total billed charges,
clobetasol 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,00472040015,NDC,facility,both,1,GR,410.34,290.52,Aetna First Health,Commercial,,348.79,85,,,181.86,348.79,percent of total billed charges,
clobetasol 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,16714078202,NDC,facility,both,1,GR,424.2,300.33,Aetna First Health,Commercial,,360.57,85,,,188.01,360.57,percent of total billed charges,
budesonide-formoterol 160-4.5 MCG/ACT Aerosol 10.2 g Inhaler,63700001,CDM,,,250,RC,00186037020,NDC,facility,both,1,GR,464.57,328.92,Aetna First Health,Commercial,,394.88,85,,,205.9,394.88,percent of total billed charges,
metroNIDAZOLE vaginal 0.75 % Gel 70 g Tube,63700001,CDM,,,250,RC,00781707787,NDC,facility,both,1,GR,489.16,346.33,Aetna First Health,Commercial,,415.79,85,,,216.8,415.79,percent of total billed charges,
metroNIDAZOLE vaginal 0.75 % Gel 70 g Tube,63700001,CDM,,,250,RC,00245086070,NDC,facility,both,1,GR,489.16,346.33,Aetna First Health,Commercial,,415.79,85,,,216.8,415.79,percent of total billed charges,
fluticasone 220 MCG/ACT Aerosol 12 g Inhaler,63700001,CDM,,,250,RC,00173072020,NDC,facility,both,1,GR,501.14,354.81,Aetna First Health,Commercial,,425.97,85,,,222.11,425.97,percent of total billed charges,
metroNIDAZOLE vaginal 0.75 % Gel 70 g Tube,63700001,CDM,,,250,RC,45802013970,NDC,facility,both,1,GR,509.32,360.6,Aetna First Health,Commercial,,432.92,85,,,225.73,432.92,percent of total billed charges,
clobetasol 0.05 % Cream 30 g Tube,63700001,CDM,,,250,RC,16714073002,NDC,facility,both,1,GR,529.8,375.1,Aetna First Health,Commercial,,450.33,85,,,234.81,450.33,percent of total billed charges,
metroNIDAZOLE vaginal 0.75 % Gel 70 g Tube,63700001,CDM,,,250,RC,68682045570,NDC,facility,both,1,GR,533.12,377.45,Aetna First Health,Commercial,,453.15,85,,,236.28,453.15,percent of total billed charges,
ipratropium HFA 17 MCG/ACT Aerosol Solution 12.9 g Inhaler,63700001,CDM,,,250,RC,00597008717,NDC,facility,both,1,GR,534.82,378.65,Aetna First Health,Commercial,,454.6,85,,,237.03,454.6,percent of total billed charges,
metroNIDAZOLE 0.75 % Cream 45 g Tube,63700001,CDM,,,250,RC,67405011045,NDC,facility,both,1,GR,540,382.32,Aetna First Health,Commercial,,459,85,,,239.33,459,percent of total billed charges,
metroNIDAZOLE 0.75 % Gel 45 g Tube,63700001,CDM,,,250,RC,00168027545,NDC,facility,both,1,GR,546.66,387.04,Aetna First Health,Commercial,,464.66,85,,,242.28,464.66,percent of total billed charges,
metroNIDAZOLE 0.75 % Gel 45 g Tube,63700001,CDM,,,250,RC,66993096245,NDC,facility,both,1,GR,551.52,390.48,Aetna First Health,Commercial,,468.79,85,,,244.43,468.79,percent of total billed charges,
tiotropium bromide-olodaterol 2.5-2.5 MCG/ACT Aerosol Solution 4 g Inhaler,63700001,CDM,,,250,RC,00597015561,NDC,facility,both,1,GR,604.62,428.07,Aetna First Health,Commercial,,513.93,85,,,267.97,513.93,percent of total billed charges,
metroNIDAZOLE 0.75 % Cream 45 g Tube,63700001,CDM,,,250,RC,00713063337,NDC,facility,both,1,GR,610.56,432.28,Aetna First Health,Commercial,,518.98,85,,,270.6,518.98,percent of total billed charges,
albuterol-ipratropium 20-100 MCG/ACT Aerosol Solution 4 g Inhaler,63700001,CDM,,,250,RC,00597002402,NDC,facility,both,1,GR,611.68,433.07,Aetna First Health,Commercial,,519.93,85,,,271.1,519.93,percent of total billed charges,
fluticasone 110 MCG/ACT Aerosol 12 g Inhaler,63700001,CDM,,,250,RC,66993007996,NDC,facility,both,1,GR,711.98,504.08,Aetna First Health,Commercial,,605.18,85,,,315.55,605.18,percent of total billed charges,
fluticasone 44 MCG/ACT Aerosol 10.6 g Inhaler,63700001,CDM,,,250,RC,00173071820,NDC,facility,both,1,GR,818.15,579.25,Aetna First Health,Commercial,,695.43,85,,,362.6,695.43,percent of total billed charges,
clobetasol 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,00168016230,NDC,facility,both,1,GR,831.24,588.52,Aetna First Health,Commercial,,706.55,85,,,368.41,706.55,percent of total billed charges,
clobetasol 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,00378819030,NDC,facility,both,1,GR,831.24,588.52,Aetna First Health,Commercial,,706.55,85,,,368.41,706.55,percent of total billed charges,
lidocaine 5 % Ointment 35.44 g Tube,63700001,CDM,,,250,RC,00168020437,NDC,facility,both,1,GR,960,679.68,Aetna First Health,Commercial,,816,85,,,425.47,816,percent of total billed charges,
hydrogen peroxide 3 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00869087143,NDC,facility,both,1,ML,0.71,0.5,Aetna First Health,Commercial,,0.6,85,,,0.31,0.6,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00904571135,NDC,facility,both,1,ML,1.15,0.81,Aetna First Health,Commercial,,0.98,85,,,0.51,0.98,percent of total billed charges,
sodium chloride 0.65 % Solution 44 mL Bottle,63700001,CDM,,,250,RC,00904386575,NDC,facility,both,1,ML,1.39,0.98,Aetna First Health,Commercial,,1.18,85,,,0.62,1.18,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,00904571130,NDC,facility,both,1,ML,1.4,0.99,Aetna First Health,Commercial,,1.19,85,,,0.62,1.19,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00904322035,NDC,facility,both,1,ML,1.73,1.22,Aetna First Health,Commercial,,1.47,85,,,0.77,1.47,percent of total billed charges,
sodium chloride 0.65 % Solution 44 mL Bottle,63700001,CDM,,,250,RC,49348035625,NDC,facility,both,1,ML,1.85,1.31,Aetna First Health,Commercial,,1.57,85,,,0.82,1.57,percent of total billed charges,
sodium chloride 0.65 % Solution 44 mL Spray Bottle,63700001,CDM,,,250,RC,87701055205,NDC,facility,both,1,ML,1.91,1.35,Aetna First Health,Commercial,,1.62,85,,,0.85,1.62,percent of total billed charges,
sodium phosphate 3.5-9.5 GM/59ML Enema 66 mL Bottle,63700001,CDM,,,250,RC,00132020220,NDC,facility,both,1,ML,2.08,1.47,Aetna First Health,Commercial,,1.77,85,,,0.92,1.77,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00536112494,NDC,facility,both,1,ML,2.09,1.48,Aetna First Health,Commercial,,1.78,85,,,0.93,1.78,percent of total billed charges,
glycerin-hypromellose-PEG 0.2-0.2-1 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,57896018405,NDC,facility,both,1,ML,2.09,1.48,Aetna First Health,Commercial,,1.78,85,,,0.93,1.78,percent of total billed charges,
sodium chloride 0.65 % Solution 44 mL Spray Bottle,63700001,CDM,,,250,RC,00536250676,NDC,facility,both,1,ML,2.18,1.54,Aetna First Health,Commercial,,1.85,85,,,0.97,1.85,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,49348023127,NDC,facility,both,1,ML,2.39,1.69,Aetna First Health,Commercial,,2.03,85,,,1.06,2.03,percent of total billed charges,
mineral oil heavy Oil 30 mL Cup,63700001,CDM,,,250,RC,48433020230,NDC,facility,both,1,ML,2.48,1.76,Aetna First Health,Commercial,,2.11,85,,,1.1,2.11,percent of total billed charges,
polyvinyl alcohol 1.4 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00904649235,NDC,facility,both,1,ML,2.5,1.77,Aetna First Health,Commercial,,2.12,85,,,1.11,2.12,percent of total billed charges,
glycerin-hypromellose-PEG 0.2-0.2-1 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,57896018105,NDC,facility,both,1,ML,2.54,1.8,Aetna First Health,Commercial,,2.16,85,,,1.13,2.16,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,49348023027,NDC,facility,both,1,ML,2.66,1.88,Aetna First Health,Commercial,,2.26,85,,,1.18,2.26,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,24385095501,NDC,facility,both,1,ML,2.95,2.09,Aetna First Health,Commercial,,2.51,85,,,1.31,2.51,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,69618005051,NDC,facility,both,1,ML,2.97,2.1,Aetna First Health,Commercial,,2.52,85,,,1.32,2.52,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00904700635,NDC,facility,both,1,ML,2.99,2.12,Aetna First Health,Commercial,,2.54,85,,,1.33,2.54,percent of total billed charges,
mineral oil heavy Oil 30 mL Cup,63700001,CDM,,,250,RC,08888800191,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,50383077515,NDC,facility,both,1,ML,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
lidocaine viscous 2 % Solution 15 mL Cup,63700001,CDM,,,250,RC,50383077517,NDC,facility,both,1,ML,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
polyvinyl alcohol 1.4 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00536108494,NDC,facility,both,1,ML,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
hydrogen peroxide 3 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,46122033443,NDC,facility,both,1,ML,3.55,2.51,Aetna First Health,Commercial,,3.02,85,,,1.57,3.02,percent of total billed charges,
Biotene Dry Mouth Liquid 237 mL Bottle,63700001,CDM,,,250,RC,48582080220,NDC,facility,both,1,ML,4.27,3.02,Aetna First Health,Commercial,,3.63,85,,,1.89,3.63,percent of total billed charges,
phenylephrine 0.25 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00024134803,NDC,facility,both,1,ML,4.37,3.09,Aetna First Health,Commercial,,3.71,85,,,1.94,3.71,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,00536128636,NDC,facility,both,1,ML,4.62,3.27,Aetna First Health,Commercial,,3.93,85,,,2.05,3.93,percent of total billed charges,
LORazepam 2 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00574016330,NDC,facility,both,1,ML,4.62,3.27,Aetna First Health,Commercial,,3.93,85,,,2.05,3.93,percent of total billed charges,
phenylephrine 0.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,69536005015,NDC,facility,both,1,ML,4.75,3.36,Aetna First Health,Commercial,,4.04,85,,,2.11,4.04,percent of total billed charges,
phenylephrine 0.25 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,69536002515,NDC,facility,both,1,ML,4.75,3.36,Aetna First Health,Commercial,,4.04,85,,,2.11,4.04,percent of total billed charges,
phenylephrine 0.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00225080547,NDC,facility,both,1,ML,4.91,3.48,Aetna First Health,Commercial,,4.17,85,,,2.18,4.17,percent of total billed charges,
phenylephrine 0.25 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00225080047,NDC,facility,both,1,ML,4.91,3.48,Aetna First Health,Commercial,,4.17,85,,,2.18,4.17,percent of total billed charges,
phenylephrine 1 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00024135202,NDC,facility,both,1,ML,4.93,3.49,Aetna First Health,Commercial,,4.19,85,,,2.18,4.19,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,49348092237,NDC,facility,both,1,ML,4.98,3.53,Aetna First Health,Commercial,,4.23,85,,,2.21,4.23,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,78112073623,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,46122024905,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00904662735,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,57896033905,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,46122055705,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,24385035210,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,45802041059,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,51672203005,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,46122016510,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Spray Bottle,63700001,CDM,,,250,RC,00904676130,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,49348002827,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,24385006710,NDC,facility,both,1,ML,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
phenylephrine 0.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00024135301,NDC,facility,both,1,ML,5.24,3.71,Aetna First Health,Commercial,,4.45,85,,,2.32,4.45,percent of total billed charges,
camphor-menthol 0.5-0.5 % Lotion 222 mL Bottle,63700001,CDM,,,250,RC,54162055009,NDC,facility,both,1,ML,5.33,3.77,Aetna First Health,Commercial,,4.53,85,,,2.36,4.53,percent of total billed charges,
phenylephrine 1 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,69536010015,NDC,facility,both,1,ML,5.33,3.77,Aetna First Health,Commercial,,4.53,85,,,2.36,4.53,percent of total billed charges,
camphor-menthol 0.5-0.5 % Lotion 222 mL Bottle,63700001,CDM,,,250,RC,46122014310,NDC,facility,both,1,ML,5.33,3.77,Aetna First Health,Commercial,,4.53,85,,,2.36,4.53,percent of total billed charges,
phenylephrine 1 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00225081047,NDC,facility,both,1,ML,5.51,3.9,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
camphor-menthol 0.5-0.5 % Lotion 222 mL Bottle,63700001,CDM,,,250,RC,54162055007,NDC,facility,both,1,ML,5.66,4.01,Aetna First Health,Commercial,,4.81,85,,,2.51,4.81,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,78112073621,NDC,facility,both,1,ML,5.72,4.05,Aetna First Health,Commercial,,4.86,85,,,2.54,4.86,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00085075605,NDC,facility,both,1,ML,5.93,4.2,Aetna First Health,Commercial,,5.04,85,,,2.63,5.04,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00573119120,NDC,facility,both,1,ML,5.99,4.24,Aetna First Health,Commercial,,5.09,85,,,2.65,5.09,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,23900001252,NDC,facility,both,1,ML,5.99,4.24,Aetna First Health,Commercial,,5.09,85,,,2.65,5.09,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,42037010478,NDC,facility,both,1,ML,6.73,4.76,Aetna First Health,Commercial,,5.72,85,,,2.98,5.72,percent of total billed charges,
benzocaine 20 % Liquid 12 mL Bottle,63700001,CDM,,,250,RC,00573021541,NDC,facility,both,1,ML,6.88,4.87,Aetna First Health,Commercial,,5.85,85,,,3.05,5.85,percent of total billed charges,
Biotene Dry Mouth Liquid 473 mL Bottle,63700001,CDM,,,250,RC,48582000330,NDC,facility,both,1,ML,7.1,5.03,Aetna First Health,Commercial,,6.03,85,,,3.15,6.03,percent of total billed charges,
camphor-menthol 0.5-0.5 % Lotion 222 mL Bottle,63700001,CDM,,,250,RC,46122057310,NDC,facility,both,1,ML,7.33,5.19,Aetna First Health,Commercial,,6.23,85,,,3.25,6.23,percent of total billed charges,
camphor-menthol 0.5-0.5 % Lotion 222 mL Bottle,63700001,CDM,,,250,RC,00536126812,NDC,facility,both,1,ML,7.66,5.42,Aetna First Health,Commercial,,6.51,85,,,3.39,6.51,percent of total billed charges,
biotene dry mouth moisturizing Solution 44.3 mL Bottle,63700001,CDM,,,250,RC,48582000155,NDC,facility,both,1,ML,7.77,5.5,Aetna First Health,Commercial,,6.6,85,,,3.44,6.6,percent of total billed charges,
povidone iodine 10 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,67618015017,NDC,facility,both,1,ML,7.8,5.52,Aetna First Health,Commercial,,6.63,85,,,3.46,6.63,percent of total billed charges,
biotene dry mouth moisturizing Solution 59 mL Bottle,63700001,CDM,,,250,RC,50930009802,NDC,facility,both,1,ML,7.88,5.58,Aetna First Health,Commercial,,6.7,85,,,3.49,6.7,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,41100081127,NDC,facility,both,1,ML,7.97,5.64,Aetna First Health,Commercial,,6.77,85,,,3.53,6.77,percent of total billed charges,
polyvinyl alcohol 1.4 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00536140894,NDC,facility,both,1,ML,8.03,5.69,Aetna First Health,Commercial,,6.83,85,,,3.56,6.83,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,41100081123,NDC,facility,both,1,ML,8.25,5.84,Aetna First Health,Commercial,,7.01,85,,,3.66,7.01,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,41100081121,NDC,facility,both,1,ML,8.25,5.84,Aetna First Health,Commercial,,7.01,85,,,3.66,7.01,percent of total billed charges,
carbamide peroxide 6.5% 6.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,42037010479,NDC,facility,both,1,ML,8.6,6.09,Aetna First Health,Commercial,,7.31,85,,,3.81,7.31,percent of total billed charges,
polyvinyl alcohol 1.4 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,17478006012,NDC,facility,both,1,ML,8.89,6.29,Aetna First Health,Commercial,,7.56,85,,,3.94,7.56,percent of total billed charges,
polyethyl glycol-propyl glycol 0.4-0.3 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00536121994,NDC,facility,both,1,ML,9.25,6.55,Aetna First Health,Commercial,,7.86,85,,,4.1,7.86,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,51672203003,NDC,facility,both,1,ML,9.59,6.79,Aetna First Health,Commercial,,8.15,85,,,4.25,8.15,percent of total billed charges,
camphor-menthol 0.5-0.5 % Lotion 222 mL Bottle,63700001,CDM,,,250,RC,00145062805,NDC,facility,both,1,ML,9.66,6.84,Aetna First Health,Commercial,,8.21,85,,,4.28,8.21,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 9.9 mL Bottle,63700001,CDM,,,250,RC,49348018243,NDC,facility,both,1,ML,9.86,6.98,Aetna First Health,Commercial,,8.38,85,,,4.37,8.38,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,87701012689,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
hydrogen peroxide 3 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,10565000116,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,41100001511,NDC,facility,both,1,ML,11.59,8.21,Aetna First Health,Commercial,,9.85,85,,,5.14,9.85,percent of total billed charges,
camphor-menthol 0.5-0.5 % Lotion 222 mL Bottle,63700001,CDM,,,250,RC,00316022975,NDC,facility,both,1,ML,11.66,8.26,Aetna First Health,Commercial,,9.91,85,,,5.17,9.91,percent of total billed charges,
chlorhexidine 0.12 % Solution 118 mL Bottle,63700001,CDM,,,250,RC,00116200104,NDC,facility,both,1,ML,12.27,8.69,Aetna First Health,Commercial,,10.43,85,,,5.44,10.43,percent of total billed charges,
carboxymethylcellulose sodium 0.5% 0.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00023079815,NDC,facility,both,1,ML,12.58,8.91,Aetna First Health,Commercial,,10.69,85,,,5.58,10.69,percent of total billed charges,
oxymetazoline 0.05 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,41100081125,NDC,facility,both,1,ML,13.86,9.81,Aetna First Health,Commercial,,11.78,85,,,6.14,11.78,percent of total billed charges,
povidone iodine 10 % Solution 236 mL Bottle,63700001,CDM,,,250,RC,00904110309,NDC,facility,both,1,ML,14.16,10.03,Aetna First Health,Commercial,,12.04,85,,,6.28,12.04,percent of total billed charges,
sodium hypochlorite 0.25 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,39328006325,NDC,facility,both,1,ML,14.19,10.05,Aetna First Health,Commercial,,12.06,85,,,6.29,12.06,percent of total billed charges,
polyethyl glycol-propyl glycol 0.4-0.3 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00065042915,NDC,facility,both,1,ML,14.47,10.24,Aetna First Health,Commercial,,12.3,85,,,6.41,12.3,percent of total billed charges,
vitamin D3 (cholecalciferol) 357 mcg/mL (400 units/drop) Liquid 2.5 mL Bottle,63700001,CDM,,,250,RC,51228000006,NDC,facility,both,1,ML,14.85,10.51,Aetna First Health,Commercial,,12.62,85,,,6.58,12.62,percent of total billed charges,
sodium hypochlorite 0.25 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00436093616,NDC,facility,both,1,ML,17.03,12.06,Aetna First Health,Commercial,,14.48,85,,,7.55,14.48,percent of total billed charges,
sodium hypochlorite 0.125 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00436067216,NDC,facility,both,1,ML,17.03,12.06,Aetna First Health,Commercial,,14.48,85,,,7.55,14.48,percent of total billed charges,
sodium hypochlorite 0.5 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00436094616,NDC,facility,both,1,ML,17.03,12.06,Aetna First Health,Commercial,,14.48,85,,,7.55,14.48,percent of total billed charges,
sodium hypochlorite 0.5 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,39328006250,NDC,facility,both,1,ML,17.03,12.06,Aetna First Health,Commercial,,14.48,85,,,7.55,14.48,percent of total billed charges,
sodium hypochlorite 0.125 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,39328006412,NDC,facility,both,1,ML,17.74,12.56,Aetna First Health,Commercial,,15.08,85,,,7.86,15.08,percent of total billed charges,
oxymetazoline 0.05 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,11523115901,NDC,facility,both,1,ML,18.48,13.08,Aetna First Health,Commercial,,15.71,85,,,8.19,15.71,percent of total billed charges,
benzocaine 20 % Liquid 12 mL Bottle,63700001,CDM,,,250,RC,50024043201,NDC,facility,both,1,ML,18.55,13.13,Aetna First Health,Commercial,,15.77,85,,,8.22,15.77,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,70756060915,NDC,facility,both,1,ML,18.75,13.28,Aetna First Health,Commercial,,15.94,85,,,8.31,15.94,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,69238161503,NDC,facility,both,1,ML,18.75,13.28,Aetna First Health,Commercial,,15.94,85,,,8.31,15.94,percent of total billed charges,
povidone iodine 10 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00395232516,NDC,facility,both,1,ML,18.92,13.4,Aetna First Health,Commercial,,16.08,85,,,8.39,16.08,percent of total billed charges,
polyvinyl alcohol 1.4 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00536132594,NDC,facility,both,1,ML,20.94,14.83,Aetna First Health,Commercial,,17.8,85,,,9.28,17.8,percent of total billed charges,
polyethyl glycol-propyl glycol 0.4-0.3 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,49348094729,NDC,facility,both,1,ML,24.48,17.33,Aetna First Health,Commercial,,20.81,85,,,10.85,20.81,percent of total billed charges,
polyethyl glycol-propyl glycol 0.4-0.3 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,49348014929,NDC,facility,both,1,ML,24.48,17.33,Aetna First Health,Commercial,,20.81,85,,,10.85,20.81,percent of total billed charges,
Ora-Sweet SF Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00574030216,NDC,facility,both,1,ML,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
glycerin Liquid 473 mL Bottle,63700001,CDM,,,250,RC,00395103116,NDC,facility,both,1,ML,31.93,22.61,Aetna First Health,Commercial,,27.14,85,,,14.15,27.14,percent of total billed charges,
hydrogen peroxide 3 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,49348017938,NDC,facility,both,1,ML,35.95,25.45,Aetna First Health,Commercial,,30.56,85,,,15.93,30.56,percent of total billed charges,
glycerin Liquid 473 mL Bottle,63700001,CDM,,,250,RC,31722013747,NDC,facility,both,1,ML,36.18,25.62,Aetna First Health,Commercial,,30.75,85,,,16.03,30.75,percent of total billed charges,
pentafluoroprop - tetrafluoroeth Aerosol 116 mL Can,63700001,CDM,,,250,RC,00386000803,NDC,facility,both,1,ML,38.57,27.31,Aetna First Health,Commercial,,32.78,85,,,17.09,32.78,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 9.9 mL Bottle,63700001,CDM,,,250,RC,00536118399,NDC,facility,both,1,ML,39.6,28.04,Aetna First Health,Commercial,,33.66,85,,,17.55,33.66,percent of total billed charges,
Ora-Sweet SF Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00395009416,NDC,facility,both,1,ML,46.35,32.82,Aetna First Health,Commercial,,39.4,85,,,20.54,39.4,percent of total billed charges,
pentafluoroprop - tetrafluoroeth Aerosol 116 mL Can,63700001,CDM,,,250,RC,00386000404,NDC,facility,both,1,ML,47.42,33.57,Aetna First Health,Commercial,,40.31,85,,,21.02,40.31,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,50383002505,NDC,facility,both,1,ML,68,48.14,Aetna First Health,Commercial,,57.8,85,,,30.14,57.8,percent of total billed charges,
azelastine 0.1 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,60505083305,NDC,facility,both,1,ML,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
azelastine 0.1 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,47335077991,NDC,facility,both,1,ML,87,61.6,Aetna First Health,Commercial,,73.95,85,,,38.56,73.95,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,68180067801,NDC,facility,both,1,ML,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,27241013909,NDC,facility,both,1,ML,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
strong iodine 5 % Solution 14 mL Bottle,63700001,CDM,,,250,RC,48433023015,NDC,facility,both,1,ML,112.9,79.93,Aetna First Health,Commercial,,95.96,85,,,50.04,95.96,percent of total billed charges,
hydrocortisone 2.5 % Lotion 59 mL Bottle,63700001,CDM,,,250,RC,45802093716,NDC,facility,both,1,ML,119.89,84.88,Aetna First Health,Commercial,,101.91,85,,,53.14,101.91,percent of total billed charges,
ipratropium 0.06 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00054004641,NDC,facility,both,1,ML,126,89.21,Aetna First Health,Commercial,,107.1,85,,,55.84,107.1,percent of total billed charges,
ipratropium 0.06 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,24208039915,NDC,facility,both,1,ML,127.73,90.43,Aetna First Health,Commercial,,108.57,85,,,56.61,108.57,percent of total billed charges,
ipratropium 0.03 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,00054004544,NDC,facility,both,1,ML,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
ipratropium 0.03 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,60505082601,NDC,facility,both,1,ML,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
ipratropium 0.06 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,60505082701,NDC,facility,both,1,ML,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
ipratropium 0.03 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,24208039830,NDC,facility,both,1,ML,146.04,103.4,Aetna First Health,Commercial,,124.13,85,,,64.72,124.13,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,24208041005,NDC,facility,both,1,ML,160.71,113.78,Aetna First Health,Commercial,,136.6,85,,,71.23,136.6,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,70710116506,NDC,facility,both,1,ML,245.7,173.96,Aetna First Health,Commercial,,208.84,85,,,108.89,208.84,percent of total billed charges,
ofloxacin 0.3 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,60505036301,NDC,facility,both,1,ML,260,184.08,Aetna First Health,Commercial,,221,85,,,115.23,221,percent of total billed charges,
calcitonin (salmon) 200 UNIT/ACT Solution 3.7 mL Bottle,63700001,CDM,,,250,RC,60505082306,NDC,facility,both,1,ML,299.48,212.03,Aetna First Health,Commercial,,254.56,85,,,132.73,254.56,percent of total billed charges,
calcitonin (salmon) 200 UNIT/ACT Solution 3.7 mL Bottle,63700001,CDM,,,250,RC,49884016111,NDC,facility,both,1,ML,299.48,212.03,Aetna First Health,Commercial,,254.56,85,,,132.73,254.56,percent of total billed charges,
neomycin-polymyxin-hydrocortisone 3.5-10000-1 Suspension 10 mL Bottle,63700001,CDM,,,250,RC,24208063562,NDC,facility,both,1,ML,335.6,237.6,Aetna First Health,Commercial,,285.26,85,,,148.74,285.26,percent of total billed charges,
neomycin-polymyxin-hydrocortisone 3.5-10000-1 Suspension 10 mL Bottle,63700001,CDM,,,250,RC,61314064511,NDC,facility,both,1,ML,335.6,237.6,Aetna First Health,Commercial,,285.26,85,,,148.74,285.26,percent of total billed charges,
azelastine 0.1 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,51525029403,NDC,facility,both,1,ML,336.6,238.31,Aetna First Health,Commercial,,286.11,85,,,149.18,286.11,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,47781038426,NDC,facility,both,1,ML,350.91,248.44,Aetna First Health,Commercial,,298.27,85,,,155.52,298.27,percent of total billed charges,
ciprofloxacin-hydrocortisone 0.2-1 % Suspension 10 mL Bottle,63700001,CDM,,,250,RC,00065853110,NDC,facility,both,1,ML,394.84,279.55,Aetna First Health,Commercial,,335.61,85,,,174.99,335.61,percent of total billed charges,
ciprofloxacin-hydrocortisone 0.2-1 % Suspension 10 mL Bottle,63700001,CDM,,,250,RC,00078085526,NDC,facility,both,1,ML,455.61,322.57,Aetna First Health,Commercial,,387.27,85,,,201.93,387.27,percent of total billed charges,
desmopressin 0.01 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,47335078891,NDC,facility,both,1,ML,492.52,348.7,Aetna First Health,Commercial,,418.64,85,,,218.28,418.64,percent of total billed charges,
Timolol Maleate (Once-Daily) 0.5 % Solution 2.5 mL Bottle,63700001,CDM,,,250,RC,60505100504,NDC,facility,both,1,ML,515.76,365.16,Aetna First Health,Commercial,,438.4,85,,,228.58,438.4,percent of total billed charges,
oseltamivir 6 MG/ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,00004082205,NDC,facility,both,1,ML,531.51,376.31,Aetna First Health,Commercial,,451.78,85,,,235.57,451.78,percent of total billed charges,
Timolol Maleate (Once-Daily) 0.5 % Solution 2.5 mL Bottle,63700001,CDM,,,250,RC,68682004525,NDC,facility,both,1,ML,584.92,414.12,Aetna First Health,Commercial,,497.18,85,,,259.24,497.18,percent of total billed charges,
desmopressin 0.01 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,62756016191,NDC,facility,both,1,ML,709.2,502.11,Aetna First Health,Commercial,,602.82,85,,,314.32,602.82,percent of total billed charges,
desmopressin 0.01 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,68382038401,NDC,facility,both,1,ML,718.12,508.43,Aetna First Health,Commercial,,610.4,85,,,318.27,610.4,percent of total billed charges,
desmopressin 0.01 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,69918050105,NDC,facility,both,1,ML,788,557.9,Aetna First Health,Commercial,,669.8,85,,,349.24,669.8,percent of total billed charges,
desmopressin 0.01 % Solution 5 mL Bottle,63700001,CDM,,,250,RC,24208034205,NDC,facility,both,1,ML,788.04,557.93,Aetna First Health,Commercial,,669.83,85,,,349.26,669.83,percent of total billed charges,
pentafluoroprop - tetrafluoroeth Aerosol 116 mL Can,63700001,CDM,,,250,RC,00386000802,NDC,facility,both,1.78448,ML,68.83,48.73,Aetna First Health,Commercial,,58.51,85,,,30.51,58.51,percent of total billed charges,
ammonium lactate 12 % Lotion 226 g Bottle,63700001,CDM,,,250,RC,00904598426,NDC,facility,both,1.99115,GR,11.48,8.13,Aetna First Health,Commercial,,9.76,85,,,5.09,9.76,percent of total billed charges,
lactulose 10 GM/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00603137858,NDC,facility,both,15,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121057716,NDC,facility,both,15,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,50383077916,NDC,facility,both,15,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121087316,NDC,facility,both,15,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00527512570,NDC,facility,both,15,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,50383070530,NDC,facility,both,30,ML,124.64,88.25,Aetna First Health,Commercial,,105.94,85,,,55.24,105.94,percent of total billed charges,
salmeterol 50 MCG/ACT Aerosol Powder Breath Activated 60 Each Inhaler,63700001,CDM,,,250,RC,00173052100,NDC,facility,inpatient,0.01667,EA,8.82,6.24,Aetna First Health,Commercial,,7.5,85,,,3.91,7.5,percent of total billed charges,
desonide 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,45802042235,NDC,facility,inpatient,1,GR,72,50.98,Aetna First Health,Commercial,,61.2,85,,,31.91,61.2,percent of total billed charges,
desonide 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,51672128001,NDC,facility,inpatient,1,GR,77.34,54.76,Aetna First Health,Commercial,,65.74,85,,,34.28,65.74,percent of total billed charges,
gabapentin 6 %-ketamine 8 %-ketoprofen 10 % 6-8-10 % 30 g Jar,63700001,CDM,,,250,RC,08888800790,NDC,facility,inpatient,1,GR,126,89.21,Aetna First Health,Commercial,,107.1,85,,,55.84,107.1,percent of total billed charges,
desonide 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,16714072901,NDC,facility,inpatient,1,GR,144.3,102.16,Aetna First Health,Commercial,,122.66,85,,,63.95,122.66,percent of total billed charges,
beclomethasone HFA 40 MCG/ACT Aerosol Breath Activated 10.6 g Inhaler,63700001,CDM,,,250,RC,59310030240,NDC,facility,inpatient,1,GR,267.12,189.12,Aetna First Health,Commercial,,227.05,85,,,118.39,227.05,percent of total billed charges,
cadexomer iodine 0.9 % Gel 40 g Tube,63700001,CDM,,,250,RC,40565012249,NDC,facility,inpatient,1,GR,342.08,242.19,Aetna First Health,Commercial,,290.77,85,,,151.61,290.77,percent of total billed charges,
brinzolamide-brimonidine 1-0.2 % Suspension 8 mL Bottle,63700001,CDM,,,250,RC,00065414727,NDC,facility,inpatient,1,ML,828.29,586.43,Aetna First Health,Commercial,,704.05,85,,,367.1,704.05,percent of total billed charges,
brinzolamide-brimonidine 1-0.2 % Suspension 8 mL Bottle,63700001,CDM,,,250,RC,00078090438,NDC,facility,inpatient,1,ML,828.29,586.43,Aetna First Health,Commercial,,704.05,85,,,367.1,704.05,percent of total billed charges,
acetaminophen 80 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,00472120001,NDC,facility,both,0.16667,UN,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084084895,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00904201159,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00904201360,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,57896092101,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00536114801,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00536123201,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00603016921,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,69618001501,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 125 Each Bottle,63700001,CDM,,,250,RC,46122059602,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 30 Each Box,63700001,CDM,,,250,RC,68084084825,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 300 Each Bottle,63700001,CDM,,,250,RC,00904201372,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 325 MG Tablet Delayed Release 750 Each Box,63700001,CDM,,,250,RC,63739052301,NDC,facility,both,0.24923,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904198860,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904198360,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904673060,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896020401,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,71399802201,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904673059,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904672059,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896020101,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904198359,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536117201,NDC,facility,both,0.65,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904198861,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50580041202,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904673061,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50580045711,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00182845389,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 150 Each Box,63700001,CDM,,,250,RC,50580045103,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00904198340,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00904672040,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,49348004214,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 700 Each Bottle,63700001,CDM,,,250,RC,50580041203,NDC,facility,both,0.65,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 500 MG Tablet 700 Each Bottle,63700001,CDM,,,250,RC,50580045770,NDC,facility,both,0.65,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen 120 MG Suppository 1 Each Blister,63700001,CDM,,,250,RC,00713011806,NDC,facility,both,1,UN,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
acetaminophen 120 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,45802073200,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 120 MG Suppository 100 Each Box,63700001,CDM,,,250,RC,45802073233,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 120 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,45802073230,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 120 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00713011812,NDC,facility,both,1,UN,0.73,0.52,Aetna First Health,Commercial,,0.62,85,,,0.32,0.62,percent of total billed charges,
acetaminophen 160 MG Tablet Chewable 24 Each Box,63700001,CDM,,,250,RC,00904664524,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Suppository 1 Each Blister,63700001,CDM,,,250,RC,51672211600,NDC,facility,both,1,UN,0.73,0.52,Aetna First Health,Commercial,,0.62,85,,,0.32,0.62,percent of total billed charges,
acetaminophen 325 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,00713016406,NDC,facility,both,1,UN,0.79,0.56,Aetna First Health,Commercial,,0.67,85,,,0.35,0.67,percent of total billed charges,
acetaminophen 325 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,00472120201,NDC,facility,both,1,UN,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
acetaminophen 325 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00713016412,NDC,facility,both,1,UN,0.79,0.56,Aetna First Health,Commercial,,0.67,85,,,0.35,0.67,percent of total billed charges,
acetaminophen 325 MG Suppository 50 Each Box,63700001,CDM,,,250,RC,51672211604,NDC,facility,both,1,UN,0.73,0.52,Aetna First Health,Commercial,,0.62,85,,,0.32,0.62,percent of total billed charges,
acetaminophen 325 MG Suppository 50 Each Box,63700001,CDM,,,250,RC,00713016450,NDC,facility,both,1,UN,0.79,0.56,Aetna First Health,Commercial,,0.67,85,,,0.35,0.67,percent of total billed charges,
acetaminophen 325 MG Suppository 6 Each Box,63700001,CDM,,,250,RC,51672211602,NDC,facility,both,1,UN,1.05,0.74,Aetna First Health,Commercial,,0.89,85,,,0.47,0.89,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904198260,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896010201,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536132701,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69618001001,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,46122039078,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,71399802401,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536322201,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896010101,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,50580050130,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 325 MG Tablet 750 Each Box,63700001,CDM,,,250,RC,63739044001,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,00713016506,NDC,facility,both,1,UN,0.86,0.61,Aetna First Health,Commercial,,0.73,85,,,0.38,0.73,percent of total billed charges,
acetaminophen 650 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,45802073000,NDC,facility,both,1,UN,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
acetaminophen 650 MG Suppository 100 Each Box,63700001,CDM,,,250,RC,45802073033,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Suppository 100 Each Box,63700001,CDM,,,250,RC,00713016501,NDC,facility,both,1,UN,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
acetaminophen 650 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,45802073030,NDC,facility,both,1,UN,0.53,0.38,Aetna First Health,Commercial,,0.45,85,,,0.23,0.45,percent of total billed charges,
acetaminophen 650 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00713016512,NDC,facility,both,1,UN,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
acetaminophen 650 MG Suppository 50 Each Box,63700001,CDM,,,250,RC,45802073032,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Suppository 50 Each Box,63700001,CDM,,,250,RC,00713016550,NDC,facility,both,1,UN,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084077795,NDC,facility,both,1,UN,1.26,0.89,Aetna First Health,Commercial,,1.07,85,,,0.56,1.07,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,50268005211,NDC,facility,both,1,UN,1.28,0.91,Aetna First Health,Commercial,,1.09,85,,,0.57,1.09,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00904576960,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,49348092410,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68001049500,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,24385062978,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00045083821,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 30 Each Box,63700001,CDM,,,250,RC,68084077725,NDC,facility,both,1,UN,1.26,0.89,Aetna First Health,Commercial,,1.07,85,,,0.56,1.07,percent of total billed charges,
acetaminophen 650 MG Tablet Extended Release 50 Each Box,63700001,CDM,,,250,RC,50268005215,NDC,facility,both,1,UN,1.28,0.91,Aetna First Health,Commercial,,1.09,85,,,0.57,1.09,percent of total billed charges,
acetaminophen 80 MG Suppository 1 Each Blister,63700001,CDM,,,250,RC,51672211400,NDC,facility,both,1,UN,1.05,0.74,Aetna First Health,Commercial,,0.89,85,,,0.47,0.89,percent of total billed charges,
acetaminophen 80 MG Suppository 6 Each Box,63700001,CDM,,,250,RC,00472120006,NDC,facility,both,1,UN,1.05,0.74,Aetna First Health,Commercial,,0.89,85,,,0.47,0.89,percent of total billed charges,
acetaminophen 80 MG Suppository 6 Each Box,63700001,CDM,,,250,RC,51672211402,NDC,facility,both,1,UN,1.05,0.74,Aetna First Health,Commercial,,0.89,85,,,0.47,0.89,percent of total billed charges,
acetaminophen 80 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,00536323307,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 80 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,00904525646,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 80 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,00904579146,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Acetaminophen Childrens 160 MG Tablet Chewable 24 Each Box,63700001,CDM,,,250,RC,00904664524,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079016101,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084037211,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406048423,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687060411,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406048401,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162003310,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093015001,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406048462,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079016120,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739000410,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 300-30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687060401,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aspirin 300 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00574703412,NDC,facility,both,1,UN,1.75,1.24,Aetna First Health,Commercial,,1.49,85,,,0.78,1.49,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00113041678,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904200960,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49348000110,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896090101,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536105301,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536105429,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904674460,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,12843053635,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536330501,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904201959,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,46122069178,NDC,facility,both,1,UN,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aspirin 325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00536105305,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 325 MG Tablet 500 Each Box,63700001,CDM,,,250,RC,66553000101,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,48433012901,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,63739043402,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,00904404073,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,49348075707,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,57896091136,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,49348049807,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,00536100836,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,24385002868,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,87701079215,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,12843013105,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 36 Each Bottle,63700001,CDM,,,250,RC,49348019107,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 500 Each Disp Pack,63700001,CDM,,,250,RC,66553000201,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 750 Each Box,63700001,CDM,,,250,RC,63739043401,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 90 Each Bottle,63700001,CDM,,,250,RC,00904628889,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin 81 MG Tablet Chewable 90 Each Bottle,63700001,CDM,,,250,RC,00904679489,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,57896098101,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,63739052210,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,63739021210,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,10135017362,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,49483048112,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,69618004602,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,00536123441,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,10135068962,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,00904770418,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,00904671318,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,00603002622,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,49483038712,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,00536100441,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,50804088001,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,71399862702,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,16526001001,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,46122059848,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 250 Each Bottle,63700001,CDM,,,250,RC,00904678370,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 250 Each Bottle,63700001,CDM,,,250,RC,00904770470,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 30 Each Box,63700001,CDM,,,250,RC,63739021202,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 300 Each Bottle,63700001,CDM,,,250,RC,46122061587,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 750 Each Box,63700001,CDM,,,250,RC,63739052201,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin EC 81 MG Tablet Delayed Release 750 Each Box,63700001,CDM,,,250,RC,63739021201,NDC,facility,both,1,UN,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
testosterone 50 MG/5GM (1%) Gel 5 g Box,63700001,CDM,,,250,RC,21922001902,NDC,facility,both,0.005,GM,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
testosterone 50 MG/5GM (1%) Gel 5 g Box,63700001,CDM,,,250,RC,00051845030,NDC,facility,both,0.005,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
testosterone 50 MG/5GM (1%) Gel 5 g Tube,63700001,CDM,,,250,RC,66887000105,NDC,facility,both,0.005,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
testosterone 50 MG/5GM (1%) Gel 5 g Package,63700001,CDM,,,250,RC,00051845001,NDC,facility,both,0.005,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
testosterone 50 MG/5GM (1%) Gel 5 g Package,63700001,CDM,,,250,RC,49884051063,NDC,facility,both,0.005,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
testosterone 50 MG/5GM (1%) Gel 5 g Package,63700001,CDM,,,250,RC,00591321730,NDC,facility,both,0.005,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
testosterone 50 MG/5GM (1%) Gel 5 g Package,63700001,CDM,,,250,RC,00591321726,NDC,facility,both,0.005,GM,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
methadone 5 MG/5ML Solution 5 mL Syringe,63700001,CDM,,,250,RC,08888800006,NDC,facility,both,0.005,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,00054372763,NDC,facility,both,0.005,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,00054022463,NDC,facility,both,0.005,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ritonavir 80 MG/ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,00074194063,NDC,facility,both,0.00521,ML,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00904005316,NDC,facility,both,0.00529,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
trihexyphenidyl 0.4 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121065816,NDC,facility,both,0.00529,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 0.4 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,61748005416,NDC,facility,both,0.00529,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 mg/5 mL Solution 473 mL Bottle,63700001,CDM,,,250,RC,54838051080,NDC,facility,both,0.00529,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 mg/5 mL Solution 473 mL Bottle,63700001,CDM,,,250,RC,60432009216,NDC,facility,both,0.00529,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine-codeine 6.25-10 MG/5ML Syrup 5 mL Syringe,63700001,CDM,,,250,RC,08888800466,NDC,facility,both,0.00529,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine sodium 20 mcg/mL 100 MCG/5ML Solution 100 mL Bottle,63700001,CDM,,,250,RC,52652195002,NDC,facility,both,0.00625,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine sodium 20 mcg/mL 100 MCG/5ML Solution 100 mL Bottle,63700001,CDM,,,250,RC,52652195001,NDC,facility,both,0.00625,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG/ML Concentrate 0.5 mL Syringe,63700001,CDM,,,250,RC,08888800364,NDC,facility,both,0.00833,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 10 MG/0.5ML Concentrate 1 mL Syringe,63700001,CDM,,,250,RC,88888800008,NDC,facility,both,0.00833,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 100 MG/5ML Concentrate 0.5 mL Syringe,63700001,CDM,,,250,RC,08888800788,NDC,facility,both,0.00833,ML,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,60432053716,NDC,facility,both,0.00846,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,50383058716,NDC,facility,both,0.00846,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00603148158,NDC,facility,both,0.00846,ML,3.43,2.43,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
nitroglycerin 0.3 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,00071041724,NDC,facility,both,0.01,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,59762330401,NDC,facility,both,0.01,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,00071041824,NDC,facility,both,0.01,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
calcium carbonate 1250 MG/5ML Suspension 500 mL Bottle,63700001,CDM,,,250,RC,00054311763,NDC,facility,both,0.01,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pediatric multivitamin with iron 11 MG/ML Solution 50 mL Bottle,63700001,CDM,,,250,RC,00087040501,NDC,facility,both,0.01,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pediatric multivitamin Solution 50 mL Bottle,63700001,CDM,,,250,RC,00087040203,NDC,facility,both,0.01,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meperidine 50 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,00054354563,NDC,facility,both,0.01,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,00054052363,NDC,facility,both,0.01,ML,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 480 mL Bottle,63700001,CDM,,,250,RC,66213042316,NDC,facility,both,0.01042,ML,31.47,22.28,Aetna First Health,Commercial,,26.75,85,,,13.95,26.75,percent of total billed charges,
ethosuximide 250 MG/5ML Solution 474 mL Bottle,63700001,CDM,,,250,RC,59762235007,NDC,facility,both,0.01055,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethosuximide 250 MG/5ML Solution 474 mL Bottle,63700001,CDM,,,250,RC,59762235006,NDC,facility,both,0.01055,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
baclofen 10 MG/5ML Solution 237 mL Bottle,63700001,CDM,,,250,RC,52817062008,NDC,facility,both,0.01055,ML,24.42,17.29,Aetna First Health,Commercial,,20.76,85,,,10.82,20.76,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 473 mL Bottle,63700001,CDM,,,250,RC,50383077116,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00536247085,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00904078816,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,57896064916,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,49348017138,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 473 mL Bottle,63700001,CDM,,,250,RC,24385046843,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 473 mL Bottle,63700001,CDM,,,250,RC,54838011680,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 473 mL Bottle,63700001,CDM,,,250,RC,57896040316,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 473 mL Bottle,63700001,CDM,,,250,RC,00536130485,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121077516,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum hydroxide 320 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00536009185,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 1250 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00121076616,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,69543025216,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00574001816,NDC,facility,both,0.01057,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00603107558,NDC,facility,both,0.01057,ML,0.57,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
cyproheptadine 2 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,64980050448,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 2 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00472140016,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 2 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,66689033316,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 473 mL Bottle,63700001,CDM,,,250,RC,00121093516,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
albuterol 2 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,50383074016,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,31722068147,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 2 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00527194947,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
albuterol 2 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00472082516,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 473 mL Bottle,63700001,CDM,,,250,RC,13925015816,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 120-12 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,50383007916,NDC,facility,both,0.01057,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,70954018810,NDC,facility,both,0.01057,ML,3.22,2.28,Aetna First Health,Commercial,,2.74,85,,,1.43,2.74,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,64376064016,NDC,facility,both,0.01057,ML,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
ethosuximide 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121067016,NDC,facility,both,0.01057,ML,6.93,4.91,Aetna First Health,Commercial,,5.89,85,,,3.07,5.89,percent of total billed charges,
ethosuximide 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,61748002416,NDC,facility,both,0.01057,ML,6.95,4.92,Aetna First Health,Commercial,,5.91,85,,,3.08,5.91,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,64950037316,NDC,facility,both,0.01057,ML,7.21,5.1,Aetna First Health,Commercial,,6.13,85,,,3.2,6.13,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,08888800756,NDC,facility,both,0.01057,ML,7.21,5.1,Aetna First Health,Commercial,,6.13,85,,,3.2,6.13,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 5 mL Syringe,63700001,CDM,,,250,RC,08888800003,NDC,facility,both,0.01057,ML,12.69,8.98,Aetna First Health,Commercial,,10.79,85,,,5.62,10.79,percent of total billed charges,
acyclovir 200 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00472008216,NDC,facility,both,0.01057,ML,13.18,9.33,Aetna First Health,Commercial,,11.2,85,,,5.84,11.2,percent of total billed charges,
acyclovir 200 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,50383081016,NDC,facility,both,0.01057,ML,13.18,9.33,Aetna First Health,Commercial,,11.2,85,,,5.84,11.2,percent of total billed charges,
acyclovir 200 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00378871273,NDC,facility,both,0.01057,ML,13.18,9.33,Aetna First Health,Commercial,,11.2,85,,,5.84,11.2,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.15-0.03 &0.01 MG Tablet 91 Each Disp Pack,63700001,CDM,,,250,RC,68180084611,NDC,facility,both,0.01099,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levonorgestrel-ethinyl estradiol 0.15-0.03 &0.01 MG Tablet 91 Each Disp Pack,63700001,CDM,,,250,RC,68180084613,NDC,facility,both,0.01099,EA,8.26,5.85,Aetna First Health,Commercial,,7.02,85,,,3.66,7.02,percent of total billed charges,
cephALEXin 250 MG/5ML Recon Susp 200 mL Bottle,63700001,CDM,,,250,RC,68180012402,NDC,facility,both,0.0125,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG/5ML Recon Susp 200 mL Bottle,63700001,CDM,,,250,RC,68180044102,NDC,facility,both,0.0125,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
diazePAM 5 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00054318544,NDC,facility,both,0.01333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00527176836,NDC,facility,both,0.01333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,62135076843,NDC,facility,both,0.01333,ML,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
magnesium carbonate 54 MG/5ML Liquid 355 mL Bottle,63700001,CDM,,,250,RC,00187526701,NDC,facility,both,0.01408,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,46122043740,NDC,facility,both,0.01408,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,00904078814,NDC,facility,both,0.01408,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium carbonate 54 MG/5ML Liquid 355 mL Bottle,63700001,CDM,,,250,RC,24208050912,NDC,facility,both,0.01408,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG/5ML Recon Susp 200 mL Bottle,63700001,CDM,,,250,RC,00093417774,NDC,facility,both,0.015,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
opium 10 MG/ML (1%) Tincture 1.8 mL Syringe,63700001,CDM,,,250,RC,88887800086,NDC,facility,both,0.01525,ML,24.03,17.01,Aetna First Health,Commercial,,20.43,85,,,10.65,20.43,percent of total billed charges,
omega-3 fatty acids Liquid 200 mL Bottle,63700001,CDM,,,250,RC,88395001540,NDC,facility,both,0.01563,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
lactulose 10 GM/15ML Solution 946 mL Bottle,63700001,CDM,,,250,RC,60432003732,NDC,facility,both,0.01586,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 946 mL Bottle,63700001,CDM,,,250,RC,00121087332,NDC,facility,both,0.01586,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 946 mL Bottle,63700001,CDM,,,250,RC,00603137859,NDC,facility,both,0.01586,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 946 mL Bottle,63700001,CDM,,,250,RC,50383077932,NDC,facility,both,0.01586,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 946 mL Bottle,63700001,CDM,,,250,RC,45963043965,NDC,facility,both,0.01586,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluticasone-umeclidin-vilant 100-62.5-25 MCG/ACT Aerosol Powder Breath Activated 60 Each Disp Pack,63700001,CDM,,,250,RC,00173088710,NDC,facility,both,0.01667,EA,12.54,8.88,Aetna First Health,Commercial,,10.66,85,,,5.56,10.66,percent of total billed charges,
nitroglycerin 2 % Ointment 30 g Tube,63700001,CDM,,,250,RC,00281032630,NDC,facility,both,0.01667,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
morphine 20 mg/mL Solution 30 mL Bottle,63700001,CDM,,,250,RC,00406800330,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 30 mL Bottle,63700001,CDM,,,250,RC,00054040444,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 30 mL Bottle,63700001,CDM,,,250,RC,00574015330,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 30 mL Bottle,63700001,CDM,,,250,RC,27808008201,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG/ML Solution 30 mL Bottle,63700001,CDM,,,250,RC,00054006344,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 30 mL Bottle,63700001,CDM,,,250,RC,00054051744,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG/ML Concentrate 1 mL Syringe,63700001,CDM,,,250,RC,88888800005,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG/ML Solution 30 mL Bottle,63700001,CDM,,,250,RC,65162067384,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG/ML Concentrate 15 mL Bottle,63700001,CDM,,,250,RC,00121058115,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 30 mL Bottle,63700001,CDM,,,250,RC,00527142536,NDC,facility,both,0.01667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG/ML Solution 30 mL Bottle,63700001,CDM,,,250,RC,50458059601,NDC,facility,both,0.01667,ML,7.1,5.03,Aetna First Health,Commercial,,6.03,85,,,3.15,6.03,percent of total billed charges,
calcitRIOL 1 MCG/ML Solution 15 mL Bottle,63700001,CDM,,,250,RC,63304024159,NDC,facility,both,0.01667,ML,7.94,5.62,Aetna First Health,Commercial,,6.75,85,,,3.52,6.75,percent of total billed charges,
calcitRIOL 1 MCG/ML Solution 15 mL Bottle,63700001,CDM,,,250,RC,00054312041,NDC,facility,both,0.01667,ML,8.35,5.91,Aetna First Health,Commercial,,7.1,85,,,3.7,7.1,percent of total billed charges,
vancomycin 25 MG/ML Recon Soln 300 mL Bottle,63700001,CDM,,,250,RC,52536010710,NDC,facility,both,0.01667,ML,8.84,6.26,Aetna First Health,Commercial,,7.51,85,,,3.92,7.51,percent of total billed charges,
vancomycin 25 MG/ML Recon Soln 300 mL Bottle,63700001,CDM,,,250,RC,52536009510,NDC,facility,both,0.01667,ML,8.84,6.26,Aetna First Health,Commercial,,7.51,85,,,3.92,7.51,percent of total billed charges,
vancomycin 25 MG/ML Recon Soln 300 mL Bottle,63700001,CDM,,,250,RC,65628020510,NDC,facility,both,0.01667,ML,9.73,6.89,Aetna First Health,Commercial,,8.27,85,,,4.31,8.27,percent of total billed charges,
risperiDONE 1 MG/ML Solution 30 mL Bottle,63700001,CDM,,,250,RC,27808000201,NDC,facility,both,0.01667,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
morphine 20 mg/mL Solution 30 mL Bottle,63700001,CDM,,,250,RC,50383096530,NDC,facility,both,0.01667,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
risperiDONE 1 MG/ML Solution 30 mL Bottle,63700001,CDM,,,250,RC,50458030503,NDC,facility,both,0.01667,ML,16.07,11.38,Aetna First Health,Commercial,,13.66,85,,,7.12,13.66,percent of total billed charges,
calcitRIOL 1 MCG/ML Solution 15 mL Bottle,63700001,CDM,,,250,RC,64980044715,NDC,facility,both,0.01667,ML,23.33,16.52,Aetna First Health,Commercial,,19.83,85,,,10.34,19.83,percent of total billed charges,
dextromethorphan ER 30 MG/5ML Suspension Extended Release 148 mL Bottle,63700001,CDM,,,250,RC,63824017565,NDC,facility,both,0.01689,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan ER 30 MG/5ML Suspension Extended Release 148 mL Bottle,63700001,CDM,,,250,RC,46122014125,NDC,facility,both,0.01689,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 1 MG/ML Liquid 59 mL Bottle,63700001,CDM,,,250,RC,30768016836,NDC,facility,both,0.01695,ML,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
vitamin D3 (cholecalciferol) 10 mcg/mL (400 units/mL) Liquid 50 mL Bottle,63700001,CDM,,,250,RC,50383091750,NDC,facility,both,0.02,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D3 (cholecalciferol) 10 mcg/mL (400 units/mL) Liquid 50 mL Bottle,63700001,CDM,,,250,RC,69618001959,NDC,facility,both,0.02,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D3 (cholecalciferol) 10 mcg/mL (400 units/mL) Liquid 50 mL Bottle,63700001,CDM,,,250,RC,00536840080,NDC,facility,both,0.02,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 6.75 mg/0.3 mL (15 units/0.3 mL) Solution 30 mL Bottle,63700001,CDM,,,250,RC,54838000530,NDC,facility,both,0.02,ML,0.82,0.58,Aetna First Health,Commercial,,0.7,85,,,0.36,0.7,percent of total billed charges,
vitamin E 6.75 mg/0.3 mL (15 units/0.3 mL) Solution 30 mL Bottle,63700001,CDM,,,250,RC,71321080230,NDC,facility,both,0.02,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetic acid 5 % Solution 50 mL Bottle,63700001,CDM,,,250,RC,51552005503,NDC,facility,both,0.02,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
naproxen 125 MG/5ML Suspension 500 mL Bottle,63700001,CDM,,,250,RC,70954015110,NDC,facility,both,0.02,ML,15.68,11.1,Aetna First Health,Commercial,,13.33,85,,,6.95,13.33,percent of total billed charges,
naproxen 125 MG/5ML Suspension 500 mL Bottle,63700001,CDM,,,250,RC,68134020116,NDC,facility,both,0.02,ML,32.87,23.27,Aetna First Health,Commercial,,27.94,85,,,14.57,27.94,percent of total billed charges,
cetirizine 1 MG/ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,51672407008,NDC,facility,both,0.02083,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 1 MG/ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,51672210208,NDC,facility,both,0.02083,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 1 MG/ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,46122020326,NDC,facility,both,0.02083,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 1 MG/ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,00093630012,NDC,facility,both,0.02083,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cetirizine 1 MG/ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,45802062626,NDC,facility,both,0.02083,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cetirizine 1 MG/ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,51991083704,NDC,facility,both,0.02083,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 20 MG/ML Concentrate 60 mL Bottle,63700001,CDM,,,250,RC,71093014311,NDC,facility,both,0.02083,ML,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
sertraline 20 MG/ML Concentrate 60 mL Bottle,63700001,CDM,,,250,RC,64980040906,NDC,facility,both,0.02083,ML,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
sertraline 20 MG/ML Concentrate 60 mL Bottle,63700001,CDM,,,250,RC,16714060102,NDC,facility,both,0.02083,ML,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
sertraline 20 MG/ML Concentrate 60 mL Bottle,63700001,CDM,,,250,RC,59762494001,NDC,facility,both,0.02083,ML,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
citalopram 10 MG/5ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,00054006258,NDC,facility,both,0.02083,ML,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
sertraline 20 MG/ML Concentrate 60 mL Bottle,63700001,CDM,,,250,RC,59762006701,NDC,facility,both,0.02083,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
citalopram 10 MG/5ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,54838054070,NDC,facility,both,0.02083,ML,10.59,7.5,Aetna First Health,Commercial,,9,85,,,4.69,9,percent of total billed charges,
felbamate 600 MG/5ML Suspension 240 mL Bottle,63700001,CDM,,,250,RC,65162068688,NDC,facility,both,0.02083,ML,37.43,26.5,Aetna First Health,Commercial,,31.82,85,,,16.59,31.82,percent of total billed charges,
levoFLOXacin 25 MG/ML Solution 480 mL Bottle,63700001,CDM,,,250,RC,50383028616,NDC,facility,both,0.02083,ML,44.2,31.29,Aetna First Health,Commercial,,37.57,85,,,19.59,37.57,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 237 mL Bottle,63700001,CDM,,,250,RC,59390012541,NDC,facility,both,0.0211,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 237 mL Bottle,63700001,CDM,,,250,RC,57896045208,NDC,facility,both,0.0211,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 237 mL Bottle,63700001,CDM,,,250,RC,00536127559,NDC,facility,both,0.0211,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 237 mL Bottle,63700001,CDM,,,250,RC,00904628909,NDC,facility,both,0.0211,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 237 mL Bottle,63700001,CDM,,,250,RC,71399823708,NDC,facility,both,0.0211,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorothiazide 250 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,65649031112,NDC,facility,both,0.0211,ML,5.09,3.6,Aetna First Health,Commercial,,4.33,85,,,2.26,4.33,percent of total billed charges,
felbamate 600 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,70954005110,NDC,facility,both,0.0211,ML,7.72,5.47,Aetna First Health,Commercial,,6.56,85,,,3.42,6.56,percent of total billed charges,
felbamate 600 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,51525044208,NDC,facility,both,0.0211,ML,37.52,26.56,Aetna First Health,Commercial,,31.89,85,,,16.63,31.89,percent of total billed charges,
felbamate 600 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,00037044267,NDC,facility,both,0.0211,ML,133.4,94.45,Aetna First Health,Commercial,,113.39,85,,,59.12,113.39,percent of total billed charges,
calcium acetate 667 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,49230064331,NDC,facility,both,0.02114,ML,12.64,8.95,Aetna First Health,Commercial,,10.74,85,,,5.6,10.74,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 236 mL Bottle,63700001,CDM,,,250,RC,54162000708,NDC,facility,both,0.02119,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 118 mL Bottle,63700001,CDM,,,250,RC,54838020940,NDC,facility,both,0.02119,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 1 MG/ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,00045020504,NDC,facility,both,0.02119,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 1 MG/ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,70677001401,NDC,facility,both,0.02119,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 1 MG/ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,70752010406,NDC,facility,both,0.02119,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 118 mL Bottle,63700001,CDM,,,250,RC,00536097097,NDC,facility,both,0.02119,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen-codeine 120-12 MG/5ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,00121050404,NDC,facility,both,0.02119,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine-codeine 6.25-10 MG/5ML Syrup 118 mL Bottle,63700001,CDM,,,250,RC,00603158554,NDC,facility,both,0.02119,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
magnesium sulfate granules Granules 454 g Box,63700001,CDM,,,250,RC,70677003801,NDC,facility,both,0.02203,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 420 mL Bottle,63700001,CDM,,,250,RC,00254101196,NDC,facility,both,0.02381,ML,14.67,10.39,Aetna First Health,Commercial,,12.47,85,,,6.5,12.47,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 420 mL Bottle,63700001,CDM,,,250,RC,58914017014,NDC,facility,both,0.02381,ML,22.26,15.76,Aetna First Health,Commercial,,18.92,85,,,9.87,18.92,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 210 mL Bottle,63700001,CDM,,,250,RC,70748029901,NDC,facility,both,0.02381,ML,33.34,23.6,Aetna First Health,Commercial,,28.34,85,,,14.78,28.34,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 210 mL Bottle,63700001,CDM,,,250,RC,31722062921,NDC,facility,both,0.02381,ML,33.34,23.6,Aetna First Health,Commercial,,28.34,85,,,14.78,28.34,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 210 mL Bottle,63700001,CDM,,,250,RC,68462042121,NDC,facility,both,0.02381,ML,33.34,23.6,Aetna First Health,Commercial,,28.34,85,,,14.78,28.34,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 210 mL Bottle,63700001,CDM,,,250,RC,65162069388,NDC,facility,both,0.02381,ML,71.66,50.74,Aetna First Health,Commercial,,60.91,85,,,31.76,60.91,percent of total billed charges,
Posaconazole 40 MG/ML Suspension 105 mL Bottle,63700001,CDM,,,250,RC,00085132801,NDC,facility,both,0.02381,ML,93.91,66.49,Aetna First Health,Commercial,,79.82,85,,,41.62,79.82,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 210 mL Bottle,63700001,CDM,,,250,RC,66993006272,NDC,facility,both,0.02381,ML,95.71,67.76,Aetna First Health,Commercial,,81.35,85,,,42.42,81.35,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 210 mL Bottle,63700001,CDM,,,250,RC,00173066518,NDC,facility,both,0.02381,ML,125.49,88.85,Aetna First Health,Commercial,,106.67,85,,,55.62,106.67,percent of total billed charges,
cephALEXin 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00093417773,NDC,facility,both,0.025,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,68180012401,NDC,facility,both,0.025,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,68180044101,NDC,facility,both,0.025,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG/5ML Recon Soln 200 mL Bottle,63700001,CDM,,,250,RC,00093412774,NDC,facility,both,0.025,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG/5ML Recon Soln 200 mL Bottle,63700001,CDM,,,250,RC,67253020320,NDC,facility,both,0.025,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin V potassium 125 MG/5ML Recon Soln 200 mL Bottle,63700001,CDM,,,250,RC,00093412574,NDC,facility,both,0.025,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,67877054588,NDC,facility,both,0.025,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG/5ML (10%) Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,68180039301,NDC,facility,both,0.025,ML,9.99,7.07,Aetna First Health,Commercial,,8.49,85,,,4.43,8.49,percent of total billed charges,
ciprofloxacin 500 MG/5ML (10%) Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,50419077301,NDC,facility,both,0.025,ML,11.56,8.18,Aetna First Health,Commercial,,9.83,85,,,5.12,9.83,percent of total billed charges,
nortriptyline 10 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121067816,NDC,facility,both,0.02643,ML,10.98,7.77,Aetna First Health,Commercial,,9.33,85,,,4.87,9.33,percent of total billed charges,
dextromethorphan ER 30 MG/5ML Suspension Extended Release 89 mL Bottle,63700001,CDM,,,250,RC,53014046361,NDC,facility,both,0.02809,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan ER 30 MG/5ML Suspension Extended Release 89 mL Bottle,63700001,CDM,,,250,RC,63824017163,NDC,facility,both,0.02809,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan ER 30 MG/5ML Suspension Extended Release 89 mL Bottle,63700001,CDM,,,250,RC,63824017563,NDC,facility,both,0.02809,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan ER 30 MG/5ML Suspension Extended Release 89 mL Bottle,63700001,CDM,,,250,RC,45802043321,NDC,facility,both,0.02809,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan ER 30 MG/5ML Suspension Extended Release 89 mL Bottle,63700001,CDM,,,250,RC,00904631256,NDC,facility,both,0.02809,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,00054348663,NDC,facility,both,0.03,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mineral oil heavy Oil 480 mL Bottle,63700001,CDM,,,250,RC,37205083143,NDC,facility,both,0.03125,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00143988701,NDC,facility,both,0.03125,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,65862007101,NDC,facility,both,0.03125,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 1 mg/7.5 mL Solution 240 mL Bottle,63700001,CDM,,,250,RC,00045013408,NDC,facility,both,0.03125,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00781615746,NDC,facility,both,0.03125,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lopinavir-ritonavir 400-100 MG/5ML Solution 160 mL Bottle,63700001,CDM,,,250,RC,00527194748,NDC,facility,both,0.03125,ML,42.32,29.96,Aetna First Health,Commercial,,35.97,85,,,18.76,35.97,percent of total billed charges,
lopinavir-ritonavir 400-100 MG/5ML Solution 160 mL Bottle,63700001,CDM,,,250,RC,00074395646,NDC,facility,both,0.03125,ML,47.16,33.39,Aetna First Health,Commercial,,40.09,85,,,20.9,40.09,percent of total billed charges,
sorbitol 70 % Solution 474 mL Bottle,63700001,CDM,,,250,RC,54162070016,NDC,facility,both,0.03165,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sorbitol 70 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,46287050001,NDC,facility,both,0.03171,ML,0.52,0.37,Aetna First Health,Commercial,,0.44,85,,,0.23,0.44,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,60258000116,NDC,facility,both,0.03171,ML,1.71,1.21,Aetna First Health,Commercial,,1.45,85,,,0.76,1.45,percent of total billed charges,
potassium citrate-citric acid 1100-334 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,60258000316,NDC,facility,both,0.03171,ML,2.97,2.1,Aetna First Health,Commercial,,2.52,85,,,1.32,2.52,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121059516,NDC,facility,both,0.03171,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 473 mL Bottle,63700001,CDM,,,250,RC,00904100716,NDC,facility,both,0.03171,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 15 mL Syringe,63700001,CDM,,,250,RC,08888800180,NDC,facility,both,0.03171,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121168016,NDC,facility,both,0.03171,ML,3.26,2.31,Aetna First Health,Commercial,,2.77,85,,,1.44,2.77,percent of total billed charges,
potassium citrate-citric acid 1100-334 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121067616,NDC,facility,both,0.03171,ML,3.94,2.79,Aetna First Health,Commercial,,3.35,85,,,1.75,3.35,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,58657031016,NDC,facility,both,0.03171,ML,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 473 mL Bottle,63700001,CDM,,,250,RC,00603153558,NDC,facility,both,0.03171,ML,4.67,3.31,Aetna First Health,Commercial,,3.97,85,,,2.07,3.97,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 473 mL Bottle,63700001,CDM,,,250,RC,16571030316,NDC,facility,both,0.03171,ML,4.67,3.31,Aetna First Health,Commercial,,3.97,85,,,2.07,3.97,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 473 mL Bottle,63700001,CDM,,,250,RC,69238145902,NDC,facility,both,0.03171,ML,6.41,4.54,Aetna First Health,Commercial,,5.45,85,,,2.84,5.45,percent of total billed charges,
potassium citrate-citric acid 1100-334 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,58657031216,NDC,facility,both,0.03171,ML,6.93,4.91,Aetna First Health,Commercial,,5.89,85,,,3.07,5.89,percent of total billed charges,
chlorhexidine 0.12 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00116200116,NDC,facility,both,0.03171,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
potassium & sodium citrate-citric acid 550-500-334 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,58657031116,NDC,facility,both,0.03171,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 473 mL Bottle,63700001,CDM,,,250,RC,00603154258,NDC,facility,both,0.03171,ML,20.53,14.54,Aetna First Health,Commercial,,17.45,85,,,9.1,17.45,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 473 mL Bottle,63700001,CDM,,,250,RC,60505618406,NDC,facility,both,0.03171,ML,20.53,14.54,Aetna First Health,Commercial,,17.45,85,,,9.1,17.45,percent of total billed charges,
tiotropium 18 MCG capsule 30 Each Box,63700001,CDM,,,250,RC,00597007541,NDC,facility,both,0.03333,EA,68.27,48.34,Aetna First Health,Commercial,,58.03,85,,,30.26,58.03,percent of total billed charges,
melatonin 1 MG/ML Liquid 30 mL Bottle,63700001,CDM,,,250,RC,58438000571,NDC,facility,both,0.03333,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
morphine 20 mg/mL Solution 15 mL Bottle,63700001,CDM,,,250,RC,00406800315,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,08888800007,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 1 mL Syringe,63700001,CDM,,,250,RC,08888800091,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 0.25 mL Syringe,63700001,CDM,,,250,RC,08888800612,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,00093415580,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,00781604155,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,00143988915,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,65862070755,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 2.5 MG/5ML Elixir 60 mL Bottle,63700001,CDM,,,250,RC,00121065402,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 15 mL Bottle,63700001,CDM,,,250,RC,00054040441,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 125 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,00143988815,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 20 mg/mL Solution 15 mL Bottle,63700001,CDM,,,250,RC,00054051741,NDC,facility,both,0.03333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 50 MG/ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,65628020205,NDC,facility,both,0.03333,ML,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
oxyCODONE 100 MG/5ML Concentrate 1 mL Syringe,63700001,CDM,,,250,RC,08888800008,NDC,facility,both,0.03333,ML,12.83,9.08,Aetna First Health,Commercial,,10.91,85,,,5.69,10.91,percent of total billed charges,
vancomycin 25 MG/ML Recon Soln 150 mL Bottle,63700001,CDM,,,250,RC,65628020405,NDC,facility,both,0.03333,ML,14.39,10.19,Aetna First Health,Commercial,,12.23,85,,,6.38,12.23,percent of total billed charges,
omeprazole 2 MG/ML Suspension 300 mL Bottle,63700001,CDM,,,250,RC,65628007010,NDC,facility,both,0.03333,ML,15.75,11.15,Aetna First Health,Commercial,,13.39,85,,,6.98,13.39,percent of total billed charges,
omeprazole-sodium bicarbonate 2-84 MG/ML Recon Susp 300 mL Bottle,63700001,CDM,,,250,RC,65628027210,NDC,facility,both,0.03333,ML,40.85,28.92,Aetna First Health,Commercial,,34.72,85,,,18.1,34.72,percent of total billed charges,
zonisamide 100 MG/5ML Suspension 150 mL Bottle,63700001,CDM,,,250,RC,52652800101,NDC,facility,both,0.03333,ML,43.28,30.64,Aetna First Health,Commercial,,36.79,85,,,19.18,36.79,percent of total billed charges,
voriconazole 40 MG/ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,00049316044,NDC,facility,both,0.03333,ML,59.81,42.35,Aetna First Health,Commercial,,50.84,85,,,26.51,50.84,percent of total billed charges,
voriconazole 40 MG/ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,65162091322,NDC,facility,both,0.03333,ML,93.57,66.25,Aetna First Health,Commercial,,79.53,85,,,41.47,79.53,percent of total billed charges,
voriconazole 40 MG/ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,00378627045,NDC,facility,both,0.03333,ML,98.5,69.74,Aetna First Health,Commercial,,83.72,85,,,43.66,83.72,percent of total billed charges,
voriconazole 40 MG/ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,59762093503,NDC,facility,both,0.03333,ML,98.5,69.74,Aetna First Health,Commercial,,83.72,85,,,43.66,83.72,percent of total billed charges,
voriconazole 40 MG/ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,43386003860,NDC,facility,both,0.03333,ML,98.5,69.74,Aetna First Health,Commercial,,83.72,85,,,43.66,83.72,percent of total billed charges,
protein Liquid 887 mL Bottle,63700001,CDM,,,250,RC,26974041007,NDC,facility,both,0.03382,ML,1.22,0.86,Aetna First Health,Commercial,,1.04,85,,,0.54,1.04,percent of total billed charges,
desogestrel-ethinyl estradiol 0.15-0.02/0.01 MG (21/5) Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00378729653,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desogestrel-ethinyl estradiol 0.15-0.02/0.01 MG (21/5) Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00378729685,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desogestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,16714046401,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desogestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,68180089113,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desogestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,70700011385,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desogestrel-ethinyl estradiol 0.15-30 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,68180089171,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,68462072084,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,68180088671,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,31722093432,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,31722093428,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00093542328,NDC,facility,both,0.03571,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00093542362,NDC,facility,both,0.03571,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,50419040503,NDC,facility,both,0.03571,EA,13.42,9.5,Aetna First Health,Commercial,,11.41,85,,,5.95,11.41,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.02 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,50419040501,NDC,facility,both,0.03571,EA,21.42,15.17,Aetna First Health,Commercial,,18.21,85,,,9.49,18.21,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.03 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00555913179,NDC,facility,both,0.03571,EA,6.9,4.89,Aetna First Health,Commercial,,5.86,85,,,3.06,5.86,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.03 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,50419040203,NDC,facility,both,0.03571,EA,13.42,9.5,Aetna First Health,Commercial,,11.41,85,,,5.95,11.41,percent of total billed charges,
drospirenone-ethinyl estradiol 3-0.03 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,50419040201,NDC,facility,both,0.03571,EA,16.1,11.4,Aetna First Health,Commercial,,13.68,85,,,7.14,13.68,percent of total billed charges,
norethindrone 0.35 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00378729253,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norethindrone 0.35 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00378729285,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norethindrone 0.35 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,52544089228,NDC,facility,both,0.03571,EA,3.11,2.2,Aetna First Health,Commercial,,2.64,85,,,1.38,2.64,percent of total billed charges,
norethindrone-ethinyl estradiol 1-20 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00378728385,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norethindrone-ethinyl estradiol 1-35 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00555901079,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-25 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,68462071984,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-25 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,70700012085,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-25 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,50102023111,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-25 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,50102023113,NDC,facility,both,0.03571,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norgestimate-ethinyl estradiol 0.18/0.215/0.25 MG-25 MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,52544008741,NDC,facility,both,0.03571,EA,3.26,2.31,Aetna First Health,Commercial,,2.77,85,,,1.44,2.77,percent of total billed charges,
dexAMETHasone 6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687072911,NDC,facility,both,0.04167,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 6 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054818325,NDC,facility,both,0.04167,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,00713052606,NDC,facility,both,0.04167,EA,19.5,13.81,Aetna First Health,Commercial,,16.58,85,,,8.64,16.58,percent of total billed charges,
loratadine 5 mg/5 mL Solution 120 mL Bottle,63700001,CDM,,,250,RC,54838055840,NDC,facility,both,0.04167,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,58657050004,NDC,facility,both,0.04167,ML,0.67,0.47,Aetna First Health,Commercial,,0.57,85,,,0.3,0.57,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,00781615757,NDC,facility,both,0.04167,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 1 MG/5ML Liquid 120 mL Bottle,63700001,CDM,,,250,RC,37205037726,NDC,facility,both,0.04167,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zidovudine 10 MG/ML Syrup 240 mL Bottle,63700001,CDM,,,250,RC,65862004824,NDC,facility,both,0.04167,ML,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,00143988775,NDC,facility,both,0.04167,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
baclofen 1 MG/ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,65628010004,NDC,facility,both,0.04167,ML,14.58,10.32,Aetna First Health,Commercial,,12.39,85,,,6.46,12.39,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 120 mL Bottle,63700001,CDM,,,250,RC,66213042204,NDC,facility,both,0.04167,ML,31.47,22.28,Aetna First Health,Commercial,,26.75,85,,,13.95,26.75,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 120 mL Bottle,63700001,CDM,,,250,RC,66213042304,NDC,facility,both,0.04167,ML,31.47,22.28,Aetna First Health,Commercial,,26.75,85,,,13.95,26.75,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 120 mL Bottle,63700001,CDM,,,250,RC,59212042204,NDC,facility,both,0.04167,ML,72.49,51.32,Aetna First Health,Commercial,,61.62,85,,,32.13,61.62,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 120 mL Bottle,63700001,CDM,,,250,RC,59212042304,NDC,facility,both,0.04167,ML,72.49,51.32,Aetna First Health,Commercial,,61.62,85,,,32.13,61.62,percent of total billed charges,
nitrofurantoin 25 MG/5ML Suspension 240 mL Bottle,63700001,CDM,,,250,RC,70408023932,NDC,facility,both,0.04167,ML,348.88,247.01,Aetna First Health,Commercial,,296.55,85,,,154.62,296.55,percent of total billed charges,
first-mouthwash BLM Suspension 119 mL Bottle,63700001,CDM,,,250,RC,65628005004,NDC,facility,both,0.04202,ML,13.23,9.37,Aetna First Health,Commercial,,11.25,85,,,5.86,11.25,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,45802095243,NDC,facility,both,0.04228,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 354 mL Bottle,63700001,CDM,,,250,RC,01490003942,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,00904006100,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,12843055104,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loperamide 1 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,50383061804,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,54838013340,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,61787006204,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine HCl 15 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,54838010440,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,54838011740,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,00603085794,NDC,facility,both,0.04237,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,49348013534,NDC,facility,both,0.04237,ML,2.78,1.97,Aetna First Health,Commercial,,2.36,85,,,1.23,2.36,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,00904676320,NDC,facility,both,0.04237,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,00121077204,NDC,facility,both,0.04237,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pseudoephedrine HCl 15 MG/5ML Liquid 118 mL Bottle,63700001,CDM,,,250,RC,50580053604,NDC,facility,both,0.04237,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine 10 MG/5ML Syrup 118 mL Bottle,63700001,CDM,,,250,RC,60432015004,NDC,facility,both,0.04237,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,64376064040,NDC,facility,both,0.04237,ML,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 10 mL Package,63700001,CDM,,,250,RC,98888800153,NDC,facility,both,0.04237,ML,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
HYDROcodone-chlorpheniramine ER 10-8 MG/5ML Suspension Extended Release 115 mL Bottle,63700001,CDM,,,250,RC,27808008601,NDC,facility,both,0.04348,ML,8.59,6.08,Aetna First Health,Commercial,,7.3,85,,,3.81,7.3,percent of total billed charges,
nitrofurantoin 25 MG/5ML Suspension 230 mL Bottle,63700001,CDM,,,250,RC,65162068988,NDC,facility,both,0.04348,ML,74.1,52.46,Aetna First Health,Commercial,,62.98,85,,,32.84,62.98,percent of total billed charges,
nitrofurantoin 25 MG/5ML Suspension 230 mL Bottle,63700001,CDM,,,250,RC,43386045011,NDC,facility,both,0.04348,ML,82.56,58.45,Aetna First Health,Commercial,,70.18,85,,,36.59,70.18,percent of total billed charges,
nitrofurantoin 25 MG/5ML Suspension 230 mL Bottle,63700001,CDM,,,250,RC,66993047173,NDC,facility,both,0.04348,ML,105.88,74.96,Aetna First Health,Commercial,,90,85,,,46.93,90,percent of total billed charges,
norethindrone-ethinyl estradiol 1-35 MG-MCG Tablet 21 Each Disp Pack,63700001,CDM,,,250,RC,00555900942,NDC,facility,both,0.04762,EA,3.31,2.34,Aetna First Health,Commercial,,2.81,85,,,1.47,2.81,percent of total billed charges,
norethindrone-ethinyl estradiol 1-35 MG-MCG Tablet 21 Each Disp Pack,63700001,CDM,,,250,RC,00555900980,NDC,facility,both,0.04762,EA,3.31,2.34,Aetna First Health,Commercial,,2.81,85,,,1.47,2.81,percent of total billed charges,
rOPINIRole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00007489420,NDC,facility,both,0.05,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268075711,NDC,facility,both,0.05,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111091801,NDC,facility,both,0.05,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722053201,NDC,facility,both,0.05,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862012801,NDC,facility,both,0.05,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268075715,NDC,facility,both,0.05,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zanamivir 5 MG/ACT Aerosol Powder Breath Activated 20 Each Inhaler,63700001,CDM,,,250,RC,00173068101,NDC,facility,both,0.05,EA,11.8,8.35,Aetna First Health,Commercial,,10.03,85,,,5.23,10.03,percent of total billed charges,
bismuth subgallate Powder 5 g Bottle,63700001,CDM,,,250,RC,88886800359,NDC,facility,both,0.05,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00781610446,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00143988901,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,00093412773,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,66685101202,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,65862053401,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Syringe,63700001,CDM,,,250,RC,08888800256,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00143998201,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00781604146,NDC,facility,both,0.05,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,16714029303,NDC,facility,both,0.05,ML,3.41,2.41,Aetna First Health,Commercial,,2.9,85,,,1.51,2.9,percent of total billed charges,
clindamycin 75 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,00574012901,NDC,facility,both,0.05,ML,4.27,3.02,Aetna First Health,Commercial,,3.63,85,,,1.89,3.63,percent of total billed charges,
clindamycin 75 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,00009076004,NDC,facility,both,0.05,ML,5.43,3.84,Aetna First Health,Commercial,,4.62,85,,,2.41,4.62,percent of total billed charges,
clindamycin 75 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,59762001601,NDC,facility,both,0.05,ML,7.25,5.13,Aetna First Health,Commercial,,6.16,85,,,3.21,6.16,percent of total billed charges,
clindamycin 75 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,65862059601,NDC,facility,both,0.05,ML,8.23,5.83,Aetna First Health,Commercial,,7,85,,,3.65,7,percent of total billed charges,
clindamycin 75 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,65862059602,NDC,facility,both,0.05,ML,8.23,5.83,Aetna First Health,Commercial,,7,85,,,3.65,7,percent of total billed charges,
clindamycin 75 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,16714048301,NDC,facility,both,0.05,ML,8.3,5.88,Aetna First Health,Commercial,,7.06,85,,,3.68,7.06,percent of total billed charges,
clindamycin 75 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,64980051110,NDC,facility,both,0.05,ML,8.68,6.15,Aetna First Health,Commercial,,7.38,85,,,3.85,7.38,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00093227973,NDC,facility,both,0.05,ML,9.07,6.42,Aetna First Health,Commercial,,7.71,85,,,4.02,7.71,percent of total billed charges,
ciprofloxacin 250 MG/5ML (5%) Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,50419077701,NDC,facility,both,0.05,ML,22.82,16.16,Aetna First Health,Commercial,,19.4,85,,,10.11,19.4,percent of total billed charges,
clarithromycin 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,00781602346,NDC,facility,both,0.05,ML,30.54,21.62,Aetna First Health,Commercial,,25.96,85,,,13.54,25.96,percent of total billed charges,
erythromycin 400 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,52536013013,NDC,facility,both,0.05,ML,63.95,45.28,Aetna First Health,Commercial,,54.36,85,,,28.34,54.36,percent of total billed charges,
erythromycin 400 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,62559063101,NDC,facility,both,0.05,ML,63.95,45.28,Aetna First Health,Commercial,,54.36,85,,,28.34,54.36,percent of total billed charges,
levoFLOXacin 25 MG/ML Solution 200 mL Bottle,63700001,CDM,,,250,RC,00527194868,NDC,facility,both,0.05,ML,89.88,63.64,Aetna First Health,Commercial,,76.4,85,,,39.83,76.4,percent of total billed charges,
erythromycin 400 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,24338013013,NDC,facility,both,0.05,ML,115.78,81.97,Aetna First Health,Commercial,,98.41,85,,,51.31,98.41,percent of total billed charges,
mineral oil light Oil 472 mL Bottle,63700001,CDM,,,250,RC,54162018516,NDC,facility,both,0.05297,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cefdinir 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,68180072310,NDC,facility,both,0.06,ML,16.13,11.42,Aetna First Health,Commercial,,13.71,85,,,7.15,13.71,percent of total billed charges,
atorvaSTATin 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084059095,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079021101,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084059025,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904629304,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,51079021103,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505267109,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781538892,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59762015801,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714087701,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687071811,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,66993073051,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,47781091413,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054418425,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,48102005101,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,47781091401,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884008701,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054817525,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687071801,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,66993073080,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904726661,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079098401,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067811,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185010401,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001020900,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904648761,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904680061,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904720061,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053511,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268063511,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038211,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001018100,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714045701,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904628161,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053501,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904664361,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687038201,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111026830,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714068501,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68180046506,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714068502,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180046509,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382006916,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180048102,NDC,facility,both,0.0625,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 240 mL Bottle,63700001,CDM,,,250,RC,37000003202,NDC,facility,both,0.0625,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,00093416176,NDC,facility,both,0.0625,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,00143988750,NDC,facility,both,0.0625,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,00781615752,NDC,facility,both,0.0625,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 400 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,65862007150,NDC,facility,both,0.0625,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 125 MG/5ML Recon Susp 80 mL Bottle,63700001,CDM,,,250,RC,00143988880,NDC,facility,both,0.0625,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamiVUDine 10 MG/ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,54838056670,NDC,facility,both,0.0625,ML,18.17,12.86,Aetna First Health,Commercial,,15.44,85,,,8.05,15.44,percent of total billed charges,
lamiVUDine 10 MG/ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,49702020548,NDC,facility,both,0.0625,ML,24.26,17.18,Aetna First Health,Commercial,,20.62,85,,,10.75,20.62,percent of total billed charges,
lactulose 10 GM/15ML Solution 237 mL Bottle,63700001,CDM,,,250,RC,00121057708,NDC,facility,both,0.06329,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 237 mL Bottle,63700001,CDM,,,250,RC,00121087308,NDC,facility,both,0.06329,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 236 mL Bottle,63700001,CDM,,,250,RC,00904131309,NDC,facility,both,0.06356,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 236 mL Bottle,63700001,CDM,,,250,RC,01490003956,NDC,facility,both,0.06356,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 236 mL Bottle,63700001,CDM,,,250,RC,01490003908,NDC,facility,both,0.06356,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactulose 10 GM/15ML Solution 236 mL Bottle,63700001,CDM,,,250,RC,00603137856,NDC,facility,both,0.06356,ML,4.04,2.86,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
ARIPiprazole 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148001113,NDC,facility,both,0.06667,EA,9.81,6.95,Aetna First Health,Commercial,,8.34,85,,,4.35,8.34,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,65862053475,NDC,facility,both,0.06667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,60432053760,NDC,facility,both,0.06667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,00603148149,NDC,facility,both,0.06667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,50383058766,NDC,facility,both,0.06667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,66689000802,NDC,facility,both,0.06667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,66685101201,NDC,facility,both,0.06667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,00121081002,NDC,facility,both,0.06667,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
amoxicillin-clavulanate 250-62.5 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,60432006547,NDC,facility,both,0.06667,ML,23.7,16.78,Aetna First Health,Commercial,,20.14,85,,,10.5,20.14,percent of total billed charges,
amoxicillin-clavulanate 250-62.5 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,43598020453,NDC,facility,both,0.06667,ML,41.48,29.37,Aetna First Health,Commercial,,35.26,85,,,18.38,35.26,percent of total billed charges,
fluconazole 40 MG/ML Recon Susp 35 mL Bottle,63700001,CDM,,,250,RC,57237015035,NDC,facility,both,0.07143,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
fluconazole 40 MG/ML Recon Susp 35 mL Bottle,63700001,CDM,,,250,RC,00054000385,NDC,facility,both,0.07143,ML,13.07,9.25,Aetna First Health,Commercial,,11.11,85,,,5.79,11.11,percent of total billed charges,
fluconazole 40 MG/ML Recon Susp 35 mL Bottle,63700001,CDM,,,250,RC,16714069601,NDC,facility,both,0.07143,ML,14.26,10.1,Aetna First Health,Commercial,,12.12,85,,,6.32,12.12,percent of total billed charges,
fluconazole 40 MG/ML Recon Susp 35 mL Bottle,63700001,CDM,,,250,RC,59762503001,NDC,facility,both,0.07143,ML,14.71,10.41,Aetna First Health,Commercial,,12.5,85,,,6.52,12.5,percent of total billed charges,
lisinopril 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378207701,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687037111,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268063411,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,47335090688,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904664261,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053401,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904639861,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268063415,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68001018306,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,16729014912,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054022321,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68180044907,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00310027460,NDC,facility,both,0.08333,EA,4.81,3.41,Aetna First Health,Commercial,,4.09,85,,,2.13,4.09,percent of total billed charges,
rOPINIRole 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00007489520,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462025701,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547027210,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332003431,NDC,facility,both,0.08333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 40 MG/ML Suspension 15 mL Bottle,63700001,CDM,,,250,RC,00904546335,NDC,facility,both,0.08333,ML,0.66,0.47,Aetna First Health,Commercial,,0.56,85,,,0.29,0.56,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 240 mL Bottle,63700001,CDM,,,250,RC,00904530909,NDC,facility,both,0.08333,ML,0.72,0.51,Aetna First Health,Commercial,,0.61,85,,,0.32,0.61,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 240 mL Bottle,63700001,CDM,,,250,RC,68001043594,NDC,facility,both,0.08333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline 25 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,68180065701,NDC,facility,both,0.08333,ML,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
doxycycline 25 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,62135041746,NDC,facility,both,0.08333,ML,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,00045040704,NDC,facility,both,0.08464,ML,0.73,0.52,Aetna First Health,Commercial,,0.62,85,,,0.32,0.62,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,00045016604,NDC,facility,both,0.08464,ML,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,00045029604,NDC,facility,both,0.08464,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levOCARNitine 1 GM/10ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,52817083004,NDC,facility,both,0.08475,ML,6.09,4.31,Aetna First Health,Commercial,,5.18,85,,,2.7,5.18,percent of total billed charges,
levOCARNitine 1 GM/10ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,64980050312,NDC,facility,both,0.08475,ML,10.99,7.78,Aetna First Health,Commercial,,9.34,85,,,4.87,9.34,percent of total billed charges,
levOCARNitine 1 GM/10ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,70954013910,NDC,facility,both,0.08475,ML,11.76,8.33,Aetna First Health,Commercial,,10,85,,,5.21,10,percent of total billed charges,
levOCARNitine 1 GM/10ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,50383017104,NDC,facility,both,0.08475,ML,12.56,8.89,Aetna First Health,Commercial,,10.68,85,,,5.57,10.68,percent of total billed charges,
levOCARNitine 1 GM/10ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,54482014508,NDC,facility,both,0.08475,ML,13.92,9.86,Aetna First Health,Commercial,,11.83,85,,,6.17,11.83,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,49348032534,NDC,facility,both,0.08607,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,45802020326,NDC,facility,both,0.08607,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,49348012334,NDC,facility,both,0.08607,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,00904744520,NDC,facility,both,0.08607,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
amitriptyline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714045001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603221621,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729017501,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300042301,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079065101,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378641001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079065120,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084095095,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079048801,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527179101,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378609701,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079048820,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079073601,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687016111,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832154089,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378032701,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382007901,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58657070301,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781139601,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832154011,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781139613,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079073620,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687016101,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832154001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59746038606,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079058001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489050001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378061801,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079058020,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079058901,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378501001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781222901,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70954001710,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60219167601,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079058920,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378241001,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781103601,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832049711,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781803601,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121989,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056017401,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382005901,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162076910,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282033501,NDC,facility,both,0.1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
wound dressing Pad 10 Each Box,63700001,CDM,,,250,RC,62794009218,NDC,facility,both,0.1,EA,22.28,15.77,Aetna First Health,Commercial,,18.94,85,,,9.87,18.94,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,66685101200,NDC,facility,both,0.1,ML,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,65862053450,NDC,facility,both,0.1,ML,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,16714029301,NDC,facility,both,0.1,ML,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
cefprozil 125 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,68180040101,NDC,facility,both,0.1,ML,5.53,3.92,Aetna First Health,Commercial,,4.7,85,,,2.45,4.7,percent of total billed charges,
cefprozil 125 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,57237003450,NDC,facility,both,0.1,ML,5.53,3.92,Aetna First Health,Commercial,,4.7,85,,,2.45,4.7,percent of total billed charges,
cefdinir 250 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,65862021960,NDC,facility,both,0.1,ML,6.99,4.95,Aetna First Health,Commercial,,5.94,85,,,3.1,5.94,percent of total billed charges,
cefdinir 250 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,68180072304,NDC,facility,both,0.1,ML,6.99,4.95,Aetna First Health,Commercial,,5.94,85,,,3.1,5.94,percent of total billed charges,
cefprozil 250 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,16714039701,NDC,facility,both,0.1,ML,10.22,7.24,Aetna First Health,Commercial,,8.69,85,,,4.53,8.69,percent of total billed charges,
cefprozil 250 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,68180040201,NDC,facility,both,0.1,ML,10.26,7.26,Aetna First Health,Commercial,,8.72,85,,,4.55,8.72,percent of total billed charges,
cefdinir 250 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,16714039301,NDC,facility,both,0.1,ML,14.15,10.02,Aetna First Health,Commercial,,12.03,85,,,6.27,12.03,percent of total billed charges,
amoxicillin-clavulanate 250-62.5 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,60432006500,NDC,facility,both,0.1,ML,24.19,17.13,Aetna First Health,Commercial,,20.56,85,,,10.72,20.56,percent of total billed charges,
cefdinir 250 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,00093413764,NDC,facility,both,0.1,ML,26.12,18.49,Aetna First Health,Commercial,,22.2,85,,,11.58,22.2,percent of total billed charges,
cefdinir 250 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,68180072320,NDC,facility,both,0.1,ML,26.12,18.49,Aetna First Health,Commercial,,22.2,85,,,11.58,22.2,percent of total billed charges,
clarithromycin 250 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,00781602352,NDC,facility,both,0.1,ML,32.97,23.34,Aetna First Health,Commercial,,28.02,85,,,14.61,28.02,percent of total billed charges,
levoFLOXacin 25 MG/ML Solution 100 mL Bottle,63700001,CDM,,,250,RC,50383028604,NDC,facility,both,0.1,ML,35.56,25.18,Aetna First Health,Commercial,,30.23,85,,,15.76,30.23,percent of total billed charges,
erythromycin 200 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,52536013413,NDC,facility,both,0.1,ML,72.66,51.44,Aetna First Health,Commercial,,61.76,85,,,32.2,61.76,percent of total billed charges,
erythromycin 200 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,62559063001,NDC,facility,both,0.1,ML,72.66,51.44,Aetna First Health,Commercial,,61.76,85,,,32.2,61.76,percent of total billed charges,
erythromycin 200 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,69238150301,NDC,facility,both,0.1,ML,73.78,52.24,Aetna First Health,Commercial,,62.71,85,,,32.7,62.71,percent of total billed charges,
itraconazole 10 MG/ML Solution 150 mL Bottle,63700001,CDM,,,250,RC,31722000631,NDC,facility,both,0.1,ML,87.52,61.96,Aetna First Health,Commercial,,74.39,85,,,38.79,74.39,percent of total billed charges,
levoFLOXacin 25 MG/ML Solution 100 mL Bottle,63700001,CDM,,,250,RC,00527194866,NDC,facility,both,0.1,ML,89.88,63.64,Aetna First Health,Commercial,,76.4,85,,,39.83,76.4,percent of total billed charges,
itraconazole 10 MG/ML Solution 150 mL Bottle,63700001,CDM,,,250,RC,10147015001,NDC,facility,both,0.1,ML,101.22,71.66,Aetna First Health,Commercial,,86.04,85,,,44.86,86.04,percent of total billed charges,
erythromycin 200 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,62559044001,NDC,facility,both,0.1,ML,113.51,80.37,Aetna First Health,Commercial,,96.48,85,,,50.31,96.48,percent of total billed charges,
erythromycin 200 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,52536013213,NDC,facility,both,0.1,ML,113.93,80.66,Aetna First Health,Commercial,,96.84,85,,,50.49,96.84,percent of total billed charges,
itraconazole 10 MG/ML Solution 150 mL Bottle,63700001,CDM,,,250,RC,65162008774,NDC,facility,both,0.1,ML,117.54,83.22,Aetna First Health,Commercial,,99.91,85,,,52.09,99.91,percent of total billed charges,
itraconazole 10 MG/ML Solution 150 mL Bottle,63700001,CDM,,,250,RC,50458029515,NDC,facility,both,0.1,ML,119.96,84.93,Aetna First Health,Commercial,,101.97,85,,,53.17,101.97,percent of total billed charges,
erythromycin 200 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,24338013402,NDC,facility,both,0.1,ML,131.67,93.22,Aetna First Health,Commercial,,111.92,85,,,58.36,111.92,percent of total billed charges,
omeprazole-sodium bicarbonate 2-84 MG/ML Recon Susp 90 mL Bottle,63700001,CDM,,,250,RC,65628027203,NDC,facility,both,0.11111,ML,68.04,48.17,Aetna First Health,Commercial,,57.83,85,,,30.16,57.83,percent of total billed charges,
omeprazole-sodium bicarbonate 2-84 MG/ML Recon Susp 90 mL Bottle,63700001,CDM,,,250,RC,65628027003,NDC,facility,both,0.11111,ML,68.04,48.17,Aetna First Health,Commercial,,57.83,85,,,30.16,57.83,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,65862021801,NDC,facility,both,0.12,ML,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,68180072205,NDC,facility,both,0.12,ML,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,16714039202,NDC,facility,both,0.12,ML,15.12,10.7,Aetna First Health,Commercial,,12.85,85,,,6.7,12.85,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,68180072210,NDC,facility,both,0.12,ML,16.55,11.72,Aetna First Health,Commercial,,14.07,85,,,7.33,14.07,percent of total billed charges,
atenolol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079068501,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093075301,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378075701,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862017001,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304062301,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742010301,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079021001,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268009511,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084009901,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904629261,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079021020,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00071015740,NDC,facility,both,0.125,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
atorvaSTATin 40 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268009515,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,59762015702,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,63304082905,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,62175089241,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378395205,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505258009,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781538492,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378395277,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378212177,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,62175089246,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carboxymethylcellulose PF 0.5 % 0.5 % Solution 30 Each Plas Cont,63700001,CDM,,,250,RC,00023040330,NDC,facility,both,0.125,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
carboxymethylcellulose PF 0.5 % 0.5 % Solution 30 Each Plas Cont,63700001,CDM,,,250,RC,46122019565,NDC,facility,both,0.125,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
carboxymethylcellulose PF 1 % Gel 30 Each Plas Cont,63700001,CDM,,,250,RC,00023455430,NDC,facility,both,0.125,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
carvedilol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079093201,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084087611,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382009501,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378363401,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015200,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079093220,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904630361,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084087601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382009505,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228300511,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729013800,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054418325,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60219205601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054817625,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 8 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268022511,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505009600,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382078601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378402801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762238006,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729041501,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547054810,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672404001,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079052701,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378023201,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781144601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64125011801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315011801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547040310,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742010601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079052720,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904579861,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00781144605,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,43547040350,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glycerin 1 g Suppository 12 Each Jar,63700001,CDM,,,250,RC,00132008112,NDC,facility,both,0.125,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glycerin 1 g Suppository 25 Each Box,63700001,CDM,,,250,RC,58980040925,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406324901,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054026525,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527135501,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 8 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68094085261,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180098101,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001033500,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591040801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378207501,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547035410,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079080201,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742010901,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378004701,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237010201,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093073401,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862006401,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584026701,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904634261,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079080220,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687074611,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43386016101,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084004101,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687074601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59762500801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,43386016106,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,70954044410,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
olmesartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65597010430,NDC,facility,both,0.125,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
oxyCODONE CR 80 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,00591270801,NDC,facility,both,0.125,EA,5.51,3.9,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
pramipexole 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687059211,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084098295,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00597019061,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084098225,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668009490,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342003410,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00597019090,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68462033390,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 200 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00071101768,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687036011,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268063311,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180044801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001018200,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714045501,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00310027210,NDC,facility,both,0.125,EA,5.5,3.89,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687036001,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739067710,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904664161,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053301,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ramipril 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57237022501,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ramipril 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001043100,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 4 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,43547034406,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268074411,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462025601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332003331,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378550201,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547027110,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054011925,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084033221,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268074415,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268071111,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904678161,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,27808015801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 40 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268071115,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,57237017190,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,72205000590,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045601,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687021011,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084016411,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079039801,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045620,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084051301,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739057310,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687021001,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084016401,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079039820,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729000610,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714068401,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68180046406,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382006805,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382006816,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714068402,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180046409,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722051390,NDC,facility,both,0.125,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
vancomycin 25 MG/ML Recon Soln 5 mL Syringe,63700001,CDM,,,250,RC,08888800330,NDC,facility,both,0.125,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sodium polystyrene sulfonate 15 GM/60ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,46287000601,NDC,facility,both,0.12685,ML,93.24,66.01,Aetna First Health,Commercial,,79.25,85,,,41.32,79.25,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,01490003904,NDC,facility,both,0.12712,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,24385030226,NDC,facility,both,0.12712,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,46122070326,NDC,facility,both,0.12712,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079014701,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729017401,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378267501,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603221521,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781148901,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300042201,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079014720,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268009011,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687019111,NDC,facility,both,0.13333,EA,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
ARIPiprazole 15 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,50268009012,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598055730,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729028110,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332010030,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714078601,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877043303,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862066430,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162089903,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13811068230,NDC,facility,both,0.13333,EA,11.96,8.47,Aetna First Health,Commercial,,10.17,85,,,5.3,10.17,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904651204,NDC,facility,both,0.13333,EA,9.72,6.88,Aetna First Health,Commercial,,8.26,85,,,4.31,8.26,percent of total billed charges,
ciprofloxacin 750 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084007111,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084007101,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 750 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,55111012850,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 750 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,16571041305,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 750 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,65862007850,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 750 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,16252051605,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 750 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,16714065301,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3.75 mg Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056017301,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121889,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056017301,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403401,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832121800,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282033401,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162076810,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093171901,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093172301,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555083402,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056017375,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121801,NDC,facility,both,0.13333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 250-62.5 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,60432006575,NDC,facility,both,0.13333,ML,24.15,17.1,Aetna First Health,Commercial,,20.53,85,,,10.7,20.53,percent of total billed charges,
amoxicillin-clavulanate 250-62.5 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,59651002675,NDC,facility,both,0.13333,ML,24.15,17.1,Aetna First Health,Commercial,,20.53,85,,,10.7,20.53,percent of total billed charges,
amoxicillin-clavulanate 250-62.5 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,43598020451,NDC,facility,both,0.13333,ML,42.28,29.93,Aetna First Health,Commercial,,35.94,85,,,18.74,35.94,percent of total billed charges,
amoxicillin-clavulanate 250-62.5 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,72508020407,NDC,facility,both,0.13333,ML,42.28,29.93,Aetna First Health,Commercial,,35.94,85,,,18.74,35.94,percent of total billed charges,
linezolid 100 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,59762130801,NDC,facility,both,0.13333,ML,306.11,216.73,Aetna First Health,Commercial,,260.19,85,,,135.67,260.19,percent of total billed charges,
linezolid 100 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,00054031950,NDC,facility,both,0.13333,ML,313.53,221.98,Aetna First Health,Commercial,,266.5,85,,,138.96,266.5,percent of total billed charges,
linezolid 100 MG/5ML Recon Susp 150 mL Bottle,63700001,CDM,,,250,RC,00009513601,NDC,facility,both,0.13333,ML,354.34,250.87,Aetna First Health,Commercial,,301.19,85,,,157.04,301.19,percent of total billed charges,
morphine ER 200 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,60951065970,NDC,facility,both,0.15,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
bismuth subgallate Powder 15 g Bottle,63700001,CDM,,,250,RC,88886800274,NDC,facility,both,0.15,GR,16.86,11.94,Aetna First Health,Commercial,,14.33,85,,,7.47,14.33,percent of total billed charges,
allopurinol 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079020617,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584071311,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079020601,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687068811,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489015701,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729013501,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378018101,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591554401,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714004210,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111073001,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300035001,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904657261,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739079610,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079020620,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687068801,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 25 Each Box,63700001,CDM,,,250,RC,51079020619,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378018105,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 60 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,64980037703,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 60 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714075901,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 60 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,55111052230,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 60 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00002323930,NDC,facility,both,0.16667,EA,8.35,5.91,Aetna First Health,Commercial,,7.1,85,,,3.7,7.1,percent of total billed charges,
dexAMETHasone 1.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054418225,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 1.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054818125,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70710115101,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079086501,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687069311,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69102015006,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079086520,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084032021,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,51672413204,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382000914,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,29300011316,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,16714070201,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862022960,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59746024760,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,69097015103,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00173064360,NDC,facility,both,0.16667,EA,6.8,4.81,Aetna First Health,Commercial,,5.78,85,,,3.01,5.78,percent of total billed charges,
mirtazapine 45 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084012111,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 45 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079008801,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 45 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079008820,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 45 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084012101,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 45 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107003234,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084052811,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505311400,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084052801,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 97.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293062801,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 97.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13517011301,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 97.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571066801,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
polyvinyl alcohol-povidone PF 1.4-0.6 % Solution 30 Each Plas Cont,63700001,CDM,,,250,RC,00023050601,NDC,facility,both,0.16667,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
polyvinyl alcohol-povidone PF 1.4-0.6 % Solution 50 Each Plas Cont,63700001,CDM,,,250,RC,00023050650,NDC,facility,both,0.16667,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pregabalin 150 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687051711,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904700261,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687051701,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00071101641,NDC,facility,both,0.16667,EA,6.49,4.59,Aetna First Health,Commercial,,5.52,85,,,2.88,5.52,percent of total billed charges,
pregabalin 150 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69097068205,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 150 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,65862076290,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 150 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00071101668,NDC,facility,both,0.16667,EA,5.9,4.18,Aetna First Health,Commercial,,5.02,85,,,2.61,5.02,percent of total billed charges,
risperiDONE 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079046401,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084027411,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904636161,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079046420,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084027401,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382011614,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,43547034306,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056018901,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121789,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162076710,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832121700,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237012501,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093171801,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555092602,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056018975,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 6 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121701,NDC,facility,both,0.16667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,66689005301,NDC,facility,both,0.16667,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,60687042945,NDC,facility,both,0.16667,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,51672213008,NDC,facility,both,0.16667,ML,0.78,0.55,Aetna First Health,Commercial,,0.66,85,,,0.35,0.66,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,49348087634,NDC,facility,both,0.16667,ML,0.93,0.66,Aetna First Health,Commercial,,0.79,85,,,0.41,0.79,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,00904530920,NDC,facility,both,0.16667,ML,1.02,0.72,Aetna First Health,Commercial,,0.87,85,,,0.45,0.87,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,00904557720,NDC,facility,both,0.16667,ML,1.02,0.72,Aetna First Health,Commercial,,0.87,85,,,0.45,0.87,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,37205064326,NDC,facility,both,0.16667,ML,1.17,0.83,Aetna First Health,Commercial,,0.99,85,,,0.52,0.99,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,00045019204,NDC,facility,both,0.16667,ML,1.68,1.19,Aetna First Health,Commercial,,1.43,85,,,0.74,1.43,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,66689005399,NDC,facility,both,0.16667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,69339015301,NDC,facility,both,0.16667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,24385000926,NDC,facility,both,0.16667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,50580060121,NDC,facility,both,0.16667,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,45802095226,NDC,facility,both,0.16667,ML,4.41,3.12,Aetna First Health,Commercial,,3.75,85,,,1.95,3.75,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,68001043592,NDC,facility,both,0.16667,ML,4.41,3.12,Aetna First Health,Commercial,,3.75,85,,,1.95,3.75,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,50580060120,NDC,facility,both,0.16667,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Syringe,63700001,CDM,,,250,RC,08888800721,NDC,facility,both,0.16667,ML,54.99,38.93,Aetna First Health,Commercial,,46.74,85,,,24.37,46.74,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,00472125594,NDC,facility,both,0.16949,ML,0.78,0.55,Aetna First Health,Commercial,,0.66,85,,,0.35,0.66,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,00472176094,NDC,facility,both,0.16949,ML,0.78,0.55,Aetna First Health,Commercial,,0.66,85,,,0.35,0.66,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,49035016626,NDC,facility,both,0.16949,ML,0.87,0.62,Aetna First Health,Commercial,,0.74,85,,,0.39,0.74,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,45802089726,NDC,facility,both,0.16949,ML,1.92,1.36,Aetna First Health,Commercial,,1.63,85,,,0.85,1.63,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,51672138508,NDC,facility,both,0.16949,ML,4.48,3.17,Aetna First Health,Commercial,,3.81,85,,,1.99,3.81,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 118 mL Bottle,63700001,CDM,,,250,RC,00472127094,NDC,facility,both,0.16949,ML,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 59 mL Bottle,63700001,CDM,,,250,RC,49348043030,NDC,facility,both,0.17214,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
amitriptyline 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687044411,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781148801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714044801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687044401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079013320,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781236801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,66993059802,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43975028110,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115149001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406895501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42858032501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115133201,NDC,facility,both,0.2,EA,3.43,2.43,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
amphetamine-dextroamphetamine 25 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228306411,NDC,facility,both,0.2,EA,3.43,2.43,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
ARIPiprazole 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268008911,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687017911,NDC,facility,both,0.2,EA,5.75,4.07,Aetna First Health,Commercial,,4.89,85,,,2.55,4.89,percent of total billed charges,
ARIPiprazole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332009931,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729028001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13811068110,NDC,facility,both,0.2,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
ARIPiprazole 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739007410,NDC,facility,both,0.2,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598055630,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342012407,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714078501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162089803,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13668021830,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505267403,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332009930,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729028010,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877043203,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148000813,NDC,facility,both,0.2,EA,13.62,9.64,Aetna First Health,Commercial,,11.58,85,,,6.04,11.58,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13811068130,NDC,facility,both,0.2,EA,17.94,12.7,Aetna First Health,Commercial,,15.25,85,,,7.95,15.25,percent of total billed charges,
ARIPiprazole 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722082730,NDC,facility,both,0.2,EA,17.98,12.73,Aetna First Health,Commercial,,15.28,85,,,7.97,15.28,percent of total billed charges,
ARIPiprazole 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904651106,NDC,facility,both,0.2,EA,5.86,4.15,Aetna First Health,Commercial,,4.98,85,,,2.6,4.98,percent of total billed charges,
ARIPiprazole 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668021890,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832051289,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084070411,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687070011,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162057310,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527135601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111032501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832051200,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679096701,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832051201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084070401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079014101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687080711,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 25 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,00555015904,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079018201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143992801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862007701,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172531260,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714065202,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111012701,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084007001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739055910,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904637861,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904708361,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079018220,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,55111012705,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00172531270,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781197301,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238105701,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155058001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742011401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45963034302,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079028601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172392760,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862094301,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079028620,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079043801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,27241016901,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378425001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079043820,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
emtricitabine-tenofovir 200-300 MG Tablet 6 Each Package,63700001,CDM,,,250,RC,08888800086,NDC,facility,both,0.2,EA,181,128.15,Aetna First Health,Commercial,,153.85,85,,,80.22,153.85,percent of total billed charges,
fluPHENAZine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687074911,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268036811,NDC,facility,both,0.2,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
fluPHENAZine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084084611,NDC,facility,both,0.2,EA,7.5,5.31,Aetna First Health,Commercial,,6.38,85,,,3.32,6.38,percent of total billed charges,
fluPHENAZine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238168001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378607401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527179001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60219168001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079048720,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268036815,NDC,facility,both,0.2,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
hydrALAZINE 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079007601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584073411,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687083311,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111032801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155000301,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722052101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380073506,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079007620,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584073401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904644261,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739012710,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739032810,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084025511,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079081601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687068611,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571011501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155010701,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093506201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714008310,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42806016101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155050201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084025501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079081620,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904661861,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093506205,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16714008311,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,42806016105,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884005601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69584042710,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781176601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315013501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,68084033511,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,68462022901,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,65862036201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,62332009631,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,16571078601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00093013201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00173052700,NDC,facility,both,0.2,EA,7.99,5.66,Aetna First Health,Commercial,,6.79,85,,,3.54,6.79,percent of total billed charges,
lamoTRIgine chewable 25 MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,68084033521,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574022201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762120701,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60793011601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42794001902,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862032101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 25 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42794001912,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079090201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 25 MG capsule 1 Each Bottle,63700001,CDM,,,250,RC,00591037103,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591037101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378702501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527139601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079090220,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687026533,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268060511,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093081201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591578801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51672400301,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 50 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268060515,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687057233,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378320501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093406901,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70010008601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70756044011,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079063220,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 20 Each Box,63700001,CDM,,,250,RC,60687057232,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 250 Each Bottle,63700001,CDM,,,250,RC,00093406952,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,59762535001,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,66993043385,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268068711,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527123101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591532101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603537221,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162054510,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746054501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,66490069110,NDC,facility,both,0.2,EA,45.64,32.31,Aetna First Health,Commercial,,38.79,85,,,20.23,38.79,percent of total billed charges,
primidone 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084020301,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 250 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268068715,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079093801,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268076611,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781205301,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59746038506,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60505011700,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079093820,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904612861,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 5 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268076615,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079056701,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378061601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378300501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70954001610,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378240501,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832049611,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781803401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781103401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584099411,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121689,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555083302,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403201,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832121600,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093172101,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237012401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382005601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162076610,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056017275,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584099401,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121601,NDC,facility,both,0.2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 120-12 MG/5ML Solution 12.5 mL Cup,63700001,CDM,,,250,RC,50383007912,NDC,facility,both,0.2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen-codeine 120-12 MG/5ML Solution 12.5 mL Cup,63700001,CDM,,,250,RC,50383033912,NDC,facility,both,0.2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mineral oil light Oil 10 mL Vial,63700001,CDM,,,250,RC,63323025410,NDC,facility,both,0.2,ML,5.99,4.24,Aetna First Health,Commercial,,5.09,85,,,2.65,5.09,percent of total billed charges,
HYDROmorphone 1 MG/ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,60687056640,NDC,facility,both,0.2,ML,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
HYDROmorphone 1 MG/ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,60687056686,NDC,facility,both,0.2,ML,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,67877054798,NDC,facility,both,0.2,ML,7.01,4.96,Aetna First Health,Commercial,,5.96,85,,,3.11,5.96,percent of total billed charges,
sodium chloride 0.9 % Nebulization Solution 15 mL Plas Cont,63700001,CDM,,,250,RC,00378698789,NDC,facility,both,0.2,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.9 % Nebulization Solution 15 mL Plas Cont,63700001,CDM,,,250,RC,76204030050,NDC,facility,both,0.2,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
acetaminophen-codeine 120-12 MG/5ML Solution 12.5 mL Cup,63700001,CDM,,,250,RC,50383007913,NDC,facility,both,0.2,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,68180072204,NDC,facility,both,0.2,ML,13.99,9.9,Aetna First Health,Commercial,,11.89,85,,,6.2,11.89,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,65862021860,NDC,facility,both,0.2,ML,13.99,9.9,Aetna First Health,Commercial,,11.89,85,,,6.2,11.89,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,68180072220,NDC,facility,both,0.2,ML,17.39,12.31,Aetna First Health,Commercial,,14.78,85,,,7.71,14.78,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,00781607761,NDC,facility,both,0.2,ML,18.48,13.08,Aetna First Health,Commercial,,15.71,85,,,8.19,15.71,percent of total billed charges,
cefdinir 125 MG/5ML Recon Susp 60 mL Bottle,63700001,CDM,,,250,RC,00093413664,NDC,facility,both,0.2,ML,26.8,18.97,Aetna First Health,Commercial,,22.78,85,,,11.88,22.78,percent of total billed charges,
amoxicillin-clavulanate 200-28.5 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,65862053301,NDC,facility,both,0.21875,ML,8.27,5.86,Aetna First Health,Commercial,,7.03,85,,,3.67,7.03,percent of total billed charges,
lopinavir-ritonavir 200-50 MG Tablet 28 Each Package,63700001,CDM,,,250,RC,00888880087,NDC,facility,both,0.23333,EA,159.18,112.7,Aetna First Health,Commercial,,135.3,85,,,70.55,135.3,percent of total billed charges,
linaclotide 290 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00456120230,NDC,facility,both,0.24828,EA,15.67,11.09,Aetna First Health,Commercial,,13.32,85,,,6.94,13.32,percent of total billed charges,
acyclovir 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722077801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69452029120,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079079001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51991070601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862067801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228203110,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781107901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762372101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253090210,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904586061,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739067410,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079079020,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084050611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,59762154005,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268008511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687049611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687027411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63739063110,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687049601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904637161,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687027401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66105052903,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268008515,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59762154001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093716898,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,67877019990,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69097012805,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555097302,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714095301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185040101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107007301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185085301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527150537,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 20 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687050995,NDC,facility,both,0.25,EA,5.07,3.59,Aetna First Health,Commercial,,4.31,85,,,2.25,4.31,percent of total billed charges,
amphetamine-dextroamphetamine XR 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228306011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781235201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406895401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,31722018801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115133101,NDC,facility,both,0.25,EA,4.29,3.04,Aetna First Health,Commercial,,3.65,85,,,1.9,3.65,percent of total billed charges,
atenolol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079068401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584046711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093075201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378023101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382002301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781522501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584046701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,52427043090,NDC,facility,both,0.25,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
atomoxetine 40 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687032695,NDC,facility,both,0.25,EA,5.53,3.92,Aetna First Health,Commercial,,4.7,85,,,2.45,4.7,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,64980037603,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,55111052130,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00093354556,NDC,facility,both,0.25,EA,3.52,2.49,Aetna First Health,Commercial,,2.99,85,,,1.56,2.99,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714075801,NDC,facility,both,0.25,EA,3.57,2.53,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,66993004330,NDC,facility,both,0.25,EA,5.63,3.99,Aetna First Health,Commercial,,4.79,85,,,2.5,4.79,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00002322930,NDC,facility,both,0.25,EA,12.53,8.87,Aetna First Health,Commercial,,10.65,85,,,5.55,10.65,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687032625,NDC,facility,both,0.25,EA,5.53,3.92,Aetna First Health,Commercial,,4.7,85,,,2.45,4.7,percent of total billed charges,
atomoxetine 40 MG capsule 30 Each Box,63700001,CDM,,,250,RC,00904690804,NDC,facility,both,0.25,EA,5.54,3.92,Aetna First Health,Commercial,,4.71,85,,,2.46,4.71,percent of total billed charges,
atorvaSTATin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084009811,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079020901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268009411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904629161,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084009801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079020920,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904629106,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505257909,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378395177,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378201777,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60429032490,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268010711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687051411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687082611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70710128601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172409760,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832105511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52817032110,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714007204,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084086801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687051401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00832105515,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benazepril 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268011111,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benazepril 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547033710,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benazepril 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268011115,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
brexpiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148003813,NDC,facility,both,0.25,EA,42.92,30.39,Aetna First Health,Commercial,,36.48,85,,,19.02,36.48,percent of total billed charges,
bumetanide 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268013211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687053511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185013001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42799012101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832054211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714083301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buprenorphine 300 MCG FILM 1 Each Package,63700001,CDM,,,250,RC,59385002301,NDC,facility,both,0.25,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
buprenorphine 300 MCG FILM 60 Each Box,63700001,CDM,,,250,RC,59385002360,NDC,facility,both,0.25,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
captopril 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687031511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143117201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378301201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781806101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69292052401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679090301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904710661,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079086420,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904504661,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 400 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084056211,NDC,facility,both,0.25,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
carBAMazepine XR 400 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687059411,NDC,facility,both,0.25,EA,5.08,3.6,Aetna First Health,Commercial,,4.32,85,,,2.25,4.32,percent of total billed charges,
carBAMazepine XR 400 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51672412501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 400 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781598801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 400 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00832602411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 400 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078051205,NDC,facility,both,0.25,EA,3.23,2.29,Aetna First Health,Commercial,,2.75,85,,,1.43,2.75,percent of total billed charges,
carBAMazepine XR 400 MG Tablet Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,68084056221,NDC,facility,both,0.25,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
carvedilol 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084086511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382009401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015100,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462016401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079093120,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084026301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904630261,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084086501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefprozil 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,68180040401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefprozil 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,16714039901,NDC,facility,both,0.25,EA,4.13,2.92,Aetna First Health,Commercial,,3.51,85,,,1.83,3.51,percent of total billed charges,
chlorthalidone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378021301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877069701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862000701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13668001101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162005410,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378623301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904608661,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 40 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65862000705,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084024411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42571025201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63304069301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591293201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729013700,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228300411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714075001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547040710,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093321201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185006401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739026410,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687055501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00228300450,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268018411,NDC,facility,both,0.25,EA,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
clopidogrel 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084075295,NDC,facility,both,0.25,EA,12.49,8.84,Aetna First Health,Commercial,,10.62,85,,,5.54,10.62,percent of total billed charges,
clopidogrel 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053795,NDC,facility,both,0.25,EA,16.64,11.78,Aetna First Health,Commercial,,14.14,85,,,7.37,14.14,percent of total billed charges,
clopidogrel 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079055801,NDC,facility,both,0.25,EA,18.17,12.86,Aetna First Health,Commercial,,15.44,85,,,8.05,15.44,percent of total billed charges,
clopidogrel 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,55111067106,NDC,facility,both,0.25,EA,20.3,14.37,Aetna First Health,Commercial,,17.26,85,,,9,17.26,percent of total billed charges,
clopidogrel 300 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,50268018412,NDC,facility,both,0.25,EA,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
clopidogrel 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904646707,NDC,facility,both,0.25,EA,11.63,8.23,Aetna First Health,Commercial,,9.89,85,,,5.15,9.89,percent of total billed charges,
clopidogrel 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084075225,NDC,facility,both,0.25,EA,12.48,8.84,Aetna First Health,Commercial,,10.61,85,,,5.53,10.61,percent of total billed charges,
clopidogrel 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084053725,NDC,facility,both,0.25,EA,16.64,11.78,Aetna First Health,Commercial,,14.14,85,,,7.37,14.14,percent of total billed charges,
clopidogrel 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,51079055803,NDC,facility,both,0.25,EA,18.54,13.13,Aetna First Health,Commercial,,15.76,85,,,8.22,15.76,percent of total billed charges,
clopidogrel 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,55111067131,NDC,facility,both,0.25,EA,20.3,14.37,Aetna First Health,Commercial,,17.26,85,,,9,17.26,percent of total billed charges,
cloZAPine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079092201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687041511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084023411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093777201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862084601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664034788,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687041501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079092220,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00093777293,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378086005,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 100 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,51079028801,NDC,facility,both,0.25,EA,5.72,4.05,Aetna First Health,Commercial,,4.86,85,,,2.54,4.86,percent of total billed charges,
cloZAPine 100 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00093541919,NDC,facility,both,0.25,EA,5.72,4.05,Aetna First Health,Commercial,,4.86,85,,,2.54,4.86,percent of total billed charges,
cloZAPine 100 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,00378381501,NDC,facility,both,0.25,EA,5.72,4.05,Aetna First Health,Commercial,,4.86,85,,,2.54,4.86,percent of total billed charges,
cloZAPine 100 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,00093541901,NDC,facility,both,0.25,EA,5.72,4.05,Aetna First Health,Commercial,,4.86,85,,,2.54,4.86,percent of total billed charges,
cloZAPine 100 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,18860010410,NDC,facility,both,0.25,EA,12.85,9.1,Aetna First Health,Commercial,,10.92,85,,,5.7,10.92,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268085511,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333093825,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,79854020062,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68094011559,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536355601,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,74312001380,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10135065201,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10006073043,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,04009310137,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333093810,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,68094011561,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 130 Each Bottle,63700001,CDM,,,250,RC,10135065263,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 130 Each Bottle,63700001,CDM,,,250,RC,00904421713,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 130 Each Bottle,63700001,CDM,,,250,RC,10006070022,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,54629058605,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268085515,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 1000 MCG Tablet 50 Each Box,63700001,CDM,,,250,RC,20555000600,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
danazol 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00555063502,NDC,facility,both,0.25,EA,5.55,3.93,Aetna First Health,Commercial,,4.72,85,,,2.46,4.72,percent of total billed charges,
danazol 200 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00555063509,NDC,facility,both,0.25,EA,6.3,4.46,Aetna First Health,Commercial,,5.36,85,,,2.79,5.36,percent of total billed charges,
dapsone 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64980056603,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dapsone 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70954013610,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dapsone 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,29033003730,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dapsone 100 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,49938010130,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dapsone 100 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,13925050530,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084060411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687073211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505025801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69918020101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001032600,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714088401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001023400,NDC,facility,both,0.25,EA,4.8,3.4,Aetna First Health,Commercial,,4.08,85,,,2.13,4.08,percent of total billed charges,
desmopressin 0.2 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084060421,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054418125,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00093555301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115992101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,70010000701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,31722023201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781268501,NDC,facility,both,0.25,EA,6.82,4.83,Aetna First Health,Commercial,,5.8,85,,,3.02,5.8,percent of total billed charges,
dexmethylphenidate 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078043205,NDC,facility,both,0.25,EA,7.58,5.37,Aetna First Health,Commercial,,6.44,85,,,3.36,6.44,percent of total billed charges,
digoxin 250 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687055111,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527132501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68084068001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143124101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115982201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714059101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904592261,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687055101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 250 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,24987024956,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084078211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 1 Each Box,63700001,CDM,,,250,RC,00832712489,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00245018211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,68001047400,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,62756079888,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00904686161,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00832712401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 500 Each Bottle,63700001,CDM,,,250,RC,00245018215,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 500 Each Bottle,63700001,CDM,,,250,RC,68382003305,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 80 Each Box,63700001,CDM,,,250,RC,51079047508,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 90 Each Box,63700001,CDM,,,250,RC,68084078261,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 500 MCG capsule 14 Each Bottle,63700001,CDM,,,250,RC,00069582061,NDC,facility,both,0.25,EA,6.94,4.91,Aetna First Health,Commercial,,5.9,85,,,3.08,5.9,percent of total billed charges,
dofetilide 500 MCG capsule 40 Each Box,63700001,CDM,,,250,RC,00069582043,NDC,facility,both,0.25,EA,9.7,6.87,Aetna First Health,Commercial,,8.24,85,,,4.3,8.24,percent of total billed charges,
dofetilide 500 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,69452013317,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 500 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,59651012060,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 500 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,72205004160,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 500 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16714084201,NDC,facility,both,0.25,EA,4.88,3.46,Aetna First Health,Commercial,,4.15,85,,,2.16,4.15,percent of total billed charges,
dofetilide 500 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,51862000560,NDC,facility,both,0.25,EA,5.99,4.24,Aetna First Health,Commercial,,5.09,85,,,2.65,5.09,percent of total billed charges,
dofetilide 500 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00069582060,NDC,facility,both,0.25,EA,9.7,6.87,Aetna First Health,Commercial,,8.24,85,,,4.3,8.24,percent of total billed charges,
doxazosin 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084086211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378402401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904552461,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
droNABinol 10 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,42858086906,NDC,facility,both,0.25,EA,3.65,2.58,Aetna First Health,Commercial,,3.1,85,,,1.62,3.1,percent of total billed charges,
droNABinol 10 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,67877057060,NDC,facility,both,0.25,EA,4.5,3.19,Aetna First Health,Commercial,,3.82,85,,,1.99,3.82,percent of total billed charges,
droNABinol 10 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,17478076306,NDC,facility,both,0.25,EA,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
enalapril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378105301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714044401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68682071201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547054710,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904561061,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079054401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084061811,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093585219,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00456202011,NDC,facility,both,0.25,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093585201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13668013701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862037501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180013601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729017001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547028210,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001045600,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00456202001,NDC,facility,both,0.25,EA,6.13,4.34,Aetna First Health,Commercial,,5.21,85,,,2.72,5.21,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079054420,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084061801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904642761,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00456202063,NDC,facility,both,0.25,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
escitalopram 20 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093585205,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378385777,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethambutol 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084028011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethambutol 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61748001401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethambutol 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68850001201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethambutol 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180028101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethambutol 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,54879000201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethambutol 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68850001202,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ethambutol 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084028001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00591327330,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093811956,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342002607,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722070830,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00054019813,NDC,facility,both,0.25,EA,4.35,3.08,Aetna First Health,Commercial,,3.7,85,,,1.93,3.7,percent of total billed charges,
famotidine 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172572960,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378304001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332000231,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001039800,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68001024104,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,53489037001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378501301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68462023501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084073511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172541360,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571021310,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904650161,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084073501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00172541346,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59762501801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714069301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68001025404,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 200 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268033915,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084010111,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268033511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687065911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781282401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093719801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862019401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001012900,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001040100,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084010101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,68001040104,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,63304063230,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,49884087211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,68001012904,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268033515,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079099301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185015701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505016601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079007301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084001611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315011701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,30698006001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054429925,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378021601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547040210,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079007320,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084001601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904717861,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084008111,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687060211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Blister,63700001,CDM,,,250,RC,68084059511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,53746010301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162010310,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,45963055711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714066301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67877022401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714050501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,71093012204,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228266711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00071080624,NDC,facility,both,0.25,EA,7.6,5.38,Aetna First Health,Commercial,,6.46,85,,,3.37,6.46,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904563361,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60505011400,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084059501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084077401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739098410,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904666761,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687060201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,45963055750,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079042601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45802094778,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111032201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729000301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001017900,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093725601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76439012510,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079042620,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084011211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00591084501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,10370074601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,64980028101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378043101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,59651027001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,16714089601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,59762503301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,59762054201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 10 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084011201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093834419,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084080711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093834401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155005801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,72241004005,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093936401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739011910,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084080701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093834405,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093834498,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378114201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253046210,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268037411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378119001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162071310,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079073501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378021401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781139301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832153011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781139313,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079073520,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172208960,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300012901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729018401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084093095,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143125401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603390121,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762007501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,54505033310,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904267460,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115170001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42543014201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 20 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084093025,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084047211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687059011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406324401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054026425,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858030201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107010801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527135401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,42858030225,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739079110,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054026424,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084047201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687059001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584074811,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687046811,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904585560,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746046601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162046610,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877032101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904585561,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084077201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739069110,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687046801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739044410,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,55111068405,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,53746046605,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,67877032105,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,42291033960,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 750 Each Box,63700001,CDM,,,250,RC,63739069101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
irbesartan 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547037603,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
irbesartan 300 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862063990,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084008311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268044911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143177201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884002201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001037500,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781169513,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084008301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739036710,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904662061,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079049901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382000801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13668004701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300011201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672413101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714070101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59746024601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079049920,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084031901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739017910,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904700861,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lifitegrast 5 % Solution 5 Each Plas Cont,63700001,CDM,,,250,RC,54092060606,NDC,facility,both,0.25,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
lifitegrast 5 % Solution 5 Each Plas Cont,63700001,CDM,,,250,RC,00078091105,NDC,facility,both,0.25,EA,11.41,8.08,Aetna First Health,Commercial,,9.7,85,,,5.06,9.7,percent of total billed charges,
lifitegrast 5 % Solution 5 Each Plas Cont,63700001,CDM,,,250,RC,00078091112,NDC,facility,both,0.25,EA,11.69,8.28,Aetna First Health,Commercial,,9.94,85,,,5.18,9.94,percent of total billed charges,
lisinopril 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687032511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084006111,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185010101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378207401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001021000,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180098001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547041610,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591040701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180051401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001033400,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079098220,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084019701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904648561,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687032501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904679861,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,63739034943,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687036711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687064911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079038701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315090601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781540801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591024201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304077401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904600960,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781537901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739050110,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904600961,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687064901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079038720,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084075401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687036701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 2 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00591024205,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382013706,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862020390,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180021209,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180037809,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382013716,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00603422602,NDC,facility,both,0.25,EA,6.85,4.85,Aetna First Health,Commercial,,5.82,85,,,3.04,5.82,percent of total billed charges,
lovastatin 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185007401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 40 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68180046907,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 40 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68001021406,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 40 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00185007460,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 10 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,60687010511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555077902,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762005601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687010521,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 40 MG TABLET SOLUBLE 100 Each Bottle,63700001,CDM,,,250,RC,00406054034,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084030111,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079017101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687041311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268054211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,49884040601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001011900,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00186109205,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,55111046801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,49884082701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527260237,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742061701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,69097040807,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,45963067711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001047000,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001035800,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62037083201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,64679073602,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084030101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,63739045410,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904632461,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687041301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084067301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 100 Each Disp Pack,63700001,CDM,,,250,RC,00186109239,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,51079017103,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,60687041365,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268054215,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,55111046805,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584026611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862006301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237010101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304058001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093073301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378003201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664047752,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742010801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584026601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904634161,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268056611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687040995,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00245021311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268056615,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
milnacipran 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00456155060,NDC,facility,both,0.25,EA,3.29,2.33,Aetna First Health,Commercial,,2.8,85,,,1.46,2.8,percent of total billed charges,
minoxidil 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591564301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884025701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489038701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084012011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079008701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739035610,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079008720,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084012001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107000334,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107000330,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714070801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 100 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687073511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 100 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084004001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 100 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00025145134,NDC,facility,both,0.25,EA,3.67,2.6,Aetna First Health,Commercial,,3.12,85,,,1.63,3.12,percent of total billed charges,
miSOPROStol 100 MCG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,59762500702,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 100 MCG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59762500701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 100 MCG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,43386016006,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 100 MCG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,70954044310,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687048311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084007811,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268062411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079058501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001038600,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001000300,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00115164501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084007801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687048301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268062415,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084074011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292001401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084074001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505311300,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904637661,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904628561,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292001420,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505311303,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598016630,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342007007,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111016630,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002411730,NDC,facility,both,0.25,EA,16.14,11.43,Aetna First Health,Commercial,,13.72,85,,,7.15,13.72,percent of total billed charges,
OXcarbazepine 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084086711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687073311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462013901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054009920,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084086701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904726461,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE CR 40 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,59011044010,NDC,facility,both,0.25,EA,7.52,5.32,Aetna First Health,Commercial,,6.39,85,,,3.33,6.39,percent of total billed charges,
PARoxetine 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382000106,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 64.8 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084098995,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 64.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603516721,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 64.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293062701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 64.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13517011201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 64.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571066701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 64.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,75826014110,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 64.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13517062701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084097495,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687058111,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00597018561,NDC,facility,both,0.25,EA,4.84,3.43,Aetna First Health,Commercial,,4.11,85,,,2.15,4.11,percent of total billed charges,
pramipexole 0.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084097425,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687058121,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668009390,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68462033290,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342003310,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687019011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079078220,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904589361,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687019001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093720298,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180048709,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,55111023190,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505017009,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00003519410,NDC,facility,both,0.25,EA,4.95,3.5,Aetna First Health,Commercial,,4.21,85,,,2.19,4.21,percent of total billed charges,
pregabalin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687050611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904700161,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687050601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00071101541,NDC,facility,both,0.25,EA,9.74,6.9,Aetna First Health,Commercial,,8.28,85,,,4.32,8.28,percent of total billed charges,
pregabalin 100 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,72205001490,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 100 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69097068105,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 100 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,64980041309,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 100 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00071101568,NDC,facility,both,0.25,EA,8.86,6.27,Aetna First Health,Commercial,,7.53,85,,,3.93,7.53,percent of total billed charges,
propranolol 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687029511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268070211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687060911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591555601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155011201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603548421,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378018401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111046901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115166101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238207901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687029501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079027920,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687060901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyridoxine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268085911,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904051860,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,87701040730,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,74312000650,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268085915,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
QUEtiapine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268063211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687034911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180044701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001018400,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093816201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877025001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714045401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054022125,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00310027110,NDC,facility,both,0.25,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054022120,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904664061,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687034901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739066510,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00310027139,NDC,facility,both,0.25,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
QUEtiapine 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268063215,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ramipril 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16252057201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ramipril 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001043000,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
repaglinide 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084096795,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
repaglinide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574024201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
repaglinide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862067201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
repaglinide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664074788,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
riboflavin 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,74312000640,NDC,facility,both,0.25,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
risperiDONE 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084027311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084027301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904636061,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382011514,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50458059360,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,51079034601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,07810531206,NDC,facility,both,0.25,EA,5.37,3.8,Aetna First Health,Commercial,,4.56,85,,,2.38,4.56,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00781531206,NDC,facility,both,0.25,EA,5.37,3.8,Aetna First Health,Commercial,,4.56,85,,,2.38,4.56,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884040152,NDC,facility,both,0.25,EA,5.81,4.11,Aetna First Health,Commercial,,4.94,85,,,2.57,4.94,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 20 Each Box,63700001,CDM,,,250,RC,51079034605,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,59746003022,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,00781531208,NDC,facility,both,0.25,EA,5.37,3.8,Aetna First Health,Commercial,,4.56,85,,,2.38,4.56,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,49884040191,NDC,facility,both,0.25,EA,5.81,4.11,Aetna First Health,Commercial,,4.94,85,,,2.57,4.94,percent of total billed charges,
risperiDONE 2 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,50458032528,NDC,facility,both,0.25,EA,13.43,9.51,Aetna First Health,Commercial,,11.42,85,,,5.95,11.42,percent of total billed charges,
rOPINIRole 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687058811,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268074311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084030711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462025501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547027010,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332003231,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378550101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904637461,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687058801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084030701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084031101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292003101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268071011,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,60687025611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687025601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904660461,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00310075239,NDC,facility,both,0.25,EA,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
rosuvastatin 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16252061730,NDC,facility,both,0.25,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
rosuvastatin 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268071015,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,57237017090,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714099001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505450409,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68462026390,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722088490,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,27808015701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862029590,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00310075290,NDC,facility,both,0.25,EA,8.07,5.71,Aetna First Health,Commercial,,6.86,85,,,3.58,6.86,percent of total billed charges,
sertraline 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687025311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762491004,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714061304,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862001301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378812701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59762491003,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084018201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687025301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00049491041,NDC,facility,both,0.25,EA,12.66,8.96,Aetna First Health,Commercial,,10.76,85,,,5.61,10.76,percent of total billed charges,
sertraline 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714061301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69097083502,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68180035302,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16729021716,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,76282021490,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180035309,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045520,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084051201,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739057210,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862005290,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382006716,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180047902,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714068302,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020811,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687048711,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079098001,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228267311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729022701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378043701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162051510,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746051501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687048701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084020801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,53489032907,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,69452034660,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,63304009911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62756052288,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,63304009919,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,62756052269,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,69452034672,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,55111029309,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,16714053311,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,16714079801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 100 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,00173073701,NDC,facility,both,0.25,EA,38.33,27.14,Aetna First Health,Commercial,,32.58,85,,,16.99,32.58,percent of total billed charges,
topiramate 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084034411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268075211,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079072801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084034401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079072820,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268075215,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382014005,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382014014,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68462010960,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,69097012403,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,69097081803,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50458064165,NDC,facility,both,0.25,EA,10.41,7.37,Aetna First Health,Commercial,,8.85,85,,,4.61,8.85,percent of total billed charges,
torsemide 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268075611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111091701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722053101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054007725,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862012701,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268075615,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687013911,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268078511,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687063411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687013901,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,51660014290,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59746036290,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342006410,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,67877041790,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 160 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00078035934,NDC,facility,both,0.25,EA,8.7,6.16,Aetna First Health,Commercial,,7.4,85,,,3.86,7.4,percent of total billed charges,
venlafaxine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093738301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382010101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015600,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332001231,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084048611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084048601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084071301,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904647061,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904707661,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 15 Each Bottle,63700001,CDM,,,250,RC,00008083620,NDC,facility,both,0.25,EA,7.81,5.53,Aetna First Health,Commercial,,6.64,85,,,3.46,6.64,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68382003606,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,65862069730,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,64679071801,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00008083621,NDC,facility,both,0.25,EA,18.27,12.94,Aetna First Health,Commercial,,15.53,85,,,8.1,15.53,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00093738698,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68382003616,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,65862069790,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00008083622,NDC,facility,both,0.25,EA,7.81,5.53,Aetna First Health,Commercial,,6.64,85,,,3.46,6.64,percent of total billed charges,
warfarin 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121589,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832121500,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093171601,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00056016870,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403101,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162076510,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555087402,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056016875,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121501,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084010611,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268081411,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 20 Each Box,63700001,CDM,,,250,RC,50268081412,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 40 Each Box,63700001,CDM,,,250,RC,63739050832,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 40 Each Box,63700001,CDM,,,250,RC,00904627208,NDC,facility,both,0.25,EA,5.08,3.6,Aetna First Health,Commercial,,4.32,85,,,2.25,4.32,percent of total billed charges,
ziprasidone 80 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001045306,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,59762200401,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68180033407,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001013906,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,55111025960,NDC,facility,both,0.25,EA,6.04,4.28,Aetna First Health,Commercial,,5.13,85,,,2.68,5.13,percent of total billed charges,
ziprasidone 80 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00049399060,NDC,facility,both,0.25,EA,13.56,9.6,Aetna First Health,Commercial,,11.53,85,,,6.01,11.53,percent of total billed charges,
ziprasidone 80 MG capsule 80 Each Box,63700001,CDM,,,250,RC,68084010609,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 80 MG capsule 80 Each Box,63700001,CDM,,,250,RC,00904627245,NDC,facility,both,0.25,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ZOLMitriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68462049840,NDC,facility,both,0.25,EA,4.37,3.09,Aetna First Health,Commercial,,3.71,85,,,1.94,3.71,percent of total billed charges,
ZOLMitriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68001025018,NDC,facility,both,0.25,EA,38.79,27.46,Aetna First Health,Commercial,,32.97,85,,,17.19,32.97,percent of total billed charges,
ZOLMitriptan 5 MG Tablet 3 Each Box,63700001,CDM,,,250,RC,68462049833,NDC,facility,both,0.25,EA,4.37,3.09,Aetna First Health,Commercial,,3.71,85,,,1.94,3.71,percent of total billed charges,
ZOLMitriptan 5 MG Tablet 3 Each Box,63700001,CDM,,,250,RC,68001025001,NDC,facility,both,0.25,EA,38.79,27.46,Aetna First Health,Commercial,,32.97,85,,,17.19,32.97,percent of total billed charges,
ZOLMitriptan 5 MG Tablet 3 Each Box,63700001,CDM,,,250,RC,64896067250,NDC,facility,both,0.25,EA,113.19,80.14,Aetna First Health,Commercial,,96.21,85,,,50.17,96.21,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 10 mL Cup,63700001,CDM,,,250,RC,00121127610,NDC,facility,both,0.25,ML,0.87,0.62,Aetna First Health,Commercial,,0.74,85,,,0.39,0.74,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 10 mL Cup,63700001,CDM,,,250,RC,69339015001,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,66689003201,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121090405,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,60687076040,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,60687076086,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG/ML Concentrate 120 mL Bottle,63700001,CDM,,,250,RC,00121058104,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 100 MG/5ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,66689002530,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG/ML Concentrate 120 mL Bottle,63700001,CDM,,,250,RC,00093960412,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 2 MG/ML Concentrate 120 mL Bottle,63700001,CDM,,,250,RC,54838050140,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121090494,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 100 MG/5ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00121082601,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 10 MG/0.5ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,66689002530,NDC,facility,both,0.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 100 MG/5ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00406855730,NDC,facility,both,0.25,ML,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
oxyCODONE 100 MG/5ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,71930002330,NDC,facility,both,0.25,ML,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
phytonadione 1 mL Ampule,63700001,CDM,,,250,RC,43598040511,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
phytonadione 1 mL Ampule,63700001,CDM,,,250,RC,43598040516,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
phytonadione 1 mL Ampule,63700001,CDM,,,250,RC,00409915831,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
phytonadione 1 mL Ampule,63700001,CDM,,,250,RC,00409915850,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
phytonadione 1 mL Ampule,63700001,CDM,,,250,RC,00409915811,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
phytonadione 1 mL Vial,63700001,CDM,,,250,RC,69097070831,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
phytonadione 1 mL Vial,63700001,CDM,,,250,RC,69097070896,NDC,facility,both,0.25,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
fluconazole 10 MG/ML Recon Susp 35 mL Bottle,63700001,CDM,,,250,RC,57237014935,NDC,facility,both,0.28571,ML,19.99,14.15,Aetna First Health,Commercial,,16.99,85,,,8.86,16.99,percent of total billed charges,
fluconazole 10 MG/ML Recon Susp 35 mL Bottle,63700001,CDM,,,250,RC,16714069501,NDC,facility,both,0.28571,ML,24.71,17.49,Aetna First Health,Commercial,,21,85,,,10.95,21,percent of total billed charges,
fluconazole 10 MG/ML Recon Susp 35 mL Bottle,63700001,CDM,,,250,RC,59762502901,NDC,facility,both,0.28571,ML,28.81,20.4,Aetna First Health,Commercial,,24.49,85,,,12.77,24.49,percent of total billed charges,
morphine ER 100 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00406839023,NDC,facility,both,0.3,EA,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
morphine ER 100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,60951065870,NDC,facility,both,0.3,EA,3.46,2.45,Aetna First Health,Commercial,,2.94,85,,,1.53,2.94,percent of total billed charges,
morphine ER 100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406839001,NDC,facility,both,0.3,EA,3.86,2.73,Aetna First Health,Commercial,,3.28,85,,,1.71,3.28,percent of total billed charges,
morphine ER 100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,42858080401,NDC,facility,both,0.3,EA,3.86,2.73,Aetna First Health,Commercial,,3.28,85,,,1.71,3.28,percent of total billed charges,
morphine ER 100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00228432311,NDC,facility,both,0.3,EA,3.86,2.73,Aetna First Health,Commercial,,3.28,85,,,1.71,3.28,percent of total billed charges,
morphine ER 100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378266101,NDC,facility,both,0.3,EA,3.86,2.73,Aetna First Health,Commercial,,3.28,85,,,1.71,3.28,percent of total billed charges,
phenytoin ER 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268066011,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378156001,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51672411101,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62756040201,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57664080888,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00071036924,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162021210,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862069201,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079090520,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00071036940,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084037601,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904618761,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,65162021250,NDC,facility,both,0.3,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
opium 10 MG/ML (1%) Tincture 118 mL Bottle,63700001,CDM,,,250,RC,62559015304,NDC,facility,both,0.3,ML,4,2.83,Aetna First Health,Commercial,,3.4,85,,,1.77,3.4,percent of total billed charges,
opium 10 MG/ML (1%) Tincture 118 mL Bottle,63700001,CDM,,,250,RC,42799021701,NDC,facility,both,0.3,ML,5.5,3.89,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228306311,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781234301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115148801,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43975033310,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406895301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42858021501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527551237,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,54092038501,NDC,facility,both,0.33333,EA,8.31,5.88,Aetna First Health,Commercial,,7.06,85,,,3.68,7.06,percent of total billed charges,
busPIRone 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687082311,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093100301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238111801,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729020301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300024601,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69584009310,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079096020,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,00591071818,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00378116591,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00591071860,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,64380074303,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,16729020312,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 75 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00832063211,NDC,facility,both,0.33333,EA,5.3,3.75,Aetna First Health,Commercial,,4.5,85,,,2.35,4.5,percent of total billed charges,
clomiPRAMINE 75 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,51672401305,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
coenzyme Q10 30 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00904501546,NDC,facility,both,0.33333,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
coenzyme Q10 30 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,80681010400,NDC,facility,both,0.33333,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dextroamphetamine SR 15 MG Capsule Extended Release 24 Hour 1 Each Box,63700001,CDM,,,250,RC,60687015011,NDC,facility,both,0.33333,EA,6.02,4.26,Aetna First Health,Commercial,,5.12,85,,,2.67,5.12,percent of total billed charges,
dextroamphetamine SR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406896201,NDC,facility,both,0.33333,EA,5.42,3.84,Aetna First Health,Commercial,,4.61,85,,,2.4,4.61,percent of total billed charges,
dilTIAZem 360 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,62037070030,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 360 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00781245631,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 360 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00258369190,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 90 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093032001,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980013501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115107201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382018901,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054043625,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,50268028811,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,60687074511,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,42292002101,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,00002327001,NDC,facility,both,0.33333,EA,8.48,6,Aetna First Health,Commercial,,7.21,85,,,3.76,7.21,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,42292002120,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,00904704561,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,60687074501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,68084069201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,00904636861,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,00904645461,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,47335038383,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,57237001930,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,27241009903,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,68001041504,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,68001025704,NDC,facility,both,0.33333,EA,7.62,5.39,Aetna First Health,Commercial,,6.48,85,,,3.38,6.48,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,66993007730,NDC,facility,both,0.33333,EA,7.63,5.4,Aetna First Health,Commercial,,6.49,85,,,3.38,6.49,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,00002327030,NDC,facility,both,0.33333,EA,10.91,7.72,Aetna First Health,Commercial,,9.27,85,,,4.84,9.27,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 30 Each Box,63700001,CDM,,,250,RC,50268028813,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,57237001990,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,51991074890,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
eszopiclone 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093553901,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fexofenadine 180 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45802057178,NDC,facility,both,0.33333,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
flecainide 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054001225,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559038201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054001221,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,70710113907,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68001025344,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00172541279,NDC,facility,both,0.33333,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
fluconazole 150 MG Tablet 1 Each Bottle,63700001,CDM,,,250,RC,68001025321,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,55111014571,NDC,facility,both,0.33333,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,68462010340,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,57237000511,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,68001025317,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,67405060301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,16714069211,NDC,facility,both,0.33333,EA,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,00172541211,NDC,facility,both,0.33333,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,55111014512,NDC,facility,both,0.33333,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,68001025320,NDC,facility,both,0.33333,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
gabapentin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084008011,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268034811,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687059111,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,53746010201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162010210,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862019901,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,45963055611,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714050401,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62756013802,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714066201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67877022301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228266611,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59762502701,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904563261,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60505011300,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084076201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739023610,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904666661,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687059101,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739068910,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,53746010205,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,65162010250,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,16714066202,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,49483060650,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,16714050402,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,69097094312,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,45963055650,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 3 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228285311,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584074711,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687045711,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746046501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111068301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877032001,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380080806,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162046510,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904585461,NDC,facility,both,0.33333,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084070301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739068410,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687045701,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,55111068305,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,53746046505,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,49483060350,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 750 Each Box,63700001,CDM,,,250,RC,63739068401,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687013611,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687046111,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172436660,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185011801,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001038300,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591060701,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001020600,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904593061,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687013601,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687046101,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904711161,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084088211,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904605361,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084088201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904712561,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084033801,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68180011416,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,65862024708,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,31722053812,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,50474059640,NDC,facility,both,0.33333,EA,15.61,11.05,Aetna First Health,Commercial,,13.27,85,,,6.92,13.27,percent of total billed charges,
levoFLOXacin 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180024201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084048301,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904635361,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458093010,NDC,facility,both,0.33333,EA,59.71,42.27,Aetna First Health,Commercial,,50.75,85,,,26.46,50.75,percent of total billed charges,
levoFLOXacin 750 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,68180024220,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 750 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111028130,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 30 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078037105,NDC,facility,both,0.33333,EA,15.06,10.66,Aetna First Health,Commercial,,12.8,85,,,6.67,12.8,percent of total billed charges,
norelgestromin-ethinyl estradiol 150-35 MCG/24HR PATCH WEEKLY 3 Each Box,63700001,CDM,,,250,RC,00378334053,NDC,facility,both,0.33333,EA,142.52,100.9,Aetna First Health,Commercial,,121.14,85,,,63.16,121.14,percent of total billed charges,
OLANZapine 7.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505311200,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 7.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598016530,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,59746030812,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,64380017401,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,55111026479,NDC,facility,both,0.33333,EA,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00093524719,NDC,facility,both,0.33333,EA,4.52,3.2,Aetna First Health,Commercial,,3.84,85,,,2,3.84,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,60687020811,NDC,facility,both,0.33333,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,66993068851,NDC,facility,both,0.33333,EA,12.49,8.84,Aetna First Health,Commercial,,10.62,85,,,5.54,10.62,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Box,63700001,CDM,,,250,RC,66993005581,NDC,facility,both,0.33333,EA,30.04,21.27,Aetna First Health,Commercial,,25.53,85,,,13.31,25.53,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 30 Each Bottle,63700001,CDM,,,250,RC,60505327703,NDC,facility,both,0.33333,EA,19.32,13.68,Aetna First Health,Commercial,,16.42,85,,,8.56,16.42,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,64380017402,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,55111026481,NDC,facility,both,0.33333,EA,4.37,3.09,Aetna First Health,Commercial,,3.71,85,,,1.94,3.71,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,00093524765,NDC,facility,both,0.33333,EA,4.51,3.19,Aetna First Health,Commercial,,3.83,85,,,2,3.83,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,59746030832,NDC,facility,both,0.33333,EA,5.64,3.99,Aetna First Health,Commercial,,4.79,85,,,2.5,4.79,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,66993068838,NDC,facility,both,0.33333,EA,12.49,8.84,Aetna First Health,Commercial,,10.62,85,,,5.54,10.62,percent of total billed charges,
oxyCODONE 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084018411,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406851523,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084097511,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228287811,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406851501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084018401,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406851562,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904718061,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084004611,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268064211,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084004601,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107015630,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382009906,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268064215,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382009916,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine CR 37.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,60505131803,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine CR 37.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,60505367503,NDC,facility,both,0.33333,EA,3.63,2.57,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
PARoxetine CR 37.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378200593,NDC,facility,both,0.33333,EA,5.29,3.75,Aetna First Health,Commercial,,4.5,85,,,2.34,4.5,percent of total billed charges,
pioglitazone 45 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342005607,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 45 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093727356,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 45 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093204656,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 45 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764045124,NDC,facility,both,0.33333,EA,20.13,14.25,Aetna First Health,Commercial,,17.11,85,,,8.92,17.11,percent of total billed charges,
pioglitazone 45 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093204698,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 45 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342005610,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687049511,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687049501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904700061,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00071101441,NDC,facility,both,0.33333,EA,12.99,9.2,Aetna First Health,Commercial,,11.04,85,,,5.76,11.04,percent of total billed charges,
pregabalin 75 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69097067905,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,43598029390,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,50228035290,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,72205001390,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 75 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00071101468,NDC,facility,both,0.33333,EA,11.81,8.36,Aetna First Health,Commercial,,10.04,85,,,5.23,10.04,percent of total billed charges,
traZODone 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084060811,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687043211,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268077611,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111044101,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489051701,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382080701,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111045001,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084060801,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904721261,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 150 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268077615,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079048201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084085611,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084033111,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382002101,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001016000,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237017501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714065801,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093738201,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093915701,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378488401,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079048220,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084033101,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084085601,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65162030709,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 120 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155048601,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 120 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904292461,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121489,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555092502,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403001,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832121400,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093171501,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162076410,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282033001,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056018875,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121401,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 60 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084010511,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 60 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268081311,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 60 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079035301,NDC,facility,both,0.33333,EA,6.77,4.79,Aetna First Health,Commercial,,5.75,85,,,3,5.75,percent of total billed charges,
ziprasidone 60 MG capsule 20 Each Box,63700001,CDM,,,250,RC,50268081312,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 60 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001045206,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 60 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16714083701,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 60 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001013806,NDC,facility,both,0.33333,EA,3.81,2.7,Aetna First Health,Commercial,,3.24,85,,,1.69,3.24,percent of total billed charges,
ziprasidone 60 MG capsule 80 Each Box,63700001,CDM,,,250,RC,68084010509,NDC,facility,both,0.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 250 MG/5ML Solution 6 mL Cup,63700001,CDM,,,250,RC,50383031106,NDC,facility,both,0.33333,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 15 mL Syringe,63700001,CDM,,,250,RC,88886800056,NDC,facility,both,0.33333,ML,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
gabapentin 250 MG/5ML Solution 6 mL Cup,63700001,CDM,,,250,RC,42192060806,NDC,facility,both,0.33333,ML,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
gabapentin 300 MG/6ML Solution 6 mL Cup,63700001,CDM,,,250,RC,42192060806,NDC,facility,both,0.33333,ML,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
gabapentin 250 MG/5ML Solution 6 mL Cup,63700001,CDM,,,250,RC,42192060840,NDC,facility,both,0.33333,ML,4.37,3.09,Aetna First Health,Commercial,,3.71,85,,,1.94,3.71,percent of total billed charges,
gabapentin 300 MG/6ML Solution 6 mL Cup,63700001,CDM,,,250,RC,42192060840,NDC,facility,both,0.33333,ML,4.37,3.09,Aetna First Health,Commercial,,3.71,85,,,1.94,3.71,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 400-400-40 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,00121176230,NDC,facility,both,0.33333,ML,4.41,3.12,Aetna First Health,Commercial,,3.75,85,,,1.95,3.75,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,00121477215,NDC,facility,both,0.33333,ML,4.74,3.36,Aetna First Health,Commercial,,4.03,85,,,2.1,4.03,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,00121231615,NDC,facility,both,0.33333,ML,5.44,3.85,Aetna First Health,Commercial,,4.62,85,,,2.41,4.62,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,00121231640,NDC,facility,both,0.33333,ML,9.64,6.83,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
multiple vitamin with minerals Liquid 15 mL Cup,63700001,CDM,,,250,RC,17856434401,NDC,facility,both,0.33333,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
multiple vitamin with minerals Liquid 15 mL Cup,63700001,CDM,,,250,RC,17856001002,NDC,facility,both,0.33333,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
propranolol LA 160 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378626001,NDC,facility,both,0.375,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 160 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43478090388,NDC,facility,both,0.375,EA,4.18,2.96,Aetna First Health,Commercial,,3.55,85,,,1.85,3.55,percent of total billed charges,
propranolol LA 160 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51991082001,NDC,facility,both,0.375,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
nitroglycerin CR 6.5 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,49483022210,NDC,facility,both,0.38462,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin CR 6.5 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00904064460,NDC,facility,both,0.38462,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acitretin 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,42794008308,NDC,facility,both,0.4,EA,43.07,30.49,Aetna First Health,Commercial,,36.61,85,,,19.09,36.61,percent of total billed charges,
amitriptyline 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079010701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687043311,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714044701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781148701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729017201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300042001,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70756020211,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079010720,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687043301,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904718461,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268008811,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687016811,NDC,facility,both,0.4,EA,11.51,8.15,Aetna First Health,Commercial,,9.78,85,,,5.1,9.78,percent of total billed charges,
ARIPiprazole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332009831,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729027901,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739007010,NDC,facility,both,0.4,EA,7.96,5.64,Aetna First Health,Commercial,,6.77,85,,,3.53,6.77,percent of total billed charges,
ARIPiprazole 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687016801,NDC,facility,both,0.4,EA,11.5,8.14,Aetna First Health,Commercial,,9.78,85,,,5.1,9.78,percent of total billed charges,
ARIPiprazole 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904651061,NDC,facility,both,0.4,EA,27.02,19.13,Aetna First Health,Commercial,,22.97,85,,,11.98,22.97,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13668021730,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862066230,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332009830,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714078401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722082030,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505267303,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598055530,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877043103,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162089703,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13811068030,NDC,facility,both,0.4,EA,11.66,8.26,Aetna First Health,Commercial,,9.91,85,,,5.17,9.91,percent of total billed charges,
ARIPiprazole 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268008815,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904651006,NDC,facility,both,0.4,EA,11.72,8.3,Aetna First Health,Commercial,,9.96,85,,,5.19,9.96,percent of total billed charges,
ARIPiprazole 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00904665640,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668021790,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65162089709,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687056711,NDC,facility,both,0.4,EA,5.13,3.63,Aetna First Health,Commercial,,4.36,85,,,2.27,4.36,percent of total billed charges,
atomoxetine 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,64980037503,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,55111052830,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,68462026730,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714075701,NDC,facility,both,0.4,EA,5.29,3.75,Aetna First Health,Commercial,,4.5,85,,,2.34,4.5,percent of total billed charges,
atomoxetine 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00002322830,NDC,facility,both,0.4,EA,18.45,13.06,Aetna First Health,Commercial,,15.68,85,,,8.18,15.68,percent of total billed charges,
atomoxetine 25 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687056721,NDC,facility,both,0.4,EA,5.13,3.63,Aetna First Health,Commercial,,4.36,85,,,2.27,4.36,percent of total billed charges,
ciprofloxacin 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687052811,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143992701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111012601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714065102,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862007601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16252051401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172531160,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571041110,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62135030801,NDC,facility,both,0.4,EA,4.12,2.92,Aetna First Health,Commercial,,3.5,85,,,1.83,3.5,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084006901,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687052801,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,55111012605,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084097295,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781197201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742011301,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084097225,NDC,facility,both,0.4,EA,3.02,2.14,Aetna First Health,Commercial,,2.57,85,,,1.34,2.57,percent of total billed charges,
diazePAM 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079028501,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172392660,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378034501,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591561901,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862006301,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00140000501,NDC,facility,both,0.4,EA,7.4,5.24,Aetna First Health,Commercial,,6.29,85,,,3.28,6.29,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079028520,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739007310,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904588061,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00603321428,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378034505,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687022811,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,62584097711,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084005511,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687022801,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,62584097701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084005501,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68084005530,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10370083211,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,24979002906,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,49884083211,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,49884083209,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,24979002907,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,50742025190,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 300 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00228257909,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378312501,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,27241016801,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904705361,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69238117009,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
empagliflozin 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00597015330,NDC,facility,both,0.4,EA,28.52,20.19,Aetna First Health,Commercial,,24.24,85,,,12.64,24.24,percent of total billed charges,
empagliflozin 25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00597015337,NDC,facility,both,0.4,EA,28.52,20.19,Aetna First Health,Commercial,,24.24,85,,,12.64,24.24,percent of total billed charges,
folic acid 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687068111,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162036110,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603316221,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,11534016501,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58657015001,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315012701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746036101,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079010520,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687068101,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904722461,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00182055400,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079007501,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687082211,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111032701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380073406,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722052001,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,75834012601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155000201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00182055489,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079007520,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584073301,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739012610,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904644161,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687082201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739032710,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079080601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067511,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155010601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378258701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093506101,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714008210,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462035301,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111030801,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67405067110,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42806016001,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155050101,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084025401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079080620,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739048610,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904661761,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687067501,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093506105,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781176401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180031201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315013401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64125013401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781176413,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268060411,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687029311,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51672400201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591578701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093081101,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084003201,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687029301,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268060415,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,51672400205,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079056601,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378061401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079056620,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70954021110,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69452024220,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084002711,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121389,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555083202,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672402901,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382006401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093171401,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282032901,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121301,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084002701,NDC,facility,both,0.4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,49999041130,NDC,facility,both,0.4,EA,3.28,2.32,Aetna First Health,Commercial,,2.79,85,,,1.45,2.79,percent of total billed charges,
diazePAM 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,68094075059,NDC,facility,both,0.4,ML,5.36,3.79,Aetna First Health,Commercial,,4.56,85,,,2.38,4.56,percent of total billed charges,
diazePAM 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,68094075062,NDC,facility,both,0.4,ML,5.36,3.79,Aetna First Health,Commercial,,4.56,85,,,2.38,4.56,percent of total billed charges,
lisdexamfetamine 70 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00406511701,NDC,facility,both,0.42857,EA,13.85,9.81,Aetna First Health,Commercial,,11.77,85,,,6.14,11.77,percent of total billed charges,
lisdexamfetamine 70 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59417010710,NDC,facility,both,0.42857,EA,19.39,13.73,Aetna First Health,Commercial,,16.48,85,,,8.59,16.48,percent of total billed charges,
linaclotide 145 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00456120130,NDC,facility,both,0.49655,EA,31.34,22.19,Aetna First Health,Commercial,,26.64,85,,,13.89,26.64,percent of total billed charges,
 cloBAZam 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687042311,NDC,facility,both,0.5,EA,4.55,3.22,Aetna First Health,Commercial,,3.87,85,,,2.02,3.87,percent of total billed charges,
 cloBAZam 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42571031501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
 cloBAZam 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67386031401,NDC,facility,both,0.5,EA,52.18,36.94,Aetna First Health,Commercial,,44.35,85,,,23.13,44.35,percent of total billed charges,
acetaZOLAMIDE 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268005411,NDC,facility,both,0.5,EA,4.7,3.33,Aetna First Health,Commercial,,4,85,,,2.08,4,percent of total billed charges,
acetaZOLAMIDE 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084054111,NDC,facility,both,0.5,EA,6.11,4.33,Aetna First Health,Commercial,,5.19,85,,,2.71,5.19,percent of total billed charges,
acetaZOLAMIDE 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687061911,NDC,facility,both,0.5,EA,6.11,4.33,Aetna First Health,Commercial,,5.19,85,,,2.71,5.19,percent of total billed charges,
acetaZOLAMIDE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527105001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672402301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70756072111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155028801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084010811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268006111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722077701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093894301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61442011201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304050401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084010801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739068210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904579061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
albuterol 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238134501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
albuterol 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489017701,NDC,facility,both,0.5,EA,8.23,5.83,Aetna First Health,Commercial,,7,85,,,3.65,7,percent of total billed charges,
allopurinol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079020501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079020517,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378013701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591554301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300034901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729013401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304053901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079020520,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584098801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904657161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739041010,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904704161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228202910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762372001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51991070501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862067701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781107701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253090110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00009005501,NDC,facility,both,0.5,EA,11.88,8.41,Aetna First Health,Commercial,,10.1,85,,,5.27,10.1,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079078920,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904585961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084067201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739066910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687038801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884011152,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aMILoride-hydroCHLOROthiazide 5-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555048302,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00245014789,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687043711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00245014701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739038710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084037101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904655661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687043701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382022705,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65862073205,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382022714,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862073260,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,51862024160,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093913306,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,59762153006,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268008411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687048811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687026311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904637061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084025901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687048801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687026301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00069153041,NDC,facility,both,0.5,EA,14.82,10.49,Aetna First Health,Commercial,,12.6,85,,,6.57,12.6,percent of total billed charges,
amLODIPine 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268008415,NDC,facility,both,0.5,EA,6.09,4.31,Aetna First Health,Commercial,,5.18,85,,,2.7,5.18,percent of total billed charges,
amLODIPine 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,67877019805,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59762153001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093716798,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,67877019890,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180072009,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382012216,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69097012705,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69097083705,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378520977,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,64679042201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amOXApine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591571401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862001701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714029903,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57237003101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 100 Each Box,63700001,CDM,,,250,RC,62584023801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00093310953,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,16714029902,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084093695,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555097202,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107007001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406889201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52343016201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185084201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714095001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527076237,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687049895,NDC,facility,both,0.5,EA,10.14,7.18,Aetna First Health,Commercial,,8.62,85,,,4.49,8.62,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406895201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42858061001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228305911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781233501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527551137,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115148701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,49884084001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,54092038301,NDC,facility,both,0.5,EA,12.47,8.83,Aetna First Health,Commercial,,10.6,85,,,5.53,10.6,percent of total billed charges,
ampicillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781214501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ampicillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67253018110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
apixaban 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00003089431,NDC,facility,both,0.5,EA,17.34,12.28,Aetna First Health,Commercial,,14.74,85,,,7.69,14.74,percent of total billed charges,
apixaban 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00003089421,NDC,facility,both,0.5,EA,17.34,12.28,Aetna First Health,Commercial,,14.74,85,,,7.69,14.74,percent of total billed charges,
atenolol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687060511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378021801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382002201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093078701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862016801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304062101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742010101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079075920,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687060501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,52427042990,NDC,facility,both,0.5,EA,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
atorvaSTATin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084009711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079020801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084056411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904629061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084009701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079020820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084056401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268009315,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904629006,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505257809,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378395077,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,55111012190,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268010611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687050311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687081511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832102400,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603240621,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527133001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172409660,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832105411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70710128501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,72888001001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904647561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687050301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904336561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268010615,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baricitinib 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002418230,NDC,facility,both,0.5,EA,159.83,113.16,Aetna First Health,Commercial,,135.86,85,,,70.84,135.86,percent of total billed charges,
benazepril 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268011011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benazepril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162075210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benazepril 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547033610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benazepril 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268011015,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687036811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832108100,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385010401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603243821,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603243421,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315013701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097082707,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084038801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687036801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904679061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084036511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832051189,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832051100,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162057210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832051101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
brexpiprazole 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148003713,NDC,facility,both,0.5,EA,85.84,60.77,Aetna First Health,Commercial,,72.96,85,,,38.04,72.96,percent of total billed charges,
brivaracetam 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50474057066,NDC,facility,both,0.5,EA,41.91,29.67,Aetna First Health,Commercial,,35.62,85,,,18.57,35.62,percent of total billed charges,
bumetanide 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079089201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038495,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268013111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185012901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093423301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714083201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832054111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42799012001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,14539070101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238149001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687038401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687038425,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268013115,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 1 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904701606,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buprenorphine 150 MCG FILM 1 Each Package,63700001,CDM,,,250,RC,59385002201,NDC,facility,both,0.5,EA,12.48,8.84,Aetna First Health,Commercial,,10.61,85,,,5.53,10.61,percent of total billed charges,
buprenorphine 150 MCG FILM 60 Each Box,63700001,CDM,,,250,RC,59385002260,NDC,facility,both,0.5,EA,12.48,8.84,Aetna First Health,Commercial,,10.61,85,,,5.53,10.61,percent of total billed charges,
buPROPion 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687035111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268014311,NDC,facility,both,0.5,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505015701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001019800,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001030900,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155019201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378043501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079094420,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904663661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687035101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268014315,NDC,facility,both,0.5,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
buPROPion SR 200 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,70436006001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 200 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00115544513,NDC,facility,both,0.5,EA,4.99,3.53,Aetna First Health,Commercial,,4.24,85,,,2.21,4.24,percent of total billed charges,
buPROPion SR 200 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00173072200,NDC,facility,both,0.5,EA,16.17,11.45,Aetna First Health,Commercial,,13.74,85,,,7.17,13.74,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687079311,NDC,facility,both,0.5,EA,4.43,3.14,Aetna First Health,Commercial,,3.77,85,,,1.96,3.77,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10370010203,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68001026404,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,45963014230,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,16729044410,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00904657304,NDC,facility,both,0.5,EA,4.07,2.88,Aetna First Health,Commercial,,3.46,85,,,1.8,3.46,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68180032009,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079098601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687081211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093005401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380074206,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591065801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729020201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115169101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300024501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24689090701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079098620,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093005405,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,64380074207,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,24689090705,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
caffeine 200 MG Tablet 16 Each Bottle,63700001,CDM,,,250,RC,00904795544,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
caffeine 200 MG Tablet 16 Each Box,63700001,CDM,,,250,RC,24385060173,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
caffeine 200 MG Tablet 16 Each Box,63700001,CDM,,,250,RC,49348077103,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
caffeine 200 MG Tablet 16 Each Box,63700001,CDM,,,250,RC,70677002101,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
caffeine 200 MG Tablet 16 Each Box,63700001,CDM,,,250,RC,46122045773,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
caffeine 200 MG Tablet 16 Each Box,63700001,CDM,,,250,RC,46017001816,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
caffeine 200 MG Tablet 40 Each Box,63700001,CDM,,,250,RC,46017001840,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcitRIOL 0.5 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,23155011901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.5 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,64380072406,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.5 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093735301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.5 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69452020820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.5 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62756096888,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687030411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143117101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781805201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69292052201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904504561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904710561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
captopril 12.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687030421,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084056111,NDC,facility,both,0.5,EA,5.88,4.16,Aetna First Health,Commercial,,5,85,,,2.61,5,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687058311,NDC,facility,both,0.5,EA,5.89,4.17,Aetna First Health,Commercial,,5.01,85,,,2.61,5.01,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51672412401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781508701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00832602311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781598701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078051105,NDC,facility,both,0.5,EA,3.23,2.29,Aetna First Health,Commercial,,2.75,85,,,1.43,2.75,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,68084056121,NDC,facility,both,0.5,EA,5.89,4.17,Aetna First Health,Commercial,,5.01,85,,,2.61,5.01,percent of total billed charges,
carBAMazepine XR 200 MG Tablet Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,60687058321,NDC,facility,both,0.5,EA,5.89,4.17,Aetna First Health,Commercial,,5.01,85,,,2.61,5.01,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084009211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228253810,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378007801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862007701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862085501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50228045701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093970101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62756051788,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739010710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904771861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,62756051713,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084009311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687066111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079088401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228253910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378008501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862085601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62756051888,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862007901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093970201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084009301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904623761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687066101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079088420,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00228253950,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084009411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687083611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228254010,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,72888010801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084009401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904623861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 50-200 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084028211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 50-200 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378009401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 50-200 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62756045788,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 50-200 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68001017200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 50-200 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084028201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084084311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382009201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015300,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093005101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862014201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378363101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084026101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904630061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084084301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079077120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093013501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015400,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862014301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378363201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382009301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462016301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084026201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904630161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084085401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382009305,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68462016305,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefpodoxime 200 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,65862009620,NDC,facility,both,0.5,EA,6.53,4.62,Aetna First Health,Commercial,,5.55,85,,,2.89,5.55,percent of total billed charges,
cefprozil 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093107701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefprozil 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714039801,NDC,facility,both,0.5,EA,3.92,2.78,Aetna First Health,Commercial,,3.33,85,,,1.74,3.33,percent of total billed charges,
cefUROXime 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687028311,NDC,facility,both,0.5,EA,8.02,5.68,Aetna First Health,Commercial,,6.82,85,,,3.55,6.82,percent of total billed charges,
cefUROXime 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,67877021620,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,65862070020,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,68180030320,NDC,facility,both,0.5,EA,6.22,4.4,Aetna First Health,Commercial,,5.29,85,,,2.76,5.29,percent of total billed charges,
cefUROXime 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,57237005920,NDC,facility,both,0.5,EA,6.22,4.4,Aetna First Health,Commercial,,5.29,85,,,2.76,5.29,percent of total billed charges,
cefUROXime 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862070060,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,67877021660,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,16714040102,NDC,facility,both,0.5,EA,5.52,3.91,Aetna First Health,Commercial,,4.69,85,,,2.45,4.69,percent of total billed charges,
cefUROXime 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68180030360,NDC,facility,both,0.5,EA,5.7,4.04,Aetna First Health,Commercial,,4.84,85,,,2.53,4.84,percent of total billed charges,
cefUROXime 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862003560,NDC,facility,both,0.5,EA,5.7,4.04,Aetna First Health,Commercial,,4.84,85,,,2.53,4.84,percent of total billed charges,
celecoxib 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268016911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084097611,NDC,facility,both,0.5,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
celecoxib 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687044711,NDC,facility,both,0.5,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
celecoxib 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079021501,NDC,facility,both,0.5,EA,8.8,6.23,Aetna First Health,Commercial,,7.48,85,,,3.9,7.48,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,13811066010,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69097042107,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862090901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714073301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378715001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62332014231,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093716601,NDC,facility,both,0.5,EA,7.96,5.64,Aetna First Health,Commercial,,6.77,85,,,3.53,6.77,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00025152531,NDC,facility,both,0.5,EA,13.44,9.52,Aetna First Health,Commercial,,11.42,85,,,5.96,11.42,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904650361,NDC,facility,both,0.5,EA,3.49,2.47,Aetna First Health,Commercial,,2.97,85,,,1.55,2.97,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084097601,NDC,facility,both,0.5,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687044701,NDC,facility,both,0.5,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079021520,NDC,facility,both,0.5,EA,8.8,6.23,Aetna First Health,Commercial,,7.48,85,,,3.9,7.48,percent of total billed charges,
celecoxib 200 MG capsule 20 Each Box,63700001,CDM,,,250,RC,68084097632,NDC,facility,both,0.5,EA,8.8,6.23,Aetna First Health,Commercial,,7.48,85,,,3.9,7.48,percent of total billed charges,
celecoxib 200 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268016915,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,69097042112,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 200 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,16714073302,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687016311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093314701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68180012201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862001901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00143989701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687016301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 100 Each Box,63700001,CDM,,,250,RC,62584023601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268015215,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,68180012202,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,42043014105,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cetirizine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079059701,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687016511,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68001043616,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378363701,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714027102,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904671760,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714079902,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904585260,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079059720,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904585261,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687016501,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904671761,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68001043696,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,45802091939,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00904585246,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714079901,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00904671740,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cetirizine 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,43598081115,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cetirizine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,49348093912,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,70677000602,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,24385099875,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
chlordiazePOXIDE 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079037520,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268016711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687031795,NDC,facility,both,0.5,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
chlorthalidone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687031711,NDC,facility,both,0.5,EA,3.94,2.79,Aetna First Health,Commercial,,3.35,85,,,1.75,3.35,percent of total billed charges,
chlorthalidone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378022201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664064888,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714080001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,75834010901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877069601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlorthalidone 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079005820,NDC,facility,both,0.5,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
chlorthalidone 25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687031725,NDC,facility,both,0.5,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
chlorthalidone 25 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268016715,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cilostazol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268017711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cilostazol 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268017715,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cilostazol 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054004421,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cilostazol 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093206406,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093474119,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084074411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084006611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13668001001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862000601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162005310,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378623201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505251903,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084074401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00093474193,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084006601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162005303,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,13668001005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clarithromycin 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268017911,NDC,facility,both,0.5,EA,3.92,2.78,Aetna First Health,Commercial,,3.33,85,,,1.74,3.33,percent of total billed charges,
clarithromycin 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084065195,NDC,facility,both,0.5,EA,8.72,6.17,Aetna First Health,Commercial,,7.41,85,,,3.86,7.41,percent of total billed charges,
clarithromycin 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687043511,NDC,facility,both,0.5,EA,8.72,6.17,Aetna First Health,Commercial,,7.41,85,,,3.86,7.41,percent of total billed charges,
clarithromycin 500 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084065125,NDC,facility,both,0.5,EA,8.72,6.17,Aetna First Health,Commercial,,7.41,85,,,3.86,7.41,percent of total billed charges,
clarithromycin 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00781196260,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clarithromycin 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00527193206,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clarithromycin 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862022660,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clarithromycin 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59746074360,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clarithromycin 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,64380090603,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clarithromycin 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382076214,NDC,facility,both,0.5,EA,6.33,4.48,Aetna First Health,Commercial,,5.38,85,,,2.81,5.38,percent of total billed charges,
clarithromycin 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68774012260,NDC,facility,both,0.5,EA,7.42,5.25,Aetna First Health,Commercial,,6.31,85,,,3.29,6.31,percent of total billed charges,
clindamycin 150 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084024311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591570801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63304069201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42571025101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862018501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00713317101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59762332801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739005910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084024301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904595961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,63304069205,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084081895,NDC,facility,both,0.5,EA,24.02,17.01,Aetna First Health,Commercial,,20.42,85,,,10.65,20.42,percent of total billed charges,
clomiPRAMINE 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62332040831,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70710106601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00832063111,NDC,facility,both,0.5,EA,7.95,5.63,Aetna First Health,Commercial,,6.76,85,,,3.52,6.76,percent of total billed charges,
clomiPRAMINE 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714085003,NDC,facility,both,0.5,EA,11.76,8.33,Aetna First Health,Commercial,,10,85,,,5.21,10,percent of total billed charges,
clomiPRAMINE 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781203701,NDC,facility,both,0.5,EA,11.8,8.35,Aetna First Health,Commercial,,10.03,85,,,5.23,10.03,percent of total billed charges,
clomiPRAMINE 50 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,27241021130,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 50 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714085001,NDC,facility,both,0.5,EA,16.15,11.43,Aetna First Health,Commercial,,13.73,85,,,7.16,13.73,percent of total billed charges,
clomiPRAMINE 50 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00406990703,NDC,facility,both,0.5,EA,69.17,48.97,Aetna First Health,Commercial,,58.79,85,,,30.66,58.79,percent of total billed charges,
clomiPRAMINE 50 MG capsule 30 Each Box,63700001,CDM,,,250,RC,68084081825,NDC,facility,both,0.5,EA,24.02,17.01,Aetna First Health,Commercial,,20.42,85,,,10.65,20.42,percent of total billed charges,
clomiPRAMINE 50 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,51672401205,NDC,facility,both,0.5,EA,15.74,11.14,Aetna First Health,Commercial,,13.38,85,,,6.98,13.38,percent of total billed charges,
clonazePAM 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079088101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687054411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093083201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228300311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729013600,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714075201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714046901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00004006801,NDC,facility,both,0.5,EA,4.47,3.16,Aetna First Health,Commercial,,3.8,85,,,1.98,3.8,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61269060510,NDC,facility,both,0.5,EA,4.47,3.16,Aetna First Health,Commercial,,3.8,85,,,1.98,3.8,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079088120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904610161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687054401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904722761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00185006305,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093083205,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00228300350,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16729013616,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16714046902,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584033901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904565761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687012401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079030020,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.2 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68001023803,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clorazepate 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378004001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clorazepate 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107032001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093440419,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093440401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378097201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862084501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00093440493,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687054801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
codeine 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527169801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
codeine 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054024425,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
codeine 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054024424,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cortisone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143970001,NDC,facility,both,0.5,EA,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
cyanocobalamin 500 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268085411,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 500 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333093725,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 500 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536355101,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 500 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,80681007200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyanocobalamin 500 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333093710,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 500 MCG Tablet 130 Each Bottle,63700001,CDM,,,250,RC,00904320713,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 500 MCG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268085415,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079064401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687055811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268019111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591565801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59746017706,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097084607,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547040010,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52817033210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093342201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300041501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702000701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084039701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739053110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687055801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904780961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00591565805,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dabigatran 150 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687075233,NDC,facility,both,0.5,EA,20.96,14.84,Aetna First Health,Commercial,,17.82,85,,,9.29,17.82,percent of total billed charges,
dabigatran 150 MG capsule 60 Each Box,63700001,CDM,,,250,RC,00597036082,NDC,facility,both,0.5,EA,5.79,4.1,Aetna First Health,Commercial,,4.92,85,,,2.57,4.92,percent of total billed charges,
dabigatran 150 MG capsule 60 Each Box,63700001,CDM,,,250,RC,00597013560,NDC,facility,both,0.5,EA,9.18,6.5,Aetna First Health,Commercial,,7.8,85,,,4.07,7.8,percent of total billed charges,
dantrolene 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,49884036301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dantrolene 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527322037,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dantrolene 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00115442201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dapagliflozin 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00310621030,NDC,facility,both,0.5,EA,33.96,24.04,Aetna First Health,Commercial,,28.87,85,,,15.05,28.87,percent of total billed charges,
dapagliflozin 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00310621039,NDC,facility,both,0.5,EA,33.96,24.04,Aetna First Health,Commercial,,28.87,85,,,15.05,28.87,percent of total billed charges,
demeclocycline 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584016311,NDC,facility,both,0.5,EA,22.07,15.63,Aetna First Health,Commercial,,18.76,85,,,9.78,18.76,percent of total billed charges,
demeclocycline 300 MG Tablet 48 Each Bottle,63700001,CDM,,,250,RC,65162055548,NDC,facility,both,0.5,EA,20.06,14.2,Aetna First Health,Commercial,,17.05,85,,,8.89,17.05,percent of total billed charges,
demeclocycline 300 MG Tablet 48 Each Bottle,63700001,CDM,,,250,RC,53746055548,NDC,facility,both,0.5,EA,20.06,14.2,Aetna First Health,Commercial,,17.05,85,,,8.89,17.05,percent of total billed charges,
demeclocycline 300 MG Tablet 48 Each Bottle,63700001,CDM,,,250,RC,42806014448,NDC,facility,both,0.5,EA,40.12,28.4,Aetna First Health,Commercial,,34.1,85,,,17.78,34.1,percent of total billed charges,
demeclocycline 300 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,62584016365,NDC,facility,both,0.5,EA,22.07,15.63,Aetna First Health,Commercial,,18.76,85,,,9.78,18.76,percent of total billed charges,
desmopressin 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687010911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084060611,NDC,facility,both,0.5,EA,3.32,2.35,Aetna First Health,Commercial,,2.82,85,,,1.47,2.82,percent of total billed charges,
desmopressin 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268022011,NDC,facility,both,0.5,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
desmopressin 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687072111,NDC,facility,both,0.5,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505025701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155048901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001057400,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69918010101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001032500,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462027501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714088301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093731601,NDC,facility,both,0.5,EA,6.66,4.72,Aetna First Health,Commercial,,5.66,85,,,2.95,5.66,percent of total billed charges,
desmopressin 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001023300,NDC,facility,both,0.5,EA,6.66,4.72,Aetna First Health,Commercial,,5.66,85,,,2.95,5.66,percent of total billed charges,
desmopressin 0.1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687072121,NDC,facility,both,0.5,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
desmopressin 0.1 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268022015,NDC,facility,both,0.5,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
desvenlafaxine succinate ER 100 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59762122203,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desvenlafaxine succinate ER 100 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,70436001304,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desvenlafaxine succinate ER 100 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00008122230,NDC,facility,both,0.5,EA,25.55,18.09,Aetna First Health,Commercial,,21.72,85,,,11.32,21.72,percent of total billed charges,
dexAMETHasone 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054417925,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexAMETHasone 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054817925,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078038105,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781568901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664037888,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702010701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,27808009201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555095302,NDC,facility,both,0.5,EA,4.41,3.12,Aetna First Health,Commercial,,3.75,85,,,1.95,3.75,percent of total billed charges,
dextroamphetamine SR 10 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687014111,NDC,facility,both,0.5,EA,7.1,5.03,Aetna First Health,Commercial,,6.03,85,,,3.15,6.03,percent of total billed charges,
dextroamphetamine SR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406896101,NDC,facility,both,0.5,EA,6.38,4.52,Aetna First Health,Commercial,,5.42,85,,,2.83,5.42,percent of total billed charges,
dextroamphetamine SR 10 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,45963030409,NDC,facility,both,0.5,EA,6.38,4.52,Aetna First Health,Commercial,,5.42,85,,,2.83,5.42,percent of total billed charges,
dextroamphetamine SR 10 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,51862034590,NDC,facility,both,0.5,EA,6.38,4.52,Aetna First Health,Commercial,,5.42,85,,,2.83,5.42,percent of total billed charges,
diazePAM 20 MG Gel 1 Each Box,63700001,CDM,,,250,RC,00093613932,NDC,facility,both,0.5,EA,534.46,378.4,Aetna First Health,Commercial,,454.29,85,,,236.87,454.29,percent of total billed charges,
dicloxacillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093312501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicloxacillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781225801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079011901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378162001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591079501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527128201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079011920,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904698861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diflunisal 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093075501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diflunisal 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093922201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diflunisal 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093075506,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diflunisal 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,64980018106,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diflunisal 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,14539067306,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diflunisal 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093922206,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292000301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687054011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527132401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143124001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115981101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714059001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238199101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378615501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904592161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292000320,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687054001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084036601,NDC,facility,both,0.5,EA,3.62,2.56,Aetna First Health,Commercial,,3.08,85,,,1.6,3.08,percent of total billed charges,
digoxin 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,24987024256,NDC,facility,both,0.5,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
dilTIAZem 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687072811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687057311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739008010,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687057301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378004505,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687021711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,63739001610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687021701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904721961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084005401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68084005430,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10370083111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,62037059990,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68682099798,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,10370083109,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,50742025090,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,49884083109,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CR 120 MG Capsule Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079092601,NDC,facility,both,0.5,EA,9.5,6.73,Aetna First Health,Commercial,,8.07,85,,,4.21,8.07,percent of total billed charges,
dilTIAZem CR 120 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378612001,NDC,facility,both,0.5,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
dilTIAZem CR 120 MG Capsule Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,51079092620,NDC,facility,both,0.5,EA,9.51,6.73,Aetna First Health,Commercial,,8.08,85,,,4.21,8.08,percent of total billed charges,
dipyridamole 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382018801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054043525,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980013401,NDC,facility,both,0.5,EA,3.34,2.36,Aetna First Health,Commercial,,2.84,85,,,1.48,2.84,percent of total billed charges,
dipyridamole 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904108761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
disulfiram 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51285052402,NDC,facility,both,0.5,EA,17.01,12.04,Aetna First Health,Commercial,,14.46,85,,,7.54,14.46,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,00245018189,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084077695,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084077611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 1 Each Box,63700001,CDM,,,250,RC,00832712389,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,62756079788,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00245018111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00378104401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00832712311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,68084077601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00832712301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 60 Each Box,63700001,CDM,,,250,RC,68084077635,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268026011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084041511,NDC,facility,both,0.5,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079076701,NDC,facility,both,0.5,EA,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084041593,NDC,facility,both,0.5,EA,4.41,3.12,Aetna First Health,Commercial,,3.75,85,,,1.95,3.75,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378047301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001010600,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,16714048501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,65862059501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,10370051110,NDC,facility,both,0.5,EA,5.71,4.04,Aetna First Health,Commercial,,4.85,85,,,2.53,4.85,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00074712613,NDC,facility,both,0.5,EA,8.15,5.77,Aetna First Health,Commercial,,6.93,85,,,3.61,6.93,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904636461,NDC,facility,both,0.5,EA,3.61,2.56,Aetna First Health,Commercial,,3.07,85,,,1.6,3.07,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084041501,NDC,facility,both,0.5,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,50268026013,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 80 Each Box,63700001,CDM,,,250,RC,51079076708,NDC,facility,both,0.5,EA,4.35,3.08,Aetna First Health,Commercial,,3.7,85,,,1.93,3.7,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 80 Each Box,63700001,CDM,,,250,RC,00904636445,NDC,facility,both,0.5,EA,4.41,3.12,Aetna First Health,Commercial,,3.75,85,,,1.95,3.75,percent of total billed charges,
dofetilide 250 MCG capsule 14 Each Bottle,63700001,CDM,,,250,RC,00069581061,NDC,facility,both,0.5,EA,7.62,5.39,Aetna First Health,Commercial,,6.48,85,,,3.38,6.48,percent of total billed charges,
dofetilide 250 MCG capsule 40 Each Box,63700001,CDM,,,250,RC,00069581043,NDC,facility,both,0.5,EA,19.39,13.73,Aetna First Health,Commercial,,16.48,85,,,8.59,16.48,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,69452013217,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,59651011960,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16729049112,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,42291041260,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,47335006286,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,59762003802,NDC,facility,both,0.5,EA,7.29,5.16,Aetna First Health,Commercial,,6.2,85,,,3.23,6.2,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00069581060,NDC,facility,both,0.5,EA,8.8,6.23,Aetna First Health,Commercial,,7.48,85,,,3.9,7.48,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16714084101,NDC,facility,both,0.5,EA,9.56,6.77,Aetna First Health,Commercial,,8.13,85,,,4.24,8.13,percent of total billed charges,
dofetilide 250 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,51862002560,NDC,facility,both,0.5,EA,11.98,8.48,Aetna First Health,Commercial,,10.18,85,,,5.31,10.18,percent of total billed charges,
donepezil 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084047811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687030311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687018211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084047801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904640961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687030301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59762024603,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084073401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904647861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62856024630,NDC,facility,both,0.5,EA,26.86,19.02,Aetna First Health,Commercial,,22.83,85,,,11.9,22.83,percent of total billed charges,
donepezil 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668010390,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59746033090,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093073998,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084085111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084085195,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268022311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378402201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762232006,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729041401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505009400,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382078401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093812101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762242007,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904552361,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079095820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084085125,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 30 Each Disp Pack,63700001,CDM,,,250,RC,68645046370,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 6 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00228331603,NDC,facility,both,0.5,EA,22.88,16.2,Aetna First Health,Commercial,,19.45,85,,,10.14,19.45,percent of total billed charges,
doxepin 6 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42847010630,NDC,facility,both,0.5,EA,31.43,22.25,Aetna First Health,Commercial,,26.72,85,,,13.93,26.72,percent of total billed charges,
doxycycline hyclate 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268027811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687051311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687011811,NDC,facility,both,0.5,EA,4.67,3.31,Aetna First Health,Commercial,,3.97,85,,,2.07,3.97,percent of total billed charges,
doxycycline hyclate 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904042861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 30 Each Box,63700001,CDM,,,250,RC,00904042804,NDC,facility,both,0.5,EA,3.74,2.65,Aetna First Health,Commercial,,3.18,85,,,1.66,3.18,percent of total billed charges,
doxycycline hyclate 100 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687011821,NDC,facility,both,0.5,EA,4.67,3.31,Aetna First Health,Commercial,,3.97,85,,,2.07,3.97,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00143980350,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,67405065155,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,47781049050,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,69238110002,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,53489011902,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,59762369001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00143314250,NDC,facility,both,0.5,EA,4.03,2.85,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00069095050,NDC,facility,both,0.5,EA,11.36,8.04,Aetna First Health,Commercial,,9.66,85,,,5.03,9.66,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268027815,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,60687051365,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,00904042806,NDC,facility,both,0.5,EA,3.58,2.53,Aetna First Health,Commercial,,3.04,85,,,1.59,3.04,percent of total billed charges,
doxycycline hyclate 100 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,47781049005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,00143314205,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,00143980305,NDC,facility,both,0.5,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
doxycycline hyclate 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584069311,NDC,facility,both,0.5,EA,6.7,4.74,Aetna First Health,Commercial,,5.7,85,,,2.97,5.7,percent of total billed charges,
doxycycline hyclate 100 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904043004,NDC,facility,both,0.5,EA,6.35,4.5,Aetna First Health,Commercial,,5.4,85,,,2.81,5.4,percent of total billed charges,
doxycycline hyclate 100 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,62584069321,NDC,facility,both,0.5,EA,6.71,4.75,Aetna First Health,Commercial,,5.7,85,,,2.97,5.7,percent of total billed charges,
doxycycline hyclate 100 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00143211250,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,42806031250,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 100 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00904043006,NDC,facility,both,0.5,EA,3.82,2.7,Aetna First Health,Commercial,,3.25,85,,,1.69,3.25,percent of total billed charges,
droNABinol 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084017511,NDC,facility,both,0.5,EA,17.16,12.15,Aetna First Health,Commercial,,14.59,85,,,7.61,14.59,percent of total billed charges,
droNABinol 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687038611,NDC,facility,both,0.5,EA,25.06,17.74,Aetna First Health,Commercial,,21.3,85,,,11.11,21.3,percent of total billed charges,
droNABinol 5 MG capsule 30 Each Box,63700001,CDM,,,250,RC,00904674604,NDC,facility,both,0.5,EA,16.87,11.94,Aetna First Health,Commercial,,14.34,85,,,7.48,14.34,percent of total billed charges,
droNABinol 5 MG capsule 30 Each Box,63700001,CDM,,,250,RC,00904659804,NDC,facility,both,0.5,EA,16.87,11.94,Aetna First Health,Commercial,,14.34,85,,,7.48,14.34,percent of total billed charges,
droNABinol 5 MG capsule 30 Each Box,63700001,CDM,,,250,RC,68084017521,NDC,facility,both,0.5,EA,17.16,12.15,Aetna First Health,Commercial,,14.59,85,,,7.61,14.59,percent of total billed charges,
droNABinol 5 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687038621,NDC,facility,both,0.5,EA,17.16,12.15,Aetna First Health,Commercial,,14.59,85,,,7.61,14.59,percent of total billed charges,
droNABinol 5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,42858086806,NDC,facility,both,0.5,EA,3.65,2.58,Aetna First Health,Commercial,,3.1,85,,,1.62,3.1,percent of total billed charges,
droNABinol 5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,67877075460,NDC,facility,both,0.5,EA,6.01,4.26,Aetna First Health,Commercial,,5.11,85,,,2.66,5.11,percent of total billed charges,
droNABinol 5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,17478076206,NDC,facility,both,0.5,EA,6.15,4.35,Aetna First Health,Commercial,,5.23,85,,,2.73,5.23,percent of total billed charges,
eletriptan 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00049234079,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
eletriptan 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00378428832,NDC,facility,both,0.5,EA,7.67,5.43,Aetna First Health,Commercial,,6.52,85,,,3.4,6.52,percent of total billed charges,
eletriptan 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093831119,NDC,facility,both,0.5,EA,32.27,22.85,Aetna First Health,Commercial,,27.43,85,,,14.3,27.43,percent of total billed charges,
eletriptan 40 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,00378428885,NDC,facility,both,0.5,EA,20.91,14.8,Aetna First Health,Commercial,,17.77,85,,,9.27,17.77,percent of total billed charges,
eletriptan 40 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,00093831118,NDC,facility,both,0.5,EA,32.27,22.85,Aetna First Health,Commercial,,27.43,85,,,14.3,27.43,percent of total billed charges,
eletriptan 40 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,00049234045,NDC,facility,both,0.5,EA,63.13,44.7,Aetna First Health,Commercial,,53.66,85,,,27.98,53.66,percent of total billed charges,
enalapril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378105201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714044301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547054610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679092402,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904550261,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084039001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
erythromycin base 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24338010413,NDC,facility,both,0.5,EA,20.39,14.44,Aetna First Health,Commercial,,17.33,85,,,9.04,17.33,percent of total billed charges,
erythromycin base 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,52536010503,NDC,facility,both,0.5,EA,24.8,17.56,Aetna First Health,Commercial,,21.08,85,,,10.99,21.08,percent of total billed charges,
erythromycin base 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69238148503,NDC,facility,both,0.5,EA,27.92,19.77,Aetna First Health,Commercial,,23.73,85,,,12.37,23.73,percent of total billed charges,
erythromycin base 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,24338010403,NDC,facility,both,0.5,EA,30.61,21.67,Aetna First Health,Commercial,,26.02,85,,,13.57,26.02,percent of total billed charges,
erythromycin delayed release 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,24338012613,NDC,facility,both,0.5,EA,13.01,9.21,Aetna First Health,Commercial,,11.06,85,,,5.77,11.06,percent of total billed charges,
escitalopram 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093585119,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00456201011,NDC,facility,both,0.5,EA,11.99,8.49,Aetna First Health,Commercial,,10.19,85,,,5.31,10.19,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093585101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001019600,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862037401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729016901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547028110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001045500,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00456201001,NDC,facility,both,0.5,EA,11.76,8.33,Aetna First Health,Commercial,,10,85,,,5.21,10,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904631461,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084061701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904642661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079054320,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00456201063,NDC,facility,both,0.5,EA,11.99,8.49,Aetna First Health,Commercial,,10.19,85,,,5.31,10.19,percent of total billed charges,
escitalopram 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378385677,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
esterified estrogens 1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61570007401,NDC,facility,both,0.5,EA,3.87,2.74,Aetna First Health,Commercial,,3.29,85,,,1.72,3.29,percent of total billed charges,
estradiol 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268029111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555088602,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591048701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862033301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42806008801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70954056510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
eszopiclone 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462038301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093811856,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342002507,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722070730,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714061501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505324603,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famciclovir 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00054019713,NDC,facility,both,0.5,EA,4.34,3.07,Aetna First Health,Commercial,,3.69,85,,,1.92,3.69,percent of total billed charges,
famotidine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084017211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268030311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687059511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268029911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172572860,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679093602,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61442012101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001024000,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862085901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001039700,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332000131,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739048410,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739064510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687059501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904719361,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 25 Each Bottle,63700001,CDM,,,250,RC,49348081705,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 20 MG Tablet 25 Each Box,63700001,CDM,,,250,RC,87701040213,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 20 MG Tablet 25 Each Box,63700001,CDM,,,250,RC,24385038563,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68001024004,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,49348081709,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,16837085550,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268030315,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268029915,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,16837085516,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00172572870,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
febuxostat 80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764067730,NDC,facility,both,0.5,EA,19.25,13.63,Aetna First Health,Commercial,,16.36,85,,,8.53,16.36,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079046701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,53489036901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378501201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68462023401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,13668013301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00603358221,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,69367026501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,23155004901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,57237010901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,51079046720,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,13668013305,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 5 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,13668013390,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268032111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054001125,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162064210,NDC,facility,both,0.5,EA,5.62,3.98,Aetna First Health,Commercial,,4.78,85,,,2.49,4.78,percent of total billed charges,
flecainide 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054001120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054001121,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00172541100,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268033711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70710113801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172541160,NDC,facility,both,0.5,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
fluconazole 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904650061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084072801,NDC,facility,both,0.5,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68462010230,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714069101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,57237000430,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68001025204,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67405060203,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111014430,NDC,facility,both,0.5,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59762501601,NDC,facility,both,0.5,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
fluconazole 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268033715,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fludrocortisone 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268033011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fludrocortisone 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555099702,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fludrocortisone 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115703301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fludrocortisone 0.1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084028801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fludrocortisone 0.1 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268033015,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flurbiprofen 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378009301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378041201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559015901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505016501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185002701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079099220,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079007201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084001411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378020801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781181801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315011601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,30698006701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547040110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054429725,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172290860,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054829725,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079007220,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904579661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904717761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084001401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687022411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084047301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687022401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268035015,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16714010105,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722022560,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,16714010102,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,69097082103,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093067006,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268035911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093725501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45802082278,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729000201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001017800,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111032101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61442011601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079042520,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084032601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268035915,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079081101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687070111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505014200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781145301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079081120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00591084401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,10370074501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,64980028001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,59651026901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,16714089501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,59762503201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084011101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,59651026905,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079087201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64720012410,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155005701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093834301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,72241003905,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862002901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079087220,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093803501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378112501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143991901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253046110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00009035201,NDC,facility,both,0.5,EA,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
glyBURIDE micronized 3 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093803505,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glycerin 1.2 g Suppository 1 Each Box,63700001,CDM,,,250,RC,00713010206,NDC,facility,both,0.5,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
glycerin 1.2 g Suppository 25 Each Jar,63700001,CDM,,,250,RC,46122022263,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glycerin 1.2 g Suppository 25 Each Jar,63700001,CDM,,,250,RC,00713010226,NDC,facility,both,0.5,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
guanFACINE 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378116001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591044401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162071110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300045801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746071101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42806004801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guanFACINE 1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084074825,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079073401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378025701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781139201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832152011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781139213,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079073420,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904592361,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172208360,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603385621,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300012801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729018301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547039710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315013101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084008601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687059301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,51407033190,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762007401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115169701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380097106,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603390021,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00009003101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,54505033210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42543014101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42543097106,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687058201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084046901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904718861,NDC,facility,both,0.5,EA,3.14,2.22,Aetna First Health,Commercial,,2.67,85,,,1.39,2.67,percent of total billed charges,
hydrocortisone 25 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,42494030100,NDC,facility,both,0.5,EA,20.27,14.35,Aetna First Health,Commercial,,17.23,85,,,8.98,17.23,percent of total billed charges,
hydrocortisone 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,50268041112,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,16477020112,NDC,facility,both,0.5,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
hydrocortisone 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,43199002112,NDC,facility,both,0.5,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
hydrocortisone 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,42494030112,NDC,facility,both,0.5,EA,23.17,16.4,Aetna First Health,Commercial,,19.69,85,,,10.27,19.69,percent of total billed charges,
hydrocortisone 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,65649041112,NDC,facility,both,0.5,EA,73.56,52.08,Aetna First Health,Commercial,,62.53,85,,,32.6,62.53,percent of total billed charges,
hydrocortisone 25 MG Suppository 24 Each Box,63700001,CDM,,,250,RC,16477020124,NDC,facility,both,0.5,EA,7.29,5.16,Aetna First Health,Commercial,,6.2,85,,,3.23,6.2,percent of total billed charges,
hydrocortisone 25 MG Suppository 24 Each Box,63700001,CDM,,,250,RC,00713050324,NDC,facility,both,0.5,EA,21.85,15.47,Aetna First Health,Commercial,,18.57,85,,,9.68,18.57,percent of total billed charges,
HYDROmorphone 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687057911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406324301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858030101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59011045210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,42858030125,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084042301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739027510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687057901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59011045201,NDC,facility,both,0.5,EA,3.1,2.19,Aetna First Health,Commercial,,2.64,85,,,1.37,2.64,percent of total billed charges,
ibuprofen 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584074611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687044611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877031901,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162046410,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49483060201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746046401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904585360,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877029401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584074601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904585361,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084065801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739067210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687044601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739013510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 400 MG Tablet 750 Each Box,63700001,CDM,,,250,RC,63739067201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228257111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378008001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559051101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079019101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093403001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68462030201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079019120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isoniazid 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079008301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isoniazid 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687055311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isoniazid 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555007102,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isoniazid 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079008320,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isoniazid 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687055301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isoniazid 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00555007101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084008211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268044811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781155601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001037400,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001022500,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739056910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084008201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904661961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781155613,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904634661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268044815,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62175010701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687079411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175011937,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742017601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,13668010501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00143226001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00603411121,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084059201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904645061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,62175011941,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ivabradine 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,55513080060,NDC,facility,both,0.5,EA,17.39,12.31,Aetna First Health,Commercial,,14.78,85,,,7.71,14.78,percent of total billed charges,
ketoconazole 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378026101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ketoconazole 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380082706,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ketoconazole 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672402601,NDC,facility,both,0.5,EA,3.88,2.75,Aetna First Health,Commercial,,3.3,85,,,1.72,3.3,percent of total billed charges,
ketoconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,53489055407,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ketoconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,35573043330,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ketoconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,51672402606,NDC,facility,both,0.5,EA,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
labetalol 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079092901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687012511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687045011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084045611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185011701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591060601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884012301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382079901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001038200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739036610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904592961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687045001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084045601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079092920,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lacosamide 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687069811,NDC,facility,both,0.5,EA,5.69,4.03,Aetna First Health,Commercial,,4.84,85,,,2.52,4.84,percent of total billed charges,
lacosamide 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722081560,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lacosamide 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00131248035,NDC,facility,both,0.5,EA,34.14,24.17,Aetna First Health,Commercial,,29.02,85,,,15.13,29.02,percent of total billed charges,
lacosamide 200 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,00904724768,NDC,facility,both,0.5,EA,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
lacosamide 200 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,00131248060,NDC,facility,both,0.5,EA,37.55,26.59,Aetna First Health,Commercial,,31.92,85,,,16.64,31.92,percent of total billed charges,
lamoTRIgine XR 100 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,55111071930,NDC,facility,both,0.5,EA,19.64,13.91,Aetna First Health,Commercial,,16.69,85,,,8.7,16.69,percent of total billed charges,
lansoprazole 30 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,00378803093,NDC,facility,both,0.5,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
lanthanum carbonate 500 MG Tablet Chewable 45 Each Bottle,63700001,CDM,,,250,RC,68180081952,NDC,facility,both,0.5,EA,9.72,6.88,Aetna First Health,Commercial,,8.26,85,,,4.31,8.26,percent of total billed charges,
lanthanum carbonate 500 MG Tablet Chewable 45 Each Bottle,63700001,CDM,,,250,RC,68180081942,NDC,facility,both,0.5,EA,9.72,6.88,Aetna First Health,Commercial,,8.26,85,,,4.31,8.26,percent of total billed charges,
lanthanum carbonate 500 MG Tablet Chewable 45 Each Bottle,63700001,CDM,,,250,RC,54092025245,NDC,facility,both,0.5,EA,16.36,11.58,Aetna First Health,Commercial,,13.91,85,,,7.25,13.91,percent of total billed charges,
lanthanum carbonate 500 MG Tablet Chewable 45 Each Bottle,63700001,CDM,,,250,RC,66993042247,NDC,facility,both,0.5,EA,18.89,13.37,Aetna First Health,Commercial,,16.06,85,,,8.37,16.06,percent of total billed charges,
lanthanum carbonate 500 MG Tablet Chewable 45 Each Bottle,63700001,CDM,,,250,RC,66993042285,NDC,facility,both,0.5,EA,18.89,13.37,Aetna First Health,Commercial,,16.06,85,,,8.37,16.06,percent of total billed charges,
lanthanum carbonate 500 MG Tablet Chewable 45 Each Bottle,63700001,CDM,,,250,RC,54092025290,NDC,facility,both,0.5,EA,21.01,14.88,Aetna First Health,Commercial,,17.86,85,,,9.31,17.86,percent of total billed charges,
leflunomide 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70710115803,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
leflunomide 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,10702027803,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
leflunomide 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,23155004403,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
leflunomide 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093017456,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
leflunomide 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00955173730,NDC,facility,both,0.5,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
leflunomide 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332006230,NDC,facility,both,0.5,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
leflunomide 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268047815,NDC,facility,both,0.5,EA,3.39,2.4,Aetna First Health,Commercial,,2.88,85,,,1.5,2.88,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079082120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084033701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904605261,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50268046811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739041110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904712461,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687065701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68180011316,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,43547022215,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68001011707,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00378561578,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,16714035501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68001040307,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,65862024608,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,31722053712,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,50474059540,NDC,facility,both,0.5,EA,17.28,12.23,Aetna First Health,Commercial,,14.69,85,,,7.66,14.69,percent of total billed charges,
levETIRAcetam 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16714035502,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68001040303,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180011309,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180024101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382001601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084048201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904635261,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458092510,NDC,facility,both,0.5,EA,47.83,33.86,Aetna First Health,Commercial,,40.66,85,,,21.2,40.66,percent of total billed charges,
levoFLOXacin 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,65862053750,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,55111028050,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,68180024108,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,31722072250,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,33342002208,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,69097028970,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,50458092550,NDC,facility,both,0.5,EA,52.56,37.21,Aetna First Health,Commercial,,44.68,85,,,23.29,44.68,percent of total billed charges,
levomilnacipran ER 40 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00456224030,NDC,facility,both,0.5,EA,29.24,20.7,Aetna First Health,Commercial,,24.85,85,,,12.96,24.85,percent of total billed charges,
levothyroxine 200 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687055211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 200 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238184001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 200 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378181901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 200 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180097501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 200 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00074714811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 200 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687055201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 200 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074714890,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 200 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518992,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079044001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687046411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378180301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00074455211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079044020,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687046401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074455290,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518192,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378180377,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 50 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00527328146,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084006011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079098101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687066711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378207301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180051301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603421021,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547035210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001033300,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547041510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591040601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185060501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185540001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001020700,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 300 Each Punchcard,63700001,CDM,,,250,RC,51079098156,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00603421002,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054252725,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68462022101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00143318901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00054852725,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60505250403,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loratadine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084024811,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268048911,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68001043816,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 10 Each Box,63700001,CDM,,,250,RC,24385047152,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loratadine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45802065078,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904579361,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084024801,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904685261,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68001043896,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68001043804,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904685207,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loratadine 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268048915,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
LORazepam 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084008911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079038601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687035511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687063811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591024101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904600860,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315090501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304077301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093342601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64125090501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228205910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00187006401,NDC,facility,both,0.5,EA,34.69,24.56,Aetna First Health,Commercial,,29.49,85,,,15.37,29.49,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079038620,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084008901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084041301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084074201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904600861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687035501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687063801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00591024105,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,69315090505,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084034701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904639061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739068610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904704861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382013606,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13668040930,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722070130,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862020230,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68180021106,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268051715,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268050515,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180021109,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382013616,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,43547036109,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342004510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722070190,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180037709,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862020290,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093736598,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781570192,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668040990,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001031500,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739028110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 20 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00185007260,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 20 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68180046807,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 20 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093057606,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079090101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084000211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591037001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378701001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527139501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079090120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lurasidone 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687075811,NDC,facility,both,0.5,EA,7.48,5.3,Aetna First Health,Commercial,,6.36,85,,,3.32,6.36,percent of total billed charges,
lurasidone 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,63402030401,NDC,facility,both,0.5,EA,78.54,55.61,Aetna First Health,Commercial,,66.76,85,,,34.81,66.76,percent of total billed charges,
lurasidone 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63402030410,NDC,facility,both,0.5,EA,78.54,55.61,Aetna First Health,Commercial,,66.76,85,,,34.81,66.76,percent of total billed charges,
lurasidone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,47335068483,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lurasidone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729034710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lurasidone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,72205020830,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lurasidone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332049530,NDC,facility,both,0.5,EA,3.31,2.34,Aetna First Health,Commercial,,2.81,85,,,1.47,2.81,percent of total billed charges,
lurasidone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63402030430,NDC,facility,both,0.5,EA,82.76,58.59,Aetna First Health,Commercial,,70.35,85,,,36.68,70.35,percent of total billed charges,
magnesium oxide 400 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00603020922,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687073011,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084049111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268052311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59746012106,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162044210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571066101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084049101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904651761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079009020,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904737661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268052315,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378548677,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00536101801,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,69618002801,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 25 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,68001052900,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
medroxyPROGESTERone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762374101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762005801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555087302,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00009028603,NDC,facility,both,0.5,EA,3.89,2.75,Aetna First Health,Commercial,,3.31,85,,,1.72,3.31,percent of total billed charges,
medroxyPROGESTERone 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00555087304,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268052611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382005101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300012501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 15 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268052615,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687018411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292000601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904650661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00456321063,NDC,facility,both,0.5,EA,12.97,9.18,Aetna First Health,Commercial,,11.02,85,,,5.75,11.02,percent of total billed charges,
memantine 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,42292000606,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00832111360,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,55111059760,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,33342029809,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00456321060,NDC,facility,both,0.5,EA,9.89,7,Aetna First Health,Commercial,,8.41,85,,,4.38,8.41,percent of total billed charges,
memantine 10 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,60687018457,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metaxalone 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268053011,NDC,facility,both,0.5,EA,3.9,2.76,Aetna First Health,Commercial,,3.32,85,,,1.73,3.32,percent of total billed charges,
metaxalone 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084013511,NDC,facility,both,0.5,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
metaxalone 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687066311,NDC,facility,both,0.5,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527143501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111065001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115174801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980047201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591234101,NDC,facility,both,0.5,EA,3.51,2.49,Aetna First Health,Commercial,,2.98,85,,,1.56,2.98,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001048500,NDC,facility,both,0.5,EA,3.56,2.52,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64720032110,NDC,facility,both,0.5,EA,7.13,5.05,Aetna First Health,Commercial,,6.06,85,,,3.16,6.06,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162055310,NDC,facility,both,0.5,EA,8.39,5.94,Aetna First Health,Commercial,,7.13,85,,,3.72,7.13,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001000400,NDC,facility,both,0.5,EA,8.39,5.94,Aetna First Health,Commercial,,7.13,85,,,3.72,7.13,percent of total billed charges,
metaxalone 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60793013601,NDC,facility,both,0.5,EA,10.49,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
metaxalone 800 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084013521,NDC,facility,both,0.5,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
metaxalone 800 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268053015,NDC,facility,both,0.5,EA,3.9,2.76,Aetna First Health,Commercial,,3.32,85,,,1.73,3.32,percent of total billed charges,
metFORMIN 1000 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687016211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 1000 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584045211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 1000 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382003001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 1000 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70010006501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 1000 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904632861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 1000 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904669161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 1000 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584045201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406577123,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084073811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406577101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054457125,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877011601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054855424,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406577162,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084073801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739000610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904653061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054071020,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methenamine 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687069411,NDC,facility,both,0.5,EA,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
methenamine 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862078201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methenamine 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742014201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methenamine 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64720013910,NDC,facility,both,0.5,EA,3.05,2.16,Aetna First Health,Commercial,,2.59,85,,,1.35,2.59,percent of total billed charges,
methenamine 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42571033201,NDC,facility,both,0.5,EA,3.05,2.16,Aetna First Health,Commercial,,2.59,85,,,1.35,2.59,percent of total billed charges,
methenamine 1 GM Tablet 30 Each Box,63700001,CDM,,,250,RC,60687069421,NDC,facility,both,0.5,EA,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
methIMAzole 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084027611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687037011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687068011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185021001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884064101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155007101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293082101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60793010501,NDC,facility,both,0.5,EA,6.22,4.4,Aetna First Health,Commercial,,5.29,85,,,2.76,5.29,percent of total billed charges,
methIMAzole 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687037001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084082311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078044005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781574901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406114401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664022988,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722017401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702010101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115180101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877061701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714082201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603457721,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084082321,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 20 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62175015237,NDC,facility,both,0.5,EA,8.08,5.72,Aetna First Health,Commercial,,6.87,85,,,3.58,6.87,percent of total billed charges,
methylphenidate 20 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51862026301,NDC,facility,both,0.5,EA,7.94,5.62,Aetna First Health,Commercial,,6.75,85,,,3.52,6.75,percent of total billed charges,
metoclopramide 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084009111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084067611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687063111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093220301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084009101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084000901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739029310,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084067601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687063101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079088820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093220305,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42291059690,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metOLazone 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079002401,NDC,facility,both,0.5,EA,5.44,3.85,Aetna First Health,Commercial,,4.62,85,,,2.41,4.62,percent of total billed charges,
metOLazone 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687063511,NDC,facility,both,0.5,EA,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
metOLazone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185005501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metOLazone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527221637,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metOLazone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385013701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metOLazone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378617301,NDC,facility,both,0.5,EA,3.59,2.54,Aetna First Health,Commercial,,3.05,85,,,1.59,3.05,percent of total billed charges,
metOLazone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079002420,NDC,facility,both,0.5,EA,5.44,3.85,Aetna First Health,Commercial,,4.62,85,,,2.41,4.62,percent of total billed charges,
metOLazone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687063501,NDC,facility,both,0.5,EA,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084030411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079017001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268054111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687040211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00186109005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62037083101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,55111046701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001012200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742061601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001050100,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,16714085301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,45963067611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,72516003101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,49884040501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001046900,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,64679073502,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904632361,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084066601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687040201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084030401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,51079017020,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268054115,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,60687040265,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,55111046705,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,68001050103,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,72516003150,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079025501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378001801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862006201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742010701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42543000101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332011231,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237010001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304057901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904634060,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584026501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904634061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378001805,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,50742010705,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111033401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300022701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001036500,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079021720,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084096601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904656861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687055001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904712661,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,29300022746,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,72578000818,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,50111033402,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68001036503,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00245021289,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687039811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268056211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00245021211,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378190201,NDC,facility,both,0.5,EA,1.22,0.86,Aetna First Health,Commercial,,1.04,85,,,0.54,1.04,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382073801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505132101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884084901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115422201,NDC,facility,both,0.5,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00245021201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045320,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739055610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687039801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084024101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42291056190,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687033611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00591569550,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,65862021150,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,63304069650,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,47781054650,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00093316753,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,60687033665,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,00904688806,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079008601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378351501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079008620,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084011901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904651961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739009810,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093720656,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505024701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107003130,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107003134,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714070701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,57664049983,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862003130,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,57237000830,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378351593,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00052010530,NDC,facility,both,0.5,EA,8.73,6.18,Aetna First Health,Commercial,,7.42,85,,,3.87,7.42,percent of total billed charges,
mirtazapine 15 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,13107003105,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 30 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,00052010830,NDC,facility,both,0.5,EA,7.16,5.07,Aetna First Health,Commercial,,6.09,85,,,3.17,6.09,percent of total billed charges,
modafinil 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084072111,NDC,facility,both,0.5,EA,29.58,20.94,Aetna First Health,Commercial,,25.14,85,,,13.11,25.14,percent of total billed charges,
modafinil 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591350001,NDC,facility,both,0.5,EA,5.54,3.92,Aetna First Health,Commercial,,4.71,85,,,2.46,4.71,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69452034313,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42043016103,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,23155060503,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505252703,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862060230,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,50742015330,NDC,facility,both,0.5,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378557593,NDC,facility,both,0.5,EA,5.54,3.92,Aetna First Health,Commercial,,4.71,85,,,2.46,4.71,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55253080230,NDC,facility,both,0.5,EA,12.15,8.6,Aetna First Health,Commercial,,10.33,85,,,5.38,10.33,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63459020130,NDC,facility,both,0.5,EA,68.02,48.16,Aetna First Health,Commercial,,57.82,85,,,30.15,57.82,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904679204,NDC,facility,both,0.5,EA,24.68,17.47,Aetna First Health,Commercial,,20.98,85,,,10.94,20.98,percent of total billed charges,
modafinil 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084072121,NDC,facility,both,0.5,EA,35.69,25.27,Aetna First Health,Commercial,,30.34,85,,,15.82,30.34,percent of total billed charges,
morphine 20 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00574711412,NDC,facility,both,0.5,EA,13.42,9.5,Aetna First Health,Commercial,,11.41,85,,,5.95,11.41,percent of total billed charges,
morphine ER 60 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084040511,NDC,facility,both,0.5,EA,4.69,3.32,Aetna First Health,Commercial,,3.99,85,,,2.08,3.99,percent of total billed charges,
morphine ER 60 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00406838023,NDC,facility,both,0.5,EA,5.44,3.85,Aetna First Health,Commercial,,4.62,85,,,2.41,4.62,percent of total billed charges,
morphine ER 60 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406838001,NDC,facility,both,0.5,EA,4.35,3.08,Aetna First Health,Commercial,,3.7,85,,,1.93,3.7,percent of total billed charges,
morphine ER 60 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378266001,NDC,facility,both,0.5,EA,4.35,3.08,Aetna First Health,Commercial,,3.7,85,,,1.93,3.7,percent of total billed charges,
morphine ER 60 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084040501,NDC,facility,both,0.5,EA,4.69,3.32,Aetna First Health,Commercial,,3.99,85,,,2.08,3.99,percent of total billed charges,
morphine ER 60 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00406838062,NDC,facility,both,0.5,EA,5.44,3.85,Aetna First Health,Commercial,,4.62,85,,,2.41,4.62,percent of total billed charges,
morphine immediate release 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054023625,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine immediate release 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054023624,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nadolol 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687031395,NDC,facility,both,0.5,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
nadolol 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084076311,NDC,facility,both,0.5,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
nadolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097086807,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nadolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10135068701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nadolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378117101,NDC,facility,both,0.5,EA,5.56,3.94,Aetna First Health,Commercial,,4.73,85,,,2.46,4.73,percent of total billed charges,
nadolol 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781118201,NDC,facility,both,0.5,EA,5.62,3.98,Aetna First Health,Commercial,,4.78,85,,,2.49,4.78,percent of total billed charges,
nadolol 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079081320,NDC,facility,both,0.5,EA,10.54,7.46,Aetna First Health,Commercial,,8.96,85,,,4.67,8.96,percent of total billed charges,
nadolol 40 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687031325,NDC,facility,both,0.5,EA,6.26,4.43,Aetna First Health,Commercial,,5.32,85,,,2.77,5.32,percent of total billed charges,
nadolol 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69238112409,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687049111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079079501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687026811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462019001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282034201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162019010,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746019001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079079520,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904559161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084012701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739040310,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687049101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687026801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68462019005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nebivolol 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687064111,NDC,facility,both,0.5,EA,5.12,3.62,Aetna First Health,Commercial,,4.35,85,,,2.27,4.35,percent of total billed charges,
nebivolol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00456140501,NDC,facility,both,0.5,EA,4.98,3.53,Aetna First Health,Commercial,,4.23,85,,,2.21,4.23,percent of total billed charges,
nebivolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547052503,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nebivolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722058630,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nebivolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70756029130,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nebivolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62559027630,NDC,facility,both,0.5,EA,4.93,3.49,Aetna First Health,Commercial,,4.19,85,,,2.18,4.19,percent of total billed charges,
nebivolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456140530,NDC,facility,both,0.5,EA,10.66,7.55,Aetna First Health,Commercial,,9.06,85,,,4.72,9.06,percent of total billed charges,
nebivolol 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,43547052509,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nebivolol 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00456140590,NDC,facility,both,0.5,EA,10.66,7.55,Aetna First Health,Commercial,,9.06,85,,,4.72,9.06,percent of total billed charges,
niacin 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904227160,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904227260,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00182440501,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin CR (antihyperlipidemic) 1000 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084077311,NDC,facility,both,0.5,EA,14.21,10.06,Aetna First Health,Commercial,,12.08,85,,,6.3,12.08,percent of total billed charges,
niacin CR (antihyperlipidemic) 1000 MG Tablet Extended Release 30 Each Box,63700001,CDM,,,250,RC,68084077321,NDC,facility,both,0.5,EA,14.21,10.06,Aetna First Health,Commercial,,12.08,85,,,6.3,12.08,percent of total billed charges,
niacin CR (antihyperlipidemic) 1000 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,47335061381,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
niacin CR (antihyperlipidemic) 1000 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,65162032309,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
niacin CR (antihyperlipidemic) 1000 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,00074308090,NDC,facility,both,0.5,EA,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 20 Each Bottle,63700001,CDM,,,250,RC,46122025560,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 20 Each Box,63700001,CDM,,,250,RC,00135050904,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,45802087305,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,43598048772,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 27 Each Bottle,63700001,CDM,,,250,RC,45802095702,NDC,facility,both,0.5,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 50 Each Box,63700001,CDM,,,250,RC,17856124101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 72 Each Box,63700001,CDM,,,250,RC,49348085316,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 81 Each Box,63700001,CDM,,,250,RC,00135050902,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 81 Each Box,63700001,CDM,,,250,RC,00135150002,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nitrofurantoin 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084007711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687047211,NDC,facility,both,0.5,EA,3.11,2.2,Aetna First Health,Commercial,,2.64,85,,,1.38,2.64,percent of total billed charges,
nitrofurantoin 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268062311,NDC,facility,both,0.5,EA,3.14,2.22,Aetna First Health,Commercial,,2.67,85,,,1.39,2.67,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,47781030701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001000200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68382055901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00115164301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57664023288,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001038500,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079058420,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084007701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687047201,NDC,facility,both,0.5,EA,3.11,2.2,Aetna First Health,Commercial,,2.64,85,,,1.38,2.64,percent of total billed charges,
nitrofurantoin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904702661,NDC,facility,both,0.5,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
nitrofurantoin 50 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268062315,NDC,facility,both,0.5,EA,3.14,2.22,Aetna First Health,Commercial,,2.67,85,,,1.39,2.67,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884032152,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,64380017301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,55111026379,NDC,facility,both,0.5,EA,4.45,3.15,Aetna First Health,Commercial,,3.78,85,,,1.97,3.78,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,59746030712,NDC,facility,both,0.5,EA,5.75,4.07,Aetna First Health,Commercial,,4.89,85,,,2.55,4.89,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00002445401,NDC,facility,both,0.5,EA,33.99,24.06,Aetna First Health,Commercial,,28.89,85,,,15.06,28.89,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 30 Each Bottle,63700001,CDM,,,250,RC,33342008407,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 30 Each Bottle,63700001,CDM,,,250,RC,60505327603,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,64380017302,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,59746030732,NDC,facility,both,0.5,EA,5.75,4.07,Aetna First Health,Commercial,,4.89,85,,,2.55,4.89,percent of total billed charges,
OLANZapine 10 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,49884032155,NDC,facility,both,0.5,EA,27.19,19.25,Aetna First Health,Commercial,,23.11,85,,,12.05,23.11,percent of total billed charges,
OLANZapine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084072311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292001301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505311100,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084072301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904637761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111016430,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598016430,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342006807,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505311103,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002411530,NDC,facility,both,0.5,EA,27.56,19.51,Aetna First Health,Commercial,,23.43,85,,,12.21,23.43,percent of total billed charges,
OLANZapine 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,43598016405,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69543038190,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 1 Each Blister,63700001,CDM,,,250,RC,68084012811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 1 Each Blister,63700001,CDM,,,250,RC,51079000701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 1 Each Blister,63700001,CDM,,,250,RC,50268061911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Bottle,63700001,CDM,,,250,RC,62175011837,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Bottle,63700001,CDM,,,250,RC,68462039601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Box,63700001,CDM,,,250,RC,68084012801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Box,63700001,CDM,,,250,RC,63739035810,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Box,63700001,CDM,,,250,RC,00904691761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Box,63700001,CDM,,,250,RC,51079000720,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,68462039630,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 50 Each Box,63700001,CDM,,,250,RC,50268061915,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 90 Each Bottle,63700001,CDM,,,250,RC,59651000290,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584014311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084085311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687072211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62756018488,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462013801,NDC,facility,both,0.5,EA,4.57,3.24,Aetna First Health,Commercial,,3.88,85,,,2.03,3.88,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584014301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084085301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904726361,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054009820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084085301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832003889,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603497521,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832003800,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111045601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702020101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315018201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980043101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,14539065301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904282161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687067001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904702761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00603497528,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,23155081005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268062811,NDC,facility,both,0.5,EA,4.69,3.32,Aetna First Health,Commercial,,3.99,85,,,2.08,3.99,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084061011,NDC,facility,both,0.5,EA,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079072301,NDC,facility,both,0.5,EA,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,64980021001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175027137,NDC,facility,both,0.5,EA,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378661001,NDC,facility,both,0.5,EA,4.6,3.26,Aetna First Health,Commercial,,3.91,85,,,2.04,3.91,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,51079072320,NDC,facility,both,0.5,EA,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
oxyBUTYnin ER 10 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268062815,NDC,facility,both,0.5,EA,4.69,3.32,Aetna First Health,Commercial,,3.99,85,,,2.08,3.99,percent of total billed charges,
oxyCODONE 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084096811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382079401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739017710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084018511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084098311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702000901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406853001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603499221,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228287911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858000501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084098301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE CR 20 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,00781572601,NDC,facility,both,0.5,EA,8.17,5.78,Aetna First Health,Commercial,,6.94,85,,,3.62,6.94,percent of total billed charges,
oxyCODONE CR 20 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,69238229601,NDC,facility,both,0.5,EA,13.12,9.29,Aetna First Health,Commercial,,11.15,85,,,5.81,11.15,percent of total billed charges,
oxyCODONE CR 20 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,59011042010,NDC,facility,both,0.5,EA,17.4,12.32,Aetna First Health,Commercial,,14.79,85,,,7.71,14.79,percent of total billed charges,
PARoxetine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084004511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268064111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079077401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382009801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762181002,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904567761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084004501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739096310,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079077420,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382009806,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547034803,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268064115,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382009816,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine CR 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,62175047132,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine CR 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,42858070503,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine CR 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378200493,NDC,facility,both,0.5,EA,3.67,2.6,Aetna First Health,Commercial,,3.12,85,,,1.63,3.12,percent of total billed charges,
PARoxetine CR 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,60505367403,NDC,facility,both,0.5,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
PARoxetine CR 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,60505131703,NDC,facility,both,0.5,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
PARoxetine CR 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,60505437803,NDC,facility,both,0.5,EA,16.8,11.89,Aetna First Health,Commercial,,14.28,85,,,7.45,14.28,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093117401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781165501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762153701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862017601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714023501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237004101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143983601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253020110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65862017605,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084029311,NDC,facility,both,0.5,EA,4.01,2.84,Aetna First Health,Commercial,,3.41,85,,,1.78,3.41,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42937070210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293081101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10135062101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162068210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69367016304,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42192080201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,75826011510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58657045101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162052010,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293080201,NDC,facility,both,0.5,EA,4.55,3.22,Aetna First Health,Commercial,,3.87,85,,,2.02,3.87,percent of total billed charges,
phenazopyridine 200 MG Tablet 6 Each Bottle,63700001,CDM,,,250,RC,49999017606,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 200 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42291054990,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13517075601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293069201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571067201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13517069201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 30 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00143145005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603516621,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13517011101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293062601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571067301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739020110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904657561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739029410,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 32.4 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00603516602,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pindolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378012701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pindolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664065688,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pindolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559056101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pindolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385013201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862051330,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342005507,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093727256,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 30 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764030114,NDC,facility,both,0.5,EA,27.84,19.71,Aetna First Health,Commercial,,23.66,85,,,12.34,23.66,percent of total billed charges,
pioglitazone 30 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342005510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium citrate 10 MEQ (1080 MG) Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084085033,NDC,facility,both,0.5,EA,4.22,2.99,Aetna First Health,Commercial,,3.59,85,,,1.87,3.59,percent of total billed charges,
potassium citrate 10 MEQ (1080 MG) Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245007111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium citrate 10 MEQ (1080 MG) Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68382053701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium citrate 10 MEQ (1080 MG) Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62559029101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium citrate 10 MEQ (1080 MG) Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00178061001,NDC,facility,both,0.5,EA,3.74,2.65,Aetna First Health,Commercial,,3.18,85,,,1.66,3.18,percent of total billed charges,
potassium citrate 10 MEQ (1080 MG) Tablet Extended Release 20 Each Box,63700001,CDM,,,250,RC,68084085032,NDC,facility,both,0.5,EA,4.22,2.99,Aetna First Health,Commercial,,3.59,85,,,1.87,3.59,percent of total billed charges,
pramipexole 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084044011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687057011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084044001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687057001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904670461,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00597018461,NDC,facility,both,0.5,EA,9.67,6.85,Aetna First Health,Commercial,,8.22,85,,,4.29,8.22,percent of total billed charges,
pramipexole 0.25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668009290,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68462033190,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342003210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00597018490,NDC,facility,both,0.5,EA,9.21,6.52,Aetna First Health,Commercial,,7.83,85,,,4.08,7.83,percent of total billed charges,
pravastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268067311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687017811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904589261,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084050101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687017801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739064910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268067315,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093720198,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,55111023090,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180048609,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 2 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084099711,NDC,facility,both,0.5,EA,3.63,2.57,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
prazosin 2 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079063101,NDC,facility,both,0.5,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
prazosin 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378230201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093406801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70010008501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 2 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904702161,NDC,facility,both,0.5,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
prazosin 2 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084099701,NDC,facility,both,0.5,EA,3.63,2.57,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
prazosin 2 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079063120,NDC,facility,both,0.5,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
prazosin 2 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,59762532001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 2 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,66993043285,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687048411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687048401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904699261,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00071101341,NDC,facility,both,0.5,EA,19.48,13.79,Aetna First Health,Commercial,,16.56,85,,,8.63,16.56,percent of total billed charges,
pregabalin 50 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,62332012090,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,72205001290,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,65862075990,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69097095505,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69097067805,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 50 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00071101368,NDC,facility,both,0.5,EA,17.71,12.54,Aetna First Health,Commercial,,15.05,85,,,7.85,15.05,percent of total billed charges,
progesterone 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70700016301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Suppository 1 Each Blister,63700001,CDM,,,250,RC,45802075900,NDC,facility,both,0.5,EA,17.06,12.08,Aetna First Health,Commercial,,14.5,85,,,7.56,14.5,percent of total billed charges,
promethazine 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00713052612,NDC,facility,both,0.5,EA,17.06,12.08,Aetna First Health,Commercial,,14.5,85,,,7.56,14.5,percent of total billed charges,
promethazine 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,45802075930,NDC,facility,both,0.5,EA,17.06,12.08,Aetna First Health,Commercial,,14.5,85,,,7.56,14.5,percent of total billed charges,
promethazine 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00591299239,NDC,facility,both,0.5,EA,19.5,13.81,Aetna First Health,Commercial,,16.58,85,,,8.64,16.58,percent of total billed charges,
promethazine 25 MG Tablet 1 Each Blister,63700001,CDM,Q0169,CPT,250,RC,51079089501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Bottle,63700001,CDM,Q0169,CPT,250,RC,68382004101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Bottle,63700001,CDM,Q0169,CPT,250,RC,10702000301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Bottle,63700001,CDM,Q0169,CPT,250,RC,68001016200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Bottle,63700001,CDM,Q0169,CPT,250,RC,00591530701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Bottle,63700001,CDM,Q0169,CPT,250,RC,00781183001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Bottle,63700001,CDM,Q0169,CPT,250,RC,65162052110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Box,63700001,CDM,Q0169,CPT,250,RC,51079089520,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Box,63700001,CDM,Q0169,CPT,250,RC,68084015501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Box,63700001,CDM,Q0169,CPT,250,RC,63739021310,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Box,63700001,CDM,Q0169,CPT,250,RC,00904646161,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Tablet 100 Each Box,63700001,CDM,Q0169,CPT,250,RC,00904730461,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268070111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687059811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687030611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378018301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591555501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155011101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115166001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111046801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603548321,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238207801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687059801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687030601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904670561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079027820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268070115,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 120 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42291052401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 120 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62559053201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 120 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527411837,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 120 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51991081901,NDC,facility,both,0.5,EA,4.26,3.02,Aetna First Health,Commercial,,3.62,85,,,1.89,3.62,percent of total billed charges,
propranolol LA 120 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228278011,NDC,facility,both,0.5,EA,4.26,3.02,Aetna First Health,Commercial,,3.62,85,,,1.89,3.62,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084049411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687050211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115351101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68682030210,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64720012810,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00187301030,NDC,facility,both,0.5,EA,18.45,13.06,Aetna First Health,Commercial,,15.68,85,,,8.18,15.68,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687050201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382065906,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,71930002890,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pyridoxine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268085811,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333094025,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904052060,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,37864090901,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10006070012,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10006073017,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536440801,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333094010,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,61748009530,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pyridoxine 50 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268085815,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
QUEtiapine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268063111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687033811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180044601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505313201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001018000,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00310027810,NDC,facility,both,0.5,EA,11.17,7.91,Aetna First Health,Commercial,,9.49,85,,,4.95,9.49,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687033801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904663961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268063115,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 400 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904680561,NDC,facility,both,0.5,EA,3.86,2.73,Aetna First Health,Commercial,,3.28,85,,,1.71,3.28,percent of total billed charges,
QUEtiapine XR 400 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00310028439,NDC,facility,both,0.5,EA,40.52,28.69,Aetna First Health,Commercial,,34.44,85,,,17.96,34.44,percent of total billed charges,
QUEtiapine XR 400 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,16729009712,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 400 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,52817016460,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 400 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,68001051506,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 400 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,68001060206,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 400 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00310028460,NDC,facility,both,0.5,EA,40.52,28.69,Aetna First Health,Commercial,,34.44,85,,,17.96,34.44,percent of total billed charges,
ramipril 2.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57237022301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ramipril 2.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001042900,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rasagiline mesylate 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,23155074703,NDC,facility,both,0.5,EA,5.02,3.55,Aetna First Health,Commercial,,4.27,85,,,2.22,4.27,percent of total billed charges,
rasagiline mesylate 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093306156,NDC,facility,both,0.5,EA,12.03,8.52,Aetna First Health,Commercial,,10.23,85,,,5.33,10.23,percent of total billed charges,
rasagiline mesylate 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42571022130,NDC,facility,both,0.5,EA,13.93,9.86,Aetna First Health,Commercial,,11.84,85,,,6.17,11.84,percent of total billed charges,
rasagiline mesylate 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714077101,NDC,facility,both,0.5,EA,23.85,16.89,Aetna First Health,Commercial,,20.27,85,,,10.57,20.27,percent of total billed charges,
rasagiline mesylate 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,47781013930,NDC,facility,both,0.5,EA,25.96,18.38,Aetna First Health,Commercial,,22.07,85,,,11.51,22.07,percent of total billed charges,
rasagiline mesylate 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68546022956,NDC,facility,both,0.5,EA,30.65,21.7,Aetna First Health,Commercial,,26.05,85,,,13.58,26.05,percent of total billed charges,
rifAMPin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084035811,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687058611,NDC,facility,both,0.5,EA,3.26,2.31,Aetna First Health,Commercial,,2.77,85,,,1.44,2.77,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,61748001801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527131501,NDC,facility,both,0.5,EA,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00185079901,NDC,facility,both,0.5,EA,6.43,4.55,Aetna First Health,Commercial,,5.47,85,,,2.85,5.47,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084035801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904528261,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739041510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687058601,NDC,facility,both,0.5,EA,3.26,2.31,Aetna First Health,Commercial,,2.77,85,,,1.44,2.77,percent of total billed charges,
rifAMPin 300 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,61748001830,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00440831130,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00527131530,NDC,facility,both,0.5,EA,3.38,2.39,Aetna First Health,Commercial,,2.87,85,,,1.5,2.87,percent of total billed charges,
rifAMPin 300 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,68180065906,NDC,facility,both,0.5,EA,6.43,4.55,Aetna First Health,Commercial,,5.47,85,,,2.85,5.47,percent of total billed charges,
rifAMPin 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,61748001860,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifAMPin 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00527131506,NDC,facility,both,0.5,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
risperiDONE 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084027211,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079046220,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084027201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904635961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458059210,NDC,facility,both,0.5,EA,3.43,2.43,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
risperiDONE 1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382011405,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,13668003705,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382011414,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,13668003760,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50458059260,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 1 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,50458060228,NDC,facility,both,0.5,EA,8.02,5.68,Aetna First Health,Commercial,,6.82,85,,,3.55,6.82,percent of total billed charges,
rivaroxaban 20 MG Tablet 10 Each Blister,63700001,CDM,,,250,RC,50458057901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivaroxaban 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458057910,NDC,facility,both,0.5,EA,33.23,23.53,Aetna First Health,Commercial,,28.25,85,,,14.73,28.25,percent of total billed charges,
rivaroxaban 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,50458057990,NDC,facility,both,0.5,EA,33.23,23.53,Aetna First Health,Commercial,,28.25,85,,,14.73,28.25,percent of total billed charges,
rivastigmine 3 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739057710,NDC,facility,both,0.5,EA,5.88,4.16,Aetna First Health,Commercial,,5,85,,,2.61,5,percent of total billed charges,
rivastigmine 3 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,55111035360,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 3 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,51991079406,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 3 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,62332006460,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 3 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00781261560,NDC,facility,both,0.5,EA,5.94,4.21,Aetna First Health,Commercial,,5.05,85,,,2.63,5.05,percent of total billed charges,
rivastigmine 3 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00078032444,NDC,facility,both,0.5,EA,10.03,7.1,Aetna First Health,Commercial,,8.53,85,,,4.45,8.53,percent of total billed charges,
rizatriptan 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68462046640,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,33342008802,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet 1 Each Package,63700001,CDM,,,250,RC,00006026701,NDC,facility,both,0.5,EA,64,45.31,Aetna First Health,Commercial,,54.4,85,,,28.36,54.4,percent of total billed charges,
rizatriptan 10 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,23155024546,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,57237008863,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,33342008841,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,51991035578,NDC,facility,both,0.5,EA,9.72,6.88,Aetna First Health,Commercial,,8.26,85,,,4.31,8.26,percent of total billed charges,
rizatriptan 10 MG Tablet 6 Each Pack,63700001,CDM,,,250,RC,23155024522,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,68462046840,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,69452015774,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,33342009452,NDC,facility,both,0.5,EA,3.48,2.46,Aetna First Health,Commercial,,2.96,85,,,1.54,2.96,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,65862062603,NDC,facility,both,0.5,EA,3.57,2.53,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,51991036399,NDC,facility,both,0.5,EA,9.72,6.88,Aetna First Health,Commercial,,8.26,85,,,4.31,8.26,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00006380101,NDC,facility,both,0.5,EA,57.07,40.41,Aetna First Health,Commercial,,48.51,85,,,25.29,48.51,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,68462046806,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,69452015773,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,57237008663,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,33342009472,NDC,facility,both,0.5,EA,5.27,3.73,Aetna First Health,Commercial,,4.48,85,,,2.34,4.48,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,60505372401,NDC,facility,both,0.5,EA,5.82,4.12,Aetna First Health,Commercial,,4.95,85,,,2.58,4.95,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,51991036378,NDC,facility,both,0.5,EA,9.72,6.88,Aetna First Health,Commercial,,8.26,85,,,4.31,8.26,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 3 Each Box,63700001,CDM,,,250,RC,68462046846,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 3 Each Box,63700001,CDM,,,250,RC,65862062690,NDC,facility,both,0.5,EA,3.57,2.53,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
rizatriptan 10 MG Tablet Disintegrating 9 Each Bottle,63700001,CDM,,,250,RC,00378370259,NDC,facility,both,0.5,EA,43.11,30.52,Aetna First Health,Commercial,,36.64,85,,,19.11,36.64,percent of total billed charges,
rOPINIRole 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084030611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462025401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547026910,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332003131,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292003001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268070911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,60687024511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292003020,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687024501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00310075139,NDC,facility,both,0.5,EA,15.22,10.78,Aetna First Health,Commercial,,12.94,85,,,6.75,12.94,percent of total billed charges,
rosuvastatin 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16252061630,NDC,facility,both,0.5,EA,12.52,8.86,Aetna First Health,Commercial,,10.64,85,,,5.55,10.64,percent of total billed charges,
rosuvastatin 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268070915,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,60687024565,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505450309,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,57237016990,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781540192,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68462026290,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668018090,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722088390,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,27808015601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,70377000712,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862029490,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00310075190,NDC,facility,both,0.5,EA,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
rufinamide 400 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00054042623,NDC,facility,both,0.5,EA,10.75,7.61,Aetna First Health,Commercial,,9.14,85,,,4.76,9.14,percent of total billed charges,
rufinamide 400 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00378233178,NDC,facility,both,0.5,EA,10.75,7.61,Aetna First Health,Commercial,,9.14,85,,,4.76,9.14,percent of total billed charges,
rufinamide 400 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68462071408,NDC,facility,both,0.5,EA,10.75,7.61,Aetna First Health,Commercial,,9.14,85,,,4.76,9.14,percent of total billed charges,
rufinamide 400 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,62856058352,NDC,facility,both,0.5,EA,46.2,32.71,Aetna First Health,Commercial,,39.27,85,,,20.48,39.27,percent of total billed charges,
saccharomyces boulardii 250 MG Packet 20 Each Box,63700001,CDM,,,250,RC,04142000040,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
saccharomyces boulardii 250 MG Packet 20 Each Packet,63700001,CDM,,,250,RC,04142000023,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sertraline 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079076301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714061204,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762490004,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862001201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084018101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904692561,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,76282021318,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59762490001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862001230,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68180035206,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714061201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,59762490005,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65862001205,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68180035202,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16729021616,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16729021615,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180035209,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sevelamer 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687044911,NDC,facility,both,0.5,EA,13.02,9.22,Aetna First Health,Commercial,,11.07,85,,,5.77,11.07,percent of total billed charges,
simvastatin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084051111,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084051101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739057110,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045420,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111019830,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382006616,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180047802,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714068202,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16729000415,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SITagliptin 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00006027731,NDC,facility,both,0.5,EA,33.43,23.67,Aetna First Health,Commercial,,28.42,85,,,14.82,28.42,percent of total billed charges,
SITagliptin 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00006027754,NDC,facility,both,0.5,EA,33.43,23.67,Aetna First Health,Commercial,,28.42,85,,,14.82,28.42,percent of total billed charges,
SITagliptin 50 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00006011254,NDC,facility,both,0.5,EA,33.43,23.67,Aetna First Health,Commercial,,28.42,85,,,14.82,28.42,percent of total billed charges,
sodium bicarbonate 650 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00223172101,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium bicarbonate 650 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333083110,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium bicarbonate 650 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333082710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sodium bicarbonate 650 MG Tablet 500 Each Box,63700001,CDM,,,250,RC,66553000801,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
solifenacin 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505470303,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
solifenacin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00591379619,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687047611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020711,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687047601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084020701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739054510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084034096,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,16714053210,NDC,facility,both,0.5,EA,3.1,2.19,Aetna First Health,Commercial,,2.64,85,,,1.37,2.64,percent of total billed charges,
SUMAtriptan 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62756052188,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 50 MG Tablet 27 Each Box,63700001,CDM,,,250,RC,68084034097,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 50 MG Tablet 36 Each Bottle,63700001,CDM,,,250,RC,55111029236,NDC,facility,both,0.5,EA,3.1,2.19,Aetna First Health,Commercial,,2.64,85,,,1.37,2.64,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Bottle,63700001,CDM,,,250,RC,00378563159,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,65862014736,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,62756052169,NDC,facility,both,0.5,EA,3.1,2.19,Aetna First Health,Commercial,,2.64,85,,,1.37,2.64,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,55111029209,NDC,facility,both,0.5,EA,3.1,2.19,Aetna First Health,Commercial,,2.64,85,,,1.37,2.64,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,16714053211,NDC,facility,both,0.5,EA,3.1,2.19,Aetna First Health,Commercial,,2.64,85,,,1.37,2.64,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,16714079701,NDC,facility,both,0.5,EA,3.1,2.19,Aetna First Health,Commercial,,2.64,85,,,1.37,2.64,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,00173073601,NDC,facility,both,0.5,EA,76.65,54.27,Aetna First Health,Commercial,,65.15,85,,,33.97,65.15,percent of total billed charges,
temazepam 15 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67877014601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 15 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162055610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 15 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228207610,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 15 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378401001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 15 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739087710,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 15 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079041820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 15 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00378401077,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 2 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079093701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59746038406,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 2 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904612761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbutaline 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115262201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbutaline 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527131101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbutaline 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559072201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
theophylline ER 400 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68462038001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
theophylline ER 400 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42858070101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 2 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079058701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378200201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781222701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70954001510,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 2 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079058720,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thyroid 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00456045901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thyroid 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42192033001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thyroid 65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64727330001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiaGABine 4 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69238110503,NDC,facility,both,0.5,EA,7.44,5.27,Aetna First Health,Commercial,,6.32,85,,,3.3,6.32,percent of total billed charges,
tiaGABine 4 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62756022483,NDC,facility,both,0.5,EA,11.11,7.87,Aetna First Health,Commercial,,9.44,85,,,4.92,9.44,percent of total billed charges,
tiaGABine 4 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093503156,NDC,facility,both,0.5,EA,11.11,7.87,Aetna First Health,Commercial,,9.44,85,,,4.92,9.44,percent of total billed charges,
tiaGABine 4 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,72205008530,NDC,facility,both,0.5,EA,11.11,7.87,Aetna First Health,Commercial,,9.44,85,,,4.92,9.44,percent of total billed charges,
tiaGABine 4 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63459040430,NDC,facility,both,0.5,EA,11.38,8.06,Aetna First Health,Commercial,,9.67,85,,,5.04,9.67,percent of total billed charges,
tiZANidine 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084001311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084064511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268076011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079099820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084001301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084064501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904641861,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,00185440051,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,55111018015,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,00378072419,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,60505025203,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 4 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,10144059415,NDC,facility,both,0.5,EA,4.15,2.94,Aetna First Health,Commercial,,3.53,85,,,1.84,3.53,percent of total billed charges,
tiZANidine 4 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268076015,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079019801,NDC,facility,both,0.5,EA,11.35,8.04,Aetna First Health,Commercial,,9.65,85,,,5.03,9.65,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687033011,NDC,facility,both,0.5,EA,17.57,12.44,Aetna First Health,Commercial,,14.93,85,,,7.79,14.93,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,13668019030,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,27241019230,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59762004801,NDC,facility,both,0.5,EA,4.43,3.14,Aetna First Health,Commercial,,3.77,85,,,1.96,3.77,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378340493,NDC,facility,both,0.5,EA,11.24,7.96,Aetna First Health,Commercial,,9.55,85,,,4.98,9.55,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00093204956,NDC,facility,both,0.5,EA,11.25,7.96,Aetna First Health,Commercial,,9.56,85,,,4.99,9.56,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00904659304,NDC,facility,both,0.5,EA,16.63,11.77,Aetna First Health,Commercial,,14.14,85,,,7.37,14.14,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,51079019803,NDC,facility,both,0.5,EA,17.69,12.52,Aetna First Health,Commercial,,15.04,85,,,7.84,15.04,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,70436016106,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084034311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079072720,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382013914,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68462015360,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,69097012303,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,69097081703,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268075511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111091601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862012601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722053001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237013901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268075515,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687045411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111043401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382080601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111056101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489051101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382080605,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,50111043402,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378240201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781103201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832049511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781803201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ursodiol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,66993040602,NDC,facility,both,0.5,EA,6.66,4.72,Aetna First Health,Commercial,,5.66,85,,,2.95,5.66,percent of total billed charges,
ursodiol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884041301,NDC,facility,both,0.5,EA,6.66,4.72,Aetna First Health,Commercial,,5.66,85,,,2.95,5.66,percent of total billed charges,
ursodiol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001022700,NDC,facility,both,0.5,EA,6.66,4.72,Aetna First Health,Commercial,,5.66,85,,,2.95,5.66,percent of total billed charges,
valACYclovir 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268078911,NDC,facility,both,0.5,EA,3.52,2.49,Aetna First Health,Commercial,,2.99,85,,,1.56,2.99,percent of total billed charges,
valACYclovir 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084030911,NDC,facility,both,0.5,EA,6.13,4.34,Aetna First Health,Commercial,,5.21,85,,,2.72,5.21,percent of total billed charges,
valACYclovir 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084040911,NDC,facility,both,0.5,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378427693,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862044930,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714069701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722070530,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59746032530,NDC,facility,both,0.5,EA,8.86,6.27,Aetna First Health,Commercial,,7.53,85,,,3.93,7.53,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00173056504,NDC,facility,both,0.5,EA,25.24,17.87,Aetna First Health,Commercial,,21.45,85,,,11.19,21.45,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Box,63700001,CDM,,,250,RC,68084030921,NDC,facility,both,0.5,EA,6.13,4.34,Aetna First Health,Commercial,,5.21,85,,,2.72,5.21,percent of total billed charges,
valACYclovir 1 GM Tablet 30 Each Box,63700001,CDM,,,250,RC,68084040921,NDC,facility,both,0.5,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
valACYclovir 1 GM Tablet 50 Each Box,63700001,CDM,,,250,RC,50268078915,NDC,facility,both,0.5,EA,3.51,2.49,Aetna First Health,Commercial,,2.98,85,,,1.56,2.98,percent of total billed charges,
valACYclovir 1 GM Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714069703,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687062311,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687062301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904659461,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,43547036809,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59746036190,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,62332004590,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342006310,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,55111073290,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,67877041690,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00078035834,NDC,facility,both,0.5,EA,16.18,11.46,Aetna First Health,Commercial,,13.75,85,,,7.17,13.75,percent of total billed charges,
vancomycin 250 MG capsule 20 Each Box,63700001,CDM,,,250,RC,42494045120,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
vancomycin 250 MG capsule 20 Each Box,63700001,CDM,,,250,RC,00121089020,NDC,facility,both,0.5,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
vancomycin 250 MG capsule 20 Each Box,63700001,CDM,,,250,RC,47781073002,NDC,facility,both,0.5,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
vancomycin 250 MG capsule 20 Each Box,63700001,CDM,,,250,RC,63323033922,NDC,facility,both,0.5,EA,31.5,22.3,Aetna First Health,Commercial,,26.78,85,,,13.96,26.78,percent of total billed charges,
vancomycin 250 MG capsule 20 Each Box,63700001,CDM,,,250,RC,66993021119,NDC,facility,both,0.5,EA,84.17,59.59,Aetna First Health,Commercial,,71.54,85,,,37.3,71.54,percent of total billed charges,
venlafaxine 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268080011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237017401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093738101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382002001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015900,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714065701,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093914901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084048511,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084070911,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,00008083302,NDC,facility,both,0.5,EA,14.33,10.15,Aetna First Health,Commercial,,12.18,85,,,6.35,12.18,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084070901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904646961,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904707761,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00093738556,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,65862052830,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68382003506,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59762018101,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00008083321,NDC,facility,both,0.5,EA,33.54,23.75,Aetna First Health,Commercial,,28.51,85,,,14.86,28.51,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,65862052890,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00093738598,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68382003516,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378051201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155002601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 80 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904292061,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,60687051511,NDC,facility,both,0.5,EA,3.24,2.29,Aetna First Health,Commercial,,2.75,85,,,1.44,2.75,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68462026001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00093304501,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,75834015901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00172428060,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378141101,NDC,facility,both,0.5,EA,3.79,2.68,Aetna First Health,Commercial,,3.22,85,,,1.68,3.22,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,51079086920,NDC,facility,both,0.5,EA,3.7,2.62,Aetna First Health,Commercial,,3.14,85,,,1.64,3.14,percent of total billed charges,
Vilazodone 40 MG Tablet 1 Each Bottle,63700001,CDM,,,250,RC,00456114007,NDC,facility,both,0.5,EA,8.06,5.71,Aetna First Health,Commercial,,6.85,85,,,3.57,6.85,percent of total billed charges,
Vilazodone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332023430,NDC,facility,both,0.5,EA,9.19,6.51,Aetna First Health,Commercial,,7.81,85,,,4.07,7.81,percent of total billed charges,
Vilazodone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00480204356,NDC,facility,both,0.5,EA,15.88,11.24,Aetna First Health,Commercial,,13.5,85,,,7.04,13.5,percent of total billed charges,
Vilazodone 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456114030,NDC,facility,both,0.5,EA,20.27,14.35,Aetna First Health,Commercial,,17.23,85,,,8.98,17.23,percent of total billed charges,
vitamin D (cholecalciferol) 10 mcg (400 Units) Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333094825,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 10 mcg (400 Units) Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904582360,NDC,facility,both,0.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
voriconazole 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268080311,NDC,facility,both,0.5,EA,31.25,22.12,Aetna First Health,Commercial,,26.56,85,,,13.85,26.56,percent of total billed charges,
voriconazole 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687027311,NDC,facility,both,0.5,EA,55.47,39.27,Aetna First Health,Commercial,,47.15,85,,,24.58,47.15,percent of total billed charges,
voriconazole 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053895,NDC,facility,both,0.5,EA,55.47,39.27,Aetna First Health,Commercial,,47.15,85,,,24.58,47.15,percent of total billed charges,
voriconazole 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079016501,NDC,facility,both,0.5,EA,65.67,46.49,Aetna First Health,Commercial,,55.82,85,,,29.1,55.82,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00049318030,NDC,facility,both,0.5,EA,6.52,4.62,Aetna First Health,Commercial,,5.54,85,,,2.89,5.54,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68462057330,NDC,facility,both,0.5,EA,13.13,9.3,Aetna First Health,Commercial,,11.16,85,,,5.82,11.16,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862089230,NDC,facility,both,0.5,EA,13.13,9.3,Aetna First Health,Commercial,,11.16,85,,,5.82,11.16,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00781566831,NDC,facility,both,0.5,EA,16.23,11.49,Aetna First Health,Commercial,,13.8,85,,,7.19,13.8,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547037803,NDC,facility,both,0.5,EA,36.01,25.5,Aetna First Health,Commercial,,30.61,85,,,15.96,30.61,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714051501,NDC,facility,both,0.5,EA,38.42,27.2,Aetna First Health,Commercial,,32.66,85,,,17.03,32.66,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378164093,NDC,facility,both,0.5,EA,65.67,46.49,Aetna First Health,Commercial,,55.82,85,,,29.1,55.82,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,63739000833,NDC,facility,both,0.5,EA,34.56,24.47,Aetna First Health,Commercial,,29.38,85,,,15.32,29.38,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904647104,NDC,facility,both,0.5,EA,40.54,28.7,Aetna First Health,Commercial,,34.46,85,,,17.97,34.46,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687027321,NDC,facility,both,0.5,EA,55.47,39.27,Aetna First Health,Commercial,,47.15,85,,,24.58,47.15,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084053825,NDC,facility,both,0.5,EA,55.47,39.27,Aetna First Health,Commercial,,47.15,85,,,24.58,47.15,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,63739070733,NDC,facility,both,0.5,EA,58.71,41.57,Aetna First Health,Commercial,,49.9,85,,,26.02,49.9,percent of total billed charges,
voriconazole 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,51079016503,NDC,facility,both,0.5,EA,65.67,46.49,Aetna First Health,Commercial,,55.82,85,,,29.1,55.82,percent of total billed charges,
warfarin 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584098411,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121289,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672402801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832121200,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382005301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282032801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093171301,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237012001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00056017070,NDC,facility,both,0.5,EA,3.13,2.22,Aetna First Health,Commercial,,2.66,85,,,1.39,2.66,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584098401,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056017075,NDC,facility,both,0.5,EA,3.76,2.66,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
zafirlukast 20 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084005921,NDC,facility,both,0.5,EA,4.22,2.99,Aetna First Health,Commercial,,3.59,85,,,1.87,3.59,percent of total billed charges,
zaleplon 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054008525,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093526901,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,29300013201,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57237024001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 40 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268081211,NDC,facility,both,0.5,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
ziprasidone 40 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084010411,NDC,facility,both,0.5,EA,4.85,3.43,Aetna First Health,Commercial,,4.12,85,,,2.15,4.12,percent of total billed charges,
ziprasidone 40 MG capsule 40 Each Box,63700001,CDM,,,250,RC,63739000532,NDC,facility,both,0.5,EA,4.87,3.45,Aetna First Health,Commercial,,4.14,85,,,2.16,4.14,percent of total billed charges,
ziprasidone 40 MG capsule 40 Each Box,63700001,CDM,,,250,RC,00904627008,NDC,facility,both,0.5,EA,8.44,5.98,Aetna First Health,Commercial,,7.17,85,,,3.74,7.17,percent of total billed charges,
ziprasidone 40 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16714083601,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 40 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001045106,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 40 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,59762200201,NDC,facility,both,0.5,EA,4.71,3.33,Aetna First Health,Commercial,,4,85,,,2.09,4,percent of total billed charges,
ziprasidone 40 MG capsule 80 Each Box,63700001,CDM,,,250,RC,00904627045,NDC,facility,both,0.5,EA,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
ziprasidone 40 MG capsule 80 Each Box,63700001,CDM,,,250,RC,68084010409,NDC,facility,both,0.5,EA,4.85,3.43,Aetna First Health,Commercial,,4.12,85,,,2.15,4.12,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68001024919,NDC,facility,both,0.5,EA,12.23,8.66,Aetna First Health,Commercial,,10.4,85,,,5.42,10.4,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,27241002168,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,68462049776,NDC,facility,both,0.5,EA,7.34,5.2,Aetna First Health,Commercial,,6.24,85,,,3.25,6.24,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,68001024901,NDC,facility,both,0.5,EA,12.23,8.66,Aetna First Health,Commercial,,10.4,85,,,5.42,10.4,percent of total billed charges,
zonisamide 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079076801,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268081611,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687023011,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68462013001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62756026002,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001024400,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,64679099001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079076820,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687023001,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268081615,NDC,facility,both,0.5,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 10 mL Cup,63700001,CDM,,,250,RC,00121174410,NDC,facility,both,0.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 10 mL Cup,63700001,CDM,,,250,RC,50383077110,NDC,facility,both,0.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 10 mL Cup,63700001,CDM,,,250,RC,50383077111,NDC,facility,both,0.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 10 mL Cup,63700001,CDM,,,250,RC,00121177510,NDC,facility,both,0.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 75 mg/mL (15 mg/mL elemental iron) Solution 50 mL Bottle,63700001,CDM,,,250,RC,50383062750,NDC,facility,both,0.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 75 mg/mL (15 mg/mL elemental iron) Solution 50 mL Bottle,63700001,CDM,,,250,RC,39328005750,NDC,facility,both,0.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 10 mL Cup,63700001,CDM,,,250,RC,50383006312,NDC,facility,both,0.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 10 mL Cup,63700001,CDM,,,250,RC,00121148810,NDC,facility,both,0.5,ML,1.21,0.86,Aetna First Health,Commercial,,1.03,85,,,0.54,1.03,percent of total billed charges,
midazolam 2 MG/ML Syrup 5 mL Syringe,63700001,CDM,,,250,RC,88886800064,NDC,facility,both,0.5,ML,1.75,1.24,Aetna First Health,Commercial,,1.49,85,,,0.78,1.49,percent of total billed charges,
cetirizine 1 MG/ML Solution 5 mL Cup,63700001,CDM,,,250,RC,68094000459,NDC,facility,both,0.5,ML,1.79,1.27,Aetna First Health,Commercial,,1.52,85,,,0.79,1.52,percent of total billed charges,
cetirizine 1 MG/ML Solution 5 mL Cup,63700001,CDM,,,250,RC,68094000462,NDC,facility,both,0.5,ML,1.79,1.27,Aetna First Health,Commercial,,1.52,85,,,0.79,1.52,percent of total billed charges,
methadone 10 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00054355344,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00527192736,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 10 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,00406412303,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 10 mL Cup,63700001,CDM,,,250,RC,48433022010,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,50383077930,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,50383077931,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,00121115440,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,00121115430,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG/5ML Solution 10 mL Cup,63700001,CDM,,,250,RC,66689003101,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 10 mL Cup,63700001,CDM,,,250,RC,50383006310,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 10 MG/ML Solution 60 mL Bottle,63700001,CDM,,,250,RC,00054329446,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 10 mL Cup,63700001,CDM,,,250,RC,17856077102,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 10 MG/ML Solution 60 mL Bottle,63700001,CDM,,,250,RC,60432061360,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ferrous sulfate 75 mg/mL (15 mg/mL elemental iron) Solution 50 mL Bottle,63700001,CDM,,,250,RC,54838001150,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ferrous sulfate 75 mg/mL (15 mg/mL elemental iron) Solution 50 mL Bottle,63700001,CDM,,,250,RC,71399748005,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,00121115400,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,50383077933,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ferrous sulfate 75 mg/mL (15 mg/mL elemental iron) Solution 50 mL Bottle,63700001,CDM,,,250,RC,00087074002,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENObarb-hyoscy-atropine-scopalamine 16.2 MG/5ML Elixir 10 mL Syringe,63700001,CDM,,,250,RC,98888800154,NDC,facility,both,0.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 10 mL Cup,63700001,CDM,,,250,RC,00121187010,NDC,facility,both,0.5,ML,3.24,2.29,Aetna First Health,Commercial,,2.75,85,,,1.44,2.75,percent of total billed charges,
oxyCODONE 10 MG/0.5ML Concentrate 0.5 mL Syringe,63700001,CDM,,,250,RC,68094080101,NDC,facility,both,0.5,ML,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121479905,NDC,facility,both,0.5,ML,3.53,2.5,Aetna First Health,Commercial,,3,85,,,1.56,3,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,69339014905,NDC,facility,both,0.5,ML,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
methadone 10 MG/ML Concentrate 30 mL Bottle,63700001,CDM,,,250,RC,66689069430,NDC,facility,both,0.5,ML,3.88,2.75,Aetna First Health,Commercial,,3.3,85,,,1.72,3.3,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 5 mL Cup,63700001,CDM,,,250,RC,63739053950,NDC,facility,both,0.5,ML,4.02,2.85,Aetna First Health,Commercial,,3.42,85,,,1.78,3.42,percent of total billed charges,
olive oil Oil 30 mL Bottle,63700001,CDM,,,250,RC,00395206311,NDC,facility,both,0.5,ML,4.1,2.9,Aetna First Health,Commercial,,3.48,85,,,1.82,3.48,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 10 mL Cup,63700001,CDM,,,250,RC,66689000501,NDC,facility,both,0.5,ML,6.63,4.69,Aetna First Health,Commercial,,5.64,85,,,2.94,5.64,percent of total billed charges,
midazolam 2 MG/ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,68094071659,NDC,facility,both,0.5,ML,7.12,5.04,Aetna First Health,Commercial,,6.05,85,,,3.16,6.05,percent of total billed charges,
midazolam 2 MG/ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,68094071662,NDC,facility,both,0.5,ML,7.13,5.05,Aetna First Health,Commercial,,6.06,85,,,3.16,6.06,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 5 mL Cup,63700001,CDM,,,250,RC,60687024940,NDC,facility,both,0.5,ML,10.15,7.19,Aetna First Health,Commercial,,8.63,85,,,4.5,8.63,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 5 mL Cup,63700001,CDM,,,250,RC,60687024977,NDC,facility,both,0.5,ML,10.37,7.34,Aetna First Health,Commercial,,8.81,85,,,4.6,8.81,percent of total billed charges,
midazolam 2 MG/ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,68094076459,NDC,facility,both,0.5,ML,10.69,7.57,Aetna First Health,Commercial,,9.09,85,,,4.74,9.09,percent of total billed charges,
midazolam 2 MG/ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,60687057640,NDC,facility,both,0.5,ML,10.79,7.64,Aetna First Health,Commercial,,9.17,85,,,4.78,9.17,percent of total billed charges,
charcoal activated Liquid 240 mL Bottle,63700001,CDM,,,250,RC,00574012108,NDC,facility,both,0.5,ML,14.22,10.07,Aetna First Health,Commercial,,12.09,85,,,6.3,12.09,percent of total billed charges,
charcoal activated Liquid 240 mL Tube,63700001,CDM,,,250,RC,00574052176,NDC,facility,both,0.5,ML,14.22,10.07,Aetna First Health,Commercial,,12.09,85,,,6.3,12.09,percent of total billed charges,
charcoal activated Liquid 240 mL Bottle,63700001,CDM,,,250,RC,66689020208,NDC,facility,both,0.5,ML,22.5,15.93,Aetna First Health,Commercial,,19.12,85,,,9.97,19.12,percent of total billed charges,
sulfamethoxazole-trimethoprim 200-40 MG/5ML Suspension 20 mL Cup,63700001,CDM,,,250,RC,00121085320,NDC,facility,both,0.5,ML,26.11,18.49,Aetna First Health,Commercial,,22.19,85,,,11.57,22.19,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 30 mL Cup,63700001,CDM,,,250,RC,00121252030,NDC,facility,both,0.5,ML,37.01,26.2,Aetna First Health,Commercial,,31.46,85,,,16.4,31.46,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 30 mL Cup,63700001,CDM,,,250,RC,66689004801,NDC,facility,both,0.5,ML,37.07,26.25,Aetna First Health,Commercial,,31.51,85,,,16.43,31.51,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 30 mL Cup,63700001,CDM,,,250,RC,60687062845,NDC,facility,both,0.5,ML,46.62,33.01,Aetna First Health,Commercial,,39.63,85,,,20.66,39.63,percent of total billed charges,
morphine dilution 1 MG/ML Solution 1 mL Syringe,63700001,CDM,,,250,RC,88886800339,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
niMODipine 6 MG/ML Solution 10 mL Syringe,63700001,CDM,,,250,RC,24338026010,NDC,facility,both,0.5,ML,171.52,121.44,Aetna First Health,Commercial,,145.79,85,,,76.02,145.79,percent of total billed charges,
niMODipine 6 MG/ML Solution 10 mL Box,63700001,CDM,,,250,RC,24338026012,NDC,facility,both,0.5,ML,171.52,121.44,Aetna First Health,Commercial,,145.79,85,,,76.02,145.79,percent of total billed charges,
sodium polystyrene sulfonate 15 GM/60ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,46287000604,NDC,facility,both,0.5,ML,203.07,143.77,Aetna First Health,Commercial,,172.61,85,,,90,172.61,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 20.3 mL Cup,63700001,CDM,,,250,RC,68094003059,NDC,facility,both,0.50031,ML,1.36,0.96,Aetna First Health,Commercial,,1.16,85,,,0.6,1.16,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,00869069338,NDC,facility,both,0.50676,ML,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,00869068638,NDC,facility,both,0.50676,ML,0.9,0.64,Aetna First Health,Commercial,,0.76,85,,,0.4,0.76,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,70677005301,NDC,facility,both,0.50676,ML,0.9,0.64,Aetna First Health,Commercial,,0.76,85,,,0.4,0.76,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,00869066738,NDC,facility,both,0.50676,ML,0.9,0.64,Aetna First Health,Commercial,,0.76,85,,,0.4,0.76,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,49348050449,NDC,facility,both,0.50676,ML,0.9,0.64,Aetna First Health,Commercial,,0.76,85,,,0.4,0.76,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,69452039098,NDC,facility,both,0.50676,ML,0.9,0.64,Aetna First Health,Commercial,,0.76,85,,,0.4,0.76,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,49348069649,NDC,facility,both,0.50676,ML,1.13,0.8,Aetna First Health,Commercial,,0.96,85,,,0.5,0.96,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,00869016638,NDC,facility,both,0.50676,ML,1.13,0.8,Aetna First Health,Commercial,,0.96,85,,,0.5,0.96,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,69452038998,NDC,facility,both,0.50676,ML,1.13,0.8,Aetna First Health,Commercial,,0.96,85,,,0.5,0.96,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,00904630477,NDC,facility,both,0.50676,ML,1.35,0.96,Aetna First Health,Commercial,,1.15,85,,,0.6,1.15,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,24385067510,NDC,facility,both,0.50676,ML,1.35,0.96,Aetna First Health,Commercial,,1.15,85,,,0.6,1.15,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,00904678744,NDC,facility,both,0.50676,ML,1.58,1.12,Aetna First Health,Commercial,,1.34,85,,,0.7,1.34,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,46122074038,NDC,facility,both,0.50676,ML,1.58,1.12,Aetna First Health,Commercial,,1.34,85,,,0.7,1.34,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,71399005101,NDC,facility,both,0.50676,ML,2.25,1.59,Aetna First Health,Commercial,,1.91,85,,,1,1.91,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,71399788901,NDC,facility,both,0.50676,ML,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,70677005101,NDC,facility,both,0.50676,ML,24.75,17.52,Aetna First Health,Commercial,,21.04,85,,,10.97,21.04,percent of total billed charges,
atomoxetine 18 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,68462026630,NDC,facility,both,0.55556,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
atomoxetine 18 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,64980037403,NDC,facility,both,0.55556,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
atomoxetine 18 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,55111052030,NDC,facility,both,0.55556,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
atomoxetine 18 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,60505283103,NDC,facility,both,0.55556,EA,7.2,5.1,Aetna First Health,Commercial,,6.12,85,,,3.19,6.12,percent of total billed charges,
atomoxetine 18 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714075601,NDC,facility,both,0.55556,EA,7.37,5.22,Aetna First Health,Commercial,,6.26,85,,,3.27,6.26,percent of total billed charges,
levothyroxine 175 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687054111,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 175 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292004001,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 175 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183901,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 175 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527135001,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 175 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378181701,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 175 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687054101,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 175 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904695761,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 175 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518892,NDC,facility,both,0.57143,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687014311,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862000901,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382002901,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155010301,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406202901,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462016001,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877056201,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00087607005,NDC,facility,both,0.58824,EA,3.45,2.44,Aetna First Health,Commercial,,2.93,85,,,1.53,2.93,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584033201,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687014301,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904669061,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904632761,NDC,facility,both,0.58824,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisdexamfetamine 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59417010510,NDC,facility,both,0.6,EA,27.14,19.22,Aetna First Health,Commercial,,23.07,85,,,12.03,23.07,percent of total billed charges,
mexiletine 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093874101,NDC,facility,both,0.6,EA,3.87,2.74,Aetna First Health,Commercial,,3.29,85,,,1.72,3.29,percent of total billed charges,
topiramate 25 MG CAPSULE SPRINKLE 60 Each Bottle,63700001,CDM,,,250,RC,00093733606,NDC,facility,both,0.6,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG CAPSULE SPRINKLE 60 Each Bottle,63700001,CDM,,,250,RC,68382000514,NDC,facility,both,0.6,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG CAPSULE SPRINKLE 60 Each Bottle,63700001,CDM,,,250,RC,50458064565,NDC,facility,both,0.6,EA,15.74,11.14,Aetna First Health,Commercial,,13.38,85,,,6.98,13.38,percent of total billed charges,
buPROPion 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079094301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687034011,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268014211,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781105301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378043301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505015801,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001030800,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001019900,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155019101,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079094320,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687034001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904663561,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084070895,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43547028910,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,31722006701,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00185041501,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,70436005901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,51079039220,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,00904658561,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,00904721461,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 250 Each Bottle,63700001,CDM,,,250,RC,00185041552,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,68084070825,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 500 Each Bottle,63700001,CDM,,,250,RC,00185041505,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00185041560,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,67767013360,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00591354160,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,69097087803,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00173013555,NDC,facility,both,0.66667,EA,11.61,8.22,Aetna First Health,Commercial,,9.87,85,,,5.15,9.87,percent of total billed charges,
busPIRone 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729020101,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59651039001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382062301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884072501,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378114501,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380078706,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24689078501,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine CR 300 MG Capsule Extended Release 12 Hour 120 Each Bottle,63700001,CDM,,,250,RC,29033000412,NDC,facility,both,0.66667,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
carBAMazepine CR 300 MG Capsule Extended Release 12 Hour 120 Each Bottle,63700001,CDM,,,250,RC,66993040932,NDC,facility,both,0.66667,EA,3.82,2.7,Aetna First Health,Commercial,,3.25,85,,,1.69,3.25,percent of total billed charges,
carBAMazepine CR 300 MG Capsule Extended Release 12 Hour 120 Each Bottle,63700001,CDM,,,250,RC,60505280707,NDC,facility,both,0.66667,EA,3.82,2.7,Aetna First Health,Commercial,,3.25,85,,,1.69,3.25,percent of total billed charges,
carBAMazepine CR 300 MG Capsule Extended Release 12 Hour 120 Each Bottle,63700001,CDM,,,250,RC,54092017312,NDC,facility,both,0.66667,EA,4.14,2.93,Aetna First Health,Commercial,,3.52,85,,,1.83,3.52,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084033311,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,51079022401,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687065811,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00378628101,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,68001028100,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00781178901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,51079022420,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,16571020106,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,68001020006,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,68001028106,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,00228255106,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084005311,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687020611,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,63739028410,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084005301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687020601,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,63739001510,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904721861,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,49884083011,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10370083011,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68084005330,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00187079630,NDC,facility,both,0.66667,EA,55.37,39.2,Aetna First Health,Commercial,,47.06,85,,,24.54,47.06,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,62037059890,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,49884083009,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,42291018590,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68084005390,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68682099498,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 180 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,10370083009,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CR 90 MG Capsule Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079092501,NDC,facility,both,0.66667,EA,9.08,6.43,Aetna First Health,Commercial,,7.72,85,,,4.02,7.72,percent of total billed charges,
dilTIAZem CR 90 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378609001,NDC,facility,both,0.66667,EA,5.89,4.17,Aetna First Health,Commercial,,5.01,85,,,2.61,5.01,percent of total billed charges,
dilTIAZem CR 90 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68462085101,NDC,facility,both,0.66667,EA,7.38,5.23,Aetna First Health,Commercial,,6.27,85,,,3.27,6.27,percent of total billed charges,
dilTIAZem CR 90 MG Capsule Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,51079092520,NDC,facility,both,0.66667,EA,9.09,6.44,Aetna First Health,Commercial,,7.73,85,,,4.03,7.73,percent of total billed charges,
dilTIAZem XR 180 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378528001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem XR 180 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,60505001506,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,50268028711,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,42292002001,NDC,facility,both,0.66667,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,60687073411,NDC,facility,both,0.66667,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,00002324001,NDC,facility,both,0.66667,EA,16.96,12.01,Aetna First Health,Commercial,,14.42,85,,,7.52,14.42,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,00904645361,NDC,facility,both,0.66667,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,00904704461,NDC,facility,both,0.66667,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,68084068301,NDC,facility,both,0.66667,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,60687073401,NDC,facility,both,0.66667,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,57237001830,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,60505299603,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,68001025604,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,68001041404,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,27241009803,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,00228289103,NDC,facility,both,0.66667,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,68180029506,NDC,facility,both,0.66667,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,00002324030,NDC,facility,both,0.66667,EA,21.82,15.45,Aetna First Health,Commercial,,18.55,85,,,9.67,18.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Box,63700001,CDM,,,250,RC,50268028713,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,57237001890,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,67877026490,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,68001041405,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,51991074790,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,68001059505,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,47335038281,NDC,facility,both,0.66667,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,68382038616,NDC,facility,both,0.66667,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,68001025605,NDC,facility,both,0.66667,EA,15.24,10.79,Aetna First Health,Commercial,,12.95,85,,,6.75,12.95,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,00002324090,NDC,facility,both,0.66667,EA,16.96,12.01,Aetna First Health,Commercial,,14.42,85,,,7.52,14.42,percent of total billed charges,
etodolac 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62559025101,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
etodolac 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60505004001,NDC,facility,both,0.66667,EA,3.02,2.14,Aetna First Health,Commercial,,2.57,85,,,1.34,2.57,percent of total billed charges,
etodolac 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51672401701,NDC,facility,both,0.66667,EA,3.02,2.14,Aetna First Health,Commercial,,2.57,85,,,1.34,2.57,percent of total billed charges,
etodolac XL 600 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,51672405304,NDC,facility,both,0.66667,EA,6.23,4.41,Aetna First Health,Commercial,,5.3,85,,,2.76,5.3,percent of total billed charges,
levothyroxine 150 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687053011,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183801,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378181501,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079044520,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687053001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518792,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378181577,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074706990,NDC,facility,both,0.66667,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268055111,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00093721201,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,60505132901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62756014301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,76385012901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51224010750,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,70010049201,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,53746017901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,67877041401,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 750 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00087606413,NDC,facility,both,0.66667,EA,3.53,2.5,Aetna First Health,Commercial,,3,85,,,1.56,3,percent of total billed charges,
methocarbamol 750 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687056811,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084005711,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143129201,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722053401,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385012401,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70010077001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739016710,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084005701,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687056801,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904705861,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 27 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,13811070710,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 27 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,31722095301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 27 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,47781041601,NDC,facility,both,0.66667,EA,4.66,3.3,Aetna First Health,Commercial,,3.96,85,,,2.07,3.96,percent of total billed charges,
methylphenidate 27 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406012701,NDC,facility,both,0.66667,EA,9.33,6.61,Aetna First Health,Commercial,,7.93,85,,,4.14,7.93,percent of total billed charges,
methylphenidate 27 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,10147068801,NDC,facility,both,0.66667,EA,18.62,13.18,Aetna First Health,Commercial,,15.83,85,,,8.25,15.83,percent of total billed charges,
methylphenidate 27 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,50458058801,NDC,facility,both,0.66667,EA,30.85,21.84,Aetna First Health,Commercial,,26.22,85,,,13.67,26.22,percent of total billed charges,
methylphenidate 27 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,65162023309,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185014601,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591367101,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115165801,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097096607,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50228046601,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462035901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
niacin CR (antihyperlipidemic) 750 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68180022201,NDC,facility,both,0.66667,EA,11.28,7.99,Aetna First Health,Commercial,,9.59,85,,,5,9.59,percent of total billed charges,
niacin CR (antihyperlipidemic) 750 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,00093739398,NDC,facility,both,0.66667,EA,11.28,7.99,Aetna First Health,Commercial,,9.59,85,,,5,9.59,percent of total billed charges,
niacin CR (antihyperlipidemic) 750 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,00074307990,NDC,facility,both,0.66667,EA,15.05,10.66,Aetna First Health,Commercial,,12.79,85,,,6.67,12.79,percent of total billed charges,
niacin CR (antihyperlipidemic) 750 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,00074327490,NDC,facility,both,0.66667,EA,17.2,12.18,Aetna First Health,Commercial,,14.62,85,,,7.62,14.62,percent of total billed charges,
niCARdipine 30 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,42806050209,NDC,facility,both,0.66667,EA,5.93,4.2,Aetna First Health,Commercial,,5.04,85,,,2.63,5.04,percent of total billed charges,
niCARdipine 30 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00378143077,NDC,facility,both,0.66667,EA,5.96,4.22,Aetna First Health,Commercial,,5.07,85,,,2.64,5.07,percent of total billed charges,
niCARdipine 30 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,62559020690,NDC,facility,both,0.66667,EA,26.96,19.09,Aetna First Health,Commercial,,22.92,85,,,11.95,22.92,percent of total billed charges,
niCARdipine 30 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,68462012190,NDC,facility,both,0.66667,EA,27.12,19.2,Aetna First Health,Commercial,,23.05,85,,,12.02,23.05,percent of total billed charges,
oxazepam 15 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228206910,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxazepam 15 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781281001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxazepam 15 MG capsule 100 Each Box,63700001,CDM,,,250,RC,62584081301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE CR 15 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,59011041510,NDC,facility,both,0.66667,EA,18.32,12.97,Aetna First Health,Commercial,,15.57,85,,,8.12,15.57,percent of total billed charges,
oxyCODONE CR 15 MG Tablet ER 12 hour Abuse-Deterrent 20 Each Box,63700001,CDM,,,250,RC,59011041520,NDC,facility,both,0.66667,EA,18.79,13.3,Aetna First Health,Commercial,,15.97,85,,,8.33,15.97,percent of total billed charges,
propafenone 225 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591058301,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 225 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489055201,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 225 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559023101,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 300 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904680461,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 300 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00310028339,NDC,facility,both,0.66667,EA,49.65,35.15,Aetna First Health,Commercial,,42.2,85,,,22,42.2,percent of total billed charges,
QUEtiapine XR 300 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00310828360,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 300 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,16729009612,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 300 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,68001051406,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 300 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00310028360,NDC,facility,both,0.66667,EA,49.65,35.15,Aetna First Health,Commercial,,42.2,85,,,22,42.2,percent of total billed charges,
rivaroxaban 15 MG Tablet 10 Each Pack,63700001,CDM,,,250,RC,50458057801,NDC,facility,both,0.66667,EA,44.3,31.36,Aetna First Health,Commercial,,37.65,85,,,19.63,37.65,percent of total billed charges,
rivaroxaban 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458057810,NDC,facility,both,0.66667,EA,44.3,31.36,Aetna First Health,Commercial,,37.65,85,,,19.63,37.65,percent of total billed charges,
rivaroxaban 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,50458057830,NDC,facility,both,0.66667,EA,44.3,31.36,Aetna First Health,Commercial,,37.65,85,,,19.63,37.65,percent of total billed charges,
rivaroxaban 15 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,50458057890,NDC,facility,both,0.66667,EA,44.3,31.36,Aetna First Health,Commercial,,37.65,85,,,19.63,37.65,percent of total billed charges,
salsalate 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293080401,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
salsalate 750 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293061601,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
salsalate 750 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904125161,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 120 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268072511,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 120 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093106001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 120 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185017001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 120 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505015900,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 120 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385011501,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079048001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084084411,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015800,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093738001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382001901,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079048020,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084033001,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084084401,NDC,facility,both,0.66667,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Methylnaltrexone 12 MG/0.6ML Solution 0.6 mL Syringe,63700001,CDM,,,250,RC,65649055107,NDC,facility,both,0.66667,ML,240.46,170.25,Aetna First Health,Commercial,,204.39,85,,,106.57,204.39,percent of total billed charges,
dolutegravir 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,49702022813,NDC,facility,both,0.7,EA,184.36,130.53,Aetna First Health,Commercial,,156.71,85,,,81.71,156.71,percent of total billed charges,
levothyroxine 137 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687056311,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292004101,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527163801,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183701,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378182301,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292004120,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687056301,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781519192,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378182377,NDC,facility,both,0.72993,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 137 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074372790,NDC,facility,both,0.72993,EA,4.03,2.85,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
atazanavir 200 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,65862071260,NDC,facility,both,0.75,EA,7.8,5.52,Aetna First Health,Commercial,,6.63,85,,,3.46,6.63,percent of total billed charges,
atazanavir 200 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00003363112,NDC,facility,both,0.75,EA,55.97,39.63,Aetna First Health,Commercial,,47.57,85,,,24.81,47.57,percent of total billed charges,
gabapentin 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228263711,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001000700,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisdexamfetamine 40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59417010410,NDC,facility,both,0.75,EA,33.93,24.02,Aetna First Health,Commercial,,28.84,85,,,15.04,28.84,percent of total billed charges,
mexiletine 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527410837,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mexiletine 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,50742024001,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mexiletine 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62756095601,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687022611,NDC,facility,both,0.75,EA,6.02,4.26,Aetna First Health,Commercial,,5.12,85,,,2.67,5.12,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51991081801,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42291052301,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527411737,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43478090188,NDC,facility,both,0.75,EA,5.13,3.63,Aetna First Health,Commercial,,4.36,85,,,2.27,4.36,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228277911,NDC,facility,both,0.75,EA,5.16,3.65,Aetna First Health,Commercial,,4.39,85,,,2.29,4.39,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687022601,NDC,facility,both,0.75,EA,6.02,4.26,Aetna First Health,Commercial,,5.12,85,,,2.67,5.12,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084050401,NDC,facility,both,0.75,EA,6.02,4.26,Aetna First Health,Commercial,,5.12,85,,,2.67,5.12,percent of total billed charges,
sulindac 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591566001,NDC,facility,both,0.75,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sodium chloride 3 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,50190014263,NDC,facility,both,0.75,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 3 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,00487900330,NDC,facility,both,0.75,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 3 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,76204002260,NDC,facility,both,0.75,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
erythromycin base EC 333 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00074632013,NDC,facility,both,0.75075,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
erythromycin base EC 333 MG Tablet Delayed Release 30 Each Bottle,63700001,CDM,,,250,RC,52536018303,NDC,facility,both,0.75075,EA,16.5,11.68,Aetna First Health,Commercial,,14.02,85,,,7.31,14.02,percent of total billed charges,
erythromycin base EC 333 MG Tablet Delayed Release 30 Each Bottle,63700001,CDM,,,250,RC,24338012403,NDC,facility,both,0.75075,EA,28.24,19.99,Aetna First Health,Commercial,,24,85,,,12.52,24,percent of total billed charges,
etodolac 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238134301,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
etodolac 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403601,NDC,facility,both,0.8,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
etodolac 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185068701,NDC,facility,both,0.8,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
etodolac 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505010201,NDC,facility,both,0.8,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
etodolac 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093189301,NDC,facility,both,0.8,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
levothyroxine 125 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079044301,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687051911,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134701,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183601,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378181301,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079044320,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687051901,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518692,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378181377,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00527328646,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 125 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074706890,NDC,facility,both,0.8,EA,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
montelukast 5 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,50268057411,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 5 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,00093742556,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 5 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,31722072830,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 5 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,57237021330,NDC,facility,both,0.8,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 5 MG Tablet Chewable 50 Each Box,63700001,CDM,,,250,RC,50268057415,NDC,facility,both,0.8,EA,3.3,2.34,Aetna First Health,Commercial,,2.8,85,,,1.46,2.8,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00904727641,NDC,facility,both,0.8,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121481005,NDC,facility,both,0.8,ML,3.95,2.8,Aetna First Health,Commercial,,3.36,85,,,1.75,3.36,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121086800,NDC,facility,both,0.8,ML,5.29,3.75,Aetna First Health,Commercial,,4.5,85,,,2.34,4.5,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,60687080040,NDC,facility,both,0.8,ML,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121086805,NDC,facility,both,0.8,ML,5.49,3.89,Aetna First Health,Commercial,,4.67,85,,,2.43,4.67,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121086850,NDC,facility,both,0.8,ML,5.49,3.89,Aetna First Health,Commercial,,4.67,85,,,2.43,4.67,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,17856053801,NDC,facility,both,0.8,ML,6.22,4.4,Aetna First Health,Commercial,,5.29,85,,,2.76,5.29,percent of total billed charges,
levothyroxine 112 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292003901,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687050811,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134601,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183501,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00456133001,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60793085501,NDC,facility,both,0.89286,EA,3.45,2.44,Aetna First Health,Commercial,,2.93,85,,,1.53,2.93,percent of total billed charges,
levothyroxine 112 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292003920,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687050801,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518592,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378181177,NDC,facility,both,0.89286,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 112 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074929690,NDC,facility,both,0.89286,EA,4.93,3.49,Aetna First Health,Commercial,,4.19,85,,,2.18,4.19,percent of total billed charges,
abacavir 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084002111,NDC,facility,both,1,EA,30.88,21.86,Aetna First Health,Commercial,,26.25,85,,,13.69,26.25,percent of total billed charges,
abacavir 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904687404,NDC,facility,both,1,EA,30.33,21.47,Aetna First Health,Commercial,,25.78,85,,,13.44,25.78,percent of total billed charges,
abacavir 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084002121,NDC,facility,both,1,EA,30.88,21.86,Aetna First Health,Commercial,,26.25,85,,,13.69,26.25,percent of total billed charges,
abacavir 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862007360,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
abacavir 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722055760,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
abacavir 300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00378410591,NDC,facility,both,1,EA,28.13,19.92,Aetna First Health,Commercial,,23.91,85,,,12.47,23.91,percent of total billed charges,
acamprosate 333 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,51079024101,NDC,facility,both,1,EA,3.02,2.14,Aetna First Health,Commercial,,2.57,85,,,1.34,2.57,percent of total billed charges,
acamprosate 333 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687012195,NDC,facility,both,1,EA,7.91,5.6,Aetna First Health,Commercial,,6.72,85,,,3.51,6.72,percent of total billed charges,
acamprosate 333 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,00378633380,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acamprosate 333 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,68462043518,NDC,facility,both,1,EA,3.84,2.72,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
acamprosate 333 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,68382056928,NDC,facility,both,1,EA,4.92,3.48,Aetna First Health,Commercial,,4.18,85,,,2.18,4.18,percent of total billed charges,
acamprosate 333 MG Tablet Delayed Release 30 Each Box,63700001,CDM,,,250,RC,60687012125,NDC,facility,both,1,EA,7.91,5.6,Aetna First Health,Commercial,,6.72,85,,,3.51,6.72,percent of total billed charges,
acamprosate 333 MG Tablet Delayed Release 50 Each Box,63700001,CDM,,,250,RC,51079024106,NDC,facility,both,1,EA,3.02,2.14,Aetna First Health,Commercial,,2.57,85,,,1.34,2.57,percent of total billed charges,
acarbose 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16252052301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acarbose 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054014025,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acarbose 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380075806,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acarbose 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69543012010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acebutolol 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268005011,NDC,facility,both,1,EA,5.18,3.67,Aetna First Health,Commercial,,4.4,85,,,2.3,4.4,percent of total billed charges,
acebutolol 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162066910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acebutolol 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,53746066901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acebutolol 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62559025501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672402201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70756072011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084040111,NDC,facility,both,1,EA,13.71,9.71,Aetna First Health,Commercial,,11.65,85,,,6.08,11.65,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687057811,NDC,facility,both,1,EA,16.64,11.78,Aetna First Health,Commercial,,14.14,85,,,7.37,14.14,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42571024301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742023301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,29033003001,NDC,facility,both,1,EA,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,23155012001,NDC,facility,both,1,EA,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68382026101,NDC,facility,both,1,EA,10.85,7.68,Aetna First Health,Commercial,,9.22,85,,,4.81,9.22,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51285075402,NDC,facility,both,1,EA,27.15,19.22,Aetna First Health,Commercial,,23.08,85,,,12.03,23.08,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,68084040121,NDC,facility,both,1,EA,13.71,9.71,Aetna First Health,Commercial,,11.65,85,,,6.08,11.65,percent of total billed charges,
acetaZOLAMIDE 500 MG Capsule Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,60687057821,NDC,facility,both,1,EA,16.64,11.78,Aetna First Health,Commercial,,14.14,85,,,7.37,14.14,percent of total billed charges,
acidophilus lactobacillus capsule 1 Each Blister,63700001,CDM,,,250,RC,77333000415,NDC,facility,both,1,EA,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
acidophilus lactobacillus capsule 100 Each Bottle,63700001,CDM,,,250,RC,57896086601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acidophilus lactobacillus capsule 50 Each Box,63700001,CDM,,,250,RC,77333000450,NDC,facility,both,1,EA,0.51,0.36,Aetna First Health,Commercial,,0.43,85,,,0.23,0.43,percent of total billed charges,
Acidophilus/Citrus Pectin Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536718001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Acidophilus/Citrus Pectin Tablet 100 Each Bottle,63700001,CDM,,,250,RC,80681002600,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Acidophilus/Pectin capsule 100 Each Bottle,63700001,CDM,,,250,RC,00904421360,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Acidophilus/Pectin capsule 100 Each Box,63700001,CDM,,,250,RC,00904660861,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
acyclovir 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084010711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268006011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63304065201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,61442011101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093894001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,75834012401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60505004206,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,72578000201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904578961,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084010701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 200 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268006015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 400 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268006115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084010911,NDC,facility,both,1,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
acyclovir 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093894701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304050501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acyclovir 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084010901,NDC,facility,both,1,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
adefovir 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,61958050101,NDC,facility,both,1,EA,190.2,134.66,Aetna First Health,Commercial,,161.67,85,,,84.3,161.67,percent of total billed charges,
albendazole 200 MG Tablet 2 Each Bottle,63700001,CDM,,,250,RC,52054055022,NDC,facility,both,1,EA,849.35,601.34,Aetna First Health,Commercial,,721.95,85,,,376.43,721.95,percent of total billed charges,
albuterol 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079065720,NDC,facility,both,1,EA,20.56,14.56,Aetna First Health,Commercial,,17.48,85,,,9.11,17.48,percent of total billed charges,
alendronate 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093514156,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
alendronate 35 MG Tablet 4 Each Box,63700001,CDM,,,250,RC,00093517244,NDC,facility,both,1,EA,6.56,4.64,Aetna First Health,Commercial,,5.58,85,,,2.91,5.58,percent of total billed charges,
alendronate 35 MG Tablet 4 Each Box,63700001,CDM,,,250,RC,16252059944,NDC,facility,both,1,EA,6.56,4.64,Aetna First Health,Commercial,,5.58,85,,,2.91,5.58,percent of total billed charges,
alendronate 35 MG Tablet 4 Each Box,63700001,CDM,,,250,RC,00378356899,NDC,facility,both,1,EA,8.98,6.36,Aetna First Health,Commercial,,7.63,85,,,3.98,7.63,percent of total billed charges,
alendronate 35 MG Tablet 4 Each Package,63700001,CDM,,,250,RC,41616063768,NDC,facility,both,1,EA,3.06,2.17,Aetna First Health,Commercial,,2.6,85,,,1.36,2.6,percent of total billed charges,
alendronate 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093514056,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
alendronate 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00115167608,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
alendronate 70 MG Tablet 1 Each Package,63700001,CDM,,,250,RC,00093517119,NDC,facility,both,1,EA,6.56,4.64,Aetna First Health,Commercial,,5.58,85,,,2.91,5.58,percent of total billed charges,
alendronate 70 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,69543013120,NDC,facility,both,1,EA,9.77,6.92,Aetna First Health,Commercial,,8.3,85,,,4.33,8.3,percent of total billed charges,
alendronate 70 MG Tablet 4 Each Box,63700001,CDM,,,250,RC,64980034214,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
alendronate 70 MG Tablet 4 Each Box,63700001,CDM,,,250,RC,16714063301,NDC,facility,both,1,EA,3.94,2.79,Aetna First Health,Commercial,,3.35,85,,,1.75,3.35,percent of total billed charges,
alendronate 70 MG Tablet 4 Each Box,63700001,CDM,,,250,RC,00378356999,NDC,facility,both,1,EA,8.98,6.36,Aetna First Health,Commercial,,7.63,85,,,3.98,7.63,percent of total billed charges,
alendronate 70 MG Tablet 4 Each Box,63700001,CDM,,,250,RC,00006003144,NDC,facility,both,1,EA,111.86,79.2,Aetna First Health,Commercial,,95.08,85,,,49.58,95.08,percent of total billed charges,
alendronate 70 MG Tablet 4 Each Package,63700001,CDM,,,250,RC,41616063868,NDC,facility,both,1,EA,3.06,2.17,Aetna First Health,Commercial,,2.6,85,,,1.36,2.6,percent of total billed charges,
alfuzosin 10 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,57237011490,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
alfuzosin 10 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,29300015519,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aliskiren 150 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00078048515,NDC,facility,both,1,EA,15.32,10.85,Aetna First Health,Commercial,,13.02,85,,,6.79,13.02,percent of total billed charges,
aliskiren 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66993014230,NDC,facility,both,1,EA,27.5,19.47,Aetna First Health,Commercial,,23.38,85,,,12.19,23.38,percent of total billed charges,
aliskiren 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70839030030,NDC,facility,both,1,EA,46.63,33.01,Aetna First Health,Commercial,,39.64,85,,,20.67,39.64,percent of total billed charges,
allopurinol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584098811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
allopurinol 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584071301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084064711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687037711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079078801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084001811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228202710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762371901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51991070401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862067601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781106101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253090010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084001801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084064701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739064410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904585861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00781106105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884011052,NDC,facility,both,1,EA,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
ALPRAZolam 0.25 MG Tablet Disintegrating 100 Each Box,63700001,CDM,,,250,RC,49884011074,NDC,facility,both,1,EA,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079078901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084067211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam XR 1 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,59762005901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam XR 1 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,65862045560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ALPRAZolam XR 1 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00228308406,NDC,facility,both,1,EA,3.37,2.39,Aetna First Health,Commercial,,2.86,85,,,1.49,2.86,percent of total billed charges,
aluminum sulfate-calcium acetate Packet 1 Each Packet,63700001,CDM,,,250,RC,51224016299,NDC,facility,both,1,EA,1.22,0.86,Aetna First Health,Commercial,,1.04,85,,,0.54,1.04,percent of total billed charges,
aluminum sulfate-calcium acetate Packet 12 Each Box,63700001,CDM,,,250,RC,57074000177,NDC,facility,both,1,EA,1,0.71,Aetna First Health,Commercial,,0.85,85,,,0.44,0.85,percent of total billed charges,
aluminum sulfate-calcium acetate Packet 12 Each Box,63700001,CDM,,,250,RC,51224016212,NDC,facility,both,1,EA,1.22,0.86,Aetna First Health,Commercial,,1.04,85,,,0.54,1.04,percent of total billed charges,
aluminum sulfate-calcium acetate Packet 12 Each Box,63700001,CDM,,,250,RC,16500002324,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
amantadine 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687042211,NDC,facility,both,1,EA,6.35,4.5,Aetna First Health,Commercial,,5.4,85,,,2.81,5.4,percent of total billed charges,
amantadine 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084061111,NDC,facility,both,1,EA,6.79,4.81,Aetna First Health,Commercial,,5.77,85,,,3.01,5.77,percent of total billed charges,
amantadine 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268006911,NDC,facility,both,1,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
amantadine 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16571083401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amantadine 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00832101500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amantadine 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68382051201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amantadine 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62332024631,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amantadine 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781204801,NDC,facility,both,1,EA,5.65,4,Aetna First Health,Commercial,,4.8,85,,,2.5,4.8,percent of total billed charges,
amantadine 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00832201200,NDC,facility,both,1,EA,5.65,4,Aetna First Health,Commercial,,4.8,85,,,2.5,4.8,percent of total billed charges,
amantadine 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904704261,NDC,facility,both,1,EA,4.53,3.21,Aetna First Health,Commercial,,3.85,85,,,2.01,3.85,percent of total billed charges,
amantadine 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904663061,NDC,facility,both,1,EA,6.28,4.45,Aetna First Health,Commercial,,5.34,85,,,2.78,5.34,percent of total billed charges,
amantadine 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687042201,NDC,facility,both,1,EA,6.35,4.5,Aetna First Health,Commercial,,5.4,85,,,2.81,5.4,percent of total billed charges,
amantadine 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084061101,NDC,facility,both,1,EA,6.79,4.81,Aetna First Health,Commercial,,5.77,85,,,3.01,5.77,percent of total billed charges,
amantadine 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,00904704206,NDC,facility,both,1,EA,4.91,3.48,Aetna First Health,Commercial,,4.17,85,,,2.18,4.17,percent of total billed charges,
amantadine 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268006915,NDC,facility,both,1,EA,10.54,7.46,Aetna First Health,Commercial,,8.96,85,,,4.67,8.96,percent of total billed charges,
aMILoride 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268007111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aMILoride 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574029201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aMILoride 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980015101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aMILoride 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884011701,NDC,facility,both,1,EA,3.16,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
aMILoride 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268007115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aMILoride-hydroCHLOROthiazide 5-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378057701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aminocaproic acid 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69680011530,NDC,facility,both,1,EA,20.88,14.78,Aetna First Health,Commercial,,17.75,85,,,9.25,17.75,percent of total billed charges,
aminocaproic acid 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,72205004930,NDC,facility,both,1,EA,37.92,26.85,Aetna First Health,Commercial,,32.23,85,,,16.81,32.23,percent of total billed charges,
aminocaproic acid 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,17478076830,NDC,facility,both,1,EA,65.34,46.26,Aetna First Health,Commercial,,55.54,85,,,28.96,55.54,percent of total billed charges,
aminocaproic acid 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,49411005030,NDC,facility,both,1,EA,75.18,53.23,Aetna First Health,Commercial,,63.9,85,,,33.32,63.9,percent of total billed charges,
amiodarone 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079090601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084037111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amiodarone 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079090620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079013101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268003711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781148601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714044601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729017101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70710122501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300041901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378261001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603221221,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079013120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079056301,NDC,facility,both,1,EA,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
amitriptyline 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079056320,NDC,facility,both,1,EA,4,2.83,Aetna First Health,Commercial,,3.4,85,,,1.77,3.4,percent of total billed charges,
amitriptyline 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904020161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079013301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amitriptyline 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904020261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084026011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045220,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59762154004,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084026001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268008311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687028511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084025811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904636961,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084025801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687028501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 300 Each Bottle,63700001,CDM,,,250,RC,59762152002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268008315,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59762152001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093008398,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,67877019790,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,64679042101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 2.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00069152068,NDC,facility,both,1,EA,13.24,9.37,Aetna First Health,Commercial,,11.25,85,,,5.87,11.25,percent of total billed charges,
amLODIPine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084050511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084025911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59762153005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084050501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amLODIPine 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00069153068,NDC,facility,both,1,EA,13.24,9.37,Aetna First Health,Commercial,,11.25,85,,,5.87,11.25,percent of total billed charges,
amoxicillin 250 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,00093310719,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781202001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862001601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714029801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093310701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57237003001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG capsule 100 Each Box,63700001,CDM,,,250,RC,62584023701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00781202076,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 250 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00093226801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781261301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00143993901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093226401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143995101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862001501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237002901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143928501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781506101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00781506120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00143995120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin 875 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,57237002920,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 200-28.5 MG Tablet Chewable 20 Each Bottle,63700001,CDM,,,250,RC,00093227034,NDC,facility,both,1,EA,8.1,5.73,Aetna First Health,Commercial,,6.88,85,,,3.59,6.88,percent of total billed charges,
amoxicillin-clavulanate 250-125 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00781187431,NDC,facility,both,1,EA,11.63,8.23,Aetna First Health,Commercial,,9.89,85,,,5.15,9.89,percent of total billed charges,
amoxicillin-clavulanate 250-125 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714047601,NDC,facility,both,1,EA,16.61,11.76,Aetna First Health,Commercial,,14.12,85,,,7.36,14.12,percent of total billed charges,
amoxicillin-clavulanate 400-57 MG Tablet Chewable 20 Each Bottle,63700001,CDM,,,250,RC,00093227234,NDC,facility,both,1,EA,15.42,10.92,Aetna First Health,Commercial,,13.11,85,,,6.83,13.11,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42571016101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,66685100202,NDC,facility,both,1,EA,4.74,3.36,Aetna First Health,Commercial,,4.03,85,,,2.1,4.03,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,65862050220,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,16714049401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00781183120,NDC,facility,both,1,EA,3.32,2.35,Aetna First Health,Commercial,,2.82,85,,,1.47,2.82,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00093227434,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,66685100200,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
amoxicillin-clavulanate 500-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,43598020614,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862050301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42571016201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,66685100101,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781185201,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714047802,NDC,facility,both,1,EA,5.27,3.73,Aetna First Health,Commercial,,4.48,85,,,2.34,4.48,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,65862050320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,42571016242,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,81964022114,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,16714047801,NDC,facility,both,1,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00781185220,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,66685100100,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00143924920,NDC,facility,both,1,EA,4.13,2.92,Aetna First Health,Commercial,,3.51,85,,,1.83,3.51,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00093227534,NDC,facility,both,1,EA,5.91,4.18,Aetna First Health,Commercial,,5.02,85,,,2.62,5.02,percent of total billed charges,
amoxicillin-clavulanate 875-125 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,43598022114,NDC,facility,both,1,EA,5.91,4.18,Aetna First Health,Commercial,,5.02,85,,,2.62,5.02,percent of total billed charges,
amphetamine-dextroamphetamine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185011101,NDC,facility,both,1,EA,4.04,2.86,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
amphetamine-dextroamphetamine 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185086401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406889101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107006801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185083101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185209801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664064108,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555097102,NDC,facility,both,1,EA,3.03,2.15,Aetna First Health,Commercial,,2.58,85,,,1.34,2.58,percent of total billed charges,
amphetamine-dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185008401,NDC,facility,both,1,EA,4.04,2.86,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084081595,NDC,facility,both,1,EA,20.28,14.36,Aetna First Health,Commercial,,17.24,85,,,8.99,17.24,percent of total billed charges,
amphetamine-dextroamphetamine XR 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115132901,NDC,facility,both,1,EA,17.17,12.16,Aetna First Health,Commercial,,14.59,85,,,7.61,14.59,percent of total billed charges,
amphetamine-dextroamphetamine XR 15 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115133001,NDC,facility,both,1,EA,17.17,12.16,Aetna First Health,Commercial,,14.59,85,,,7.61,14.59,percent of total billed charges,
amphetamine-dextroamphetamine XR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,42858005501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amphetamine-dextroamphetamine XR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781232901,NDC,facility,both,1,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
amphetamine-dextroamphetamine XR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406895101,NDC,facility,both,1,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
amphetamine-dextroamphetamine XR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527079037,NDC,facility,both,1,EA,4.07,2.88,Aetna First Health,Commercial,,3.46,85,,,1.8,3.46,percent of total billed charges,
amphetamine-dextroamphetamine XR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228306211,NDC,facility,both,1,EA,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
amphetamine-dextroamphetamine XR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115148601,NDC,facility,both,1,EA,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
amphetamine-dextroamphetamine XR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115132801,NDC,facility,both,1,EA,17.17,12.16,Aetna First Health,Commercial,,14.59,85,,,7.61,14.59,percent of total billed charges,
anagrelide 0.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00172524160,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
apixaban 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00003089331,NDC,facility,both,1,EA,34.68,24.55,Aetna First Health,Commercial,,29.48,85,,,15.37,29.48,percent of total billed charges,
apixaban 2.5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00003089321,NDC,facility,both,1,EA,34.67,24.55,Aetna First Health,Commercial,,29.47,85,,,15.37,29.47,percent of total billed charges,
apremilast 30 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,55513013760,NDC,facility,both,1,EA,281.78,199.5,Aetna First Health,Commercial,,239.51,85,,,124.88,239.51,percent of total billed charges,
ARIPiprazole 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904651161,NDC,facility,both,1,EA,78.31,55.44,Aetna First Health,Commercial,,66.56,85,,,34.71,66.56,percent of total billed charges,
ARIPiprazole 10 MG Tablet Disintegrating 30 Each Bottle,63700001,CDM,,,250,RC,43598073330,NDC,facility,both,1,EA,87.98,62.29,Aetna First Health,Commercial,,74.78,85,,,38.99,74.78,percent of total billed charges,
ARIPiprazole 10 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,13811069230,NDC,facility,both,1,EA,107.22,75.91,Aetna First Health,Commercial,,91.14,85,,,47.52,91.14,percent of total billed charges,
ARIPiprazole 10 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,62332010330,NDC,facility,both,1,EA,117.3,83.05,Aetna First Health,Commercial,,99.7,85,,,51.99,99.7,percent of total billed charges,
ARIPiprazole 10 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,59148064023,NDC,facility,both,1,EA,123.86,87.69,Aetna First Health,Commercial,,105.28,85,,,54.89,105.28,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148000913,NDC,facility,both,1,EA,68.11,48.22,Aetna First Health,Commercial,,57.89,85,,,30.19,57.89,percent of total billed charges,
ARIPiprazole 15 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687019121,NDC,facility,both,1,EA,90.14,63.82,Aetna First Health,Commercial,,76.62,85,,,39.95,76.62,percent of total billed charges,
ARIPiprazole 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268008711,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
ARIPiprazole 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687015711,NDC,facility,both,1,EA,32.69,23.14,Aetna First Health,Commercial,,27.79,85,,,14.49,27.79,percent of total billed charges,
ARIPiprazole 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332009731,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,50268008712,NDC,facility,both,1,EA,3.63,2.57,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13668021630,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722081930,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162089603,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877043003,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598055430,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342012207,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332009730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862066130,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729027810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714078301,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505307503,NDC,facility,both,1,EA,5.2,3.68,Aetna First Health,Commercial,,4.42,85,,,2.3,4.42,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13811067930,NDC,facility,both,1,EA,89.7,63.51,Aetna First Health,Commercial,,76.24,85,,,39.76,76.24,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148000613,NDC,facility,both,1,EA,104.06,73.67,Aetna First Health,Commercial,,88.45,85,,,46.12,88.45,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687015721,NDC,facility,both,1,EA,32.71,23.16,Aetna First Health,Commercial,,27.8,85,,,14.5,27.8,percent of total billed charges,
ARIPiprazole 2 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904650904,NDC,facility,both,1,EA,72.92,51.63,Aetna First Health,Commercial,,61.98,85,,,32.32,61.98,percent of total billed charges,
ARIPiprazole 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148000713,NDC,facility,both,1,EA,68.11,48.22,Aetna First Health,Commercial,,57.89,85,,,30.19,57.89,percent of total billed charges,
armodafinil 150 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093309256,NDC,facility,both,1,EA,4.6,3.26,Aetna First Health,Commercial,,3.91,85,,,2.04,3.91,percent of total billed charges,
armodafinil 150 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378343293,NDC,facility,both,1,EA,61.22,43.34,Aetna First Health,Commercial,,52.04,85,,,27.13,52.04,percent of total billed charges,
Armodafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093309356,NDC,facility,both,1,EA,4.6,3.26,Aetna First Health,Commercial,,3.91,85,,,2.04,3.91,percent of total billed charges,
Armodafinil 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00591385630,NDC,facility,both,1,EA,61.29,43.39,Aetna First Health,Commercial,,52.1,85,,,27.16,52.1,percent of total billed charges,
armodafinil 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862080730,NDC,facility,both,1,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
armodafinil 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093309456,NDC,facility,both,1,EA,4.6,3.26,Aetna First Health,Commercial,,3.91,85,,,2.04,3.91,percent of total billed charges,
armodafinil 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378343393,NDC,facility,both,1,EA,61.22,43.34,Aetna First Health,Commercial,,52.04,85,,,27.13,52.04,percent of total billed charges,
armodafinil 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63459022530,NDC,facility,both,1,EA,127.59,90.33,Aetna First Health,Commercial,,108.45,85,,,56.55,108.45,percent of total billed charges,
armodafinil 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378343193,NDC,facility,both,1,EA,20.34,14.4,Aetna First Health,Commercial,,17.29,85,,,9.01,17.29,percent of total billed charges,
ascorbic acid 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,20555000100,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ascorbic acid 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904052361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
asenapine 10 MG SL Tab 10 Each Box,63700001,CDM,,,250,RC,59762288806,NDC,facility,both,1,EA,21.01,14.88,Aetna First Health,Commercial,,17.86,85,,,9.31,17.86,percent of total billed charges,
asenapine 10 MG SL Tab 10 Each Box,63700001,CDM,,,250,RC,00456241060,NDC,facility,both,1,EA,70.05,49.6,Aetna First Health,Commercial,,59.54,85,,,31.05,59.54,percent of total billed charges,
asenapine 10 MG SL Tab 60 Each Bottle,63700001,CDM,,,250,RC,42794001710,NDC,facility,both,1,EA,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
asenapine 5 MG SL Tab 1 Each Blister,63700001,CDM,,,250,RC,00456240506,NDC,facility,both,1,EA,63.98,45.3,Aetna First Health,Commercial,,54.38,85,,,28.36,54.38,percent of total billed charges,
asenapine 5 MG SL Tab 1 Each Blister,63700001,CDM,,,250,RC,00456240511,NDC,facility,both,1,EA,70.04,49.59,Aetna First Health,Commercial,,59.53,85,,,31.04,59.53,percent of total billed charges,
asenapine 5 MG SL Tab 10 Each Box,63700001,CDM,,,250,RC,51991035860,NDC,facility,both,1,EA,17.85,12.64,Aetna First Health,Commercial,,15.17,85,,,7.91,15.17,percent of total billed charges,
asenapine 5 MG SL Tab 10 Each Box,63700001,CDM,,,250,RC,59762201206,NDC,facility,both,1,EA,21.01,14.88,Aetna First Health,Commercial,,17.86,85,,,9.31,17.86,percent of total billed charges,
asenapine 5 MG SL Tab 10 Each Box,63700001,CDM,,,250,RC,00456240560,NDC,facility,both,1,EA,70.36,49.81,Aetna First Health,Commercial,,59.81,85,,,31.18,59.81,percent of total billed charges,
asenapine 5 MG SL Tab 100 Each Box,63700001,CDM,,,250,RC,00456240563,NDC,facility,both,1,EA,70.05,49.6,Aetna First Health,Commercial,,59.54,85,,,31.05,59.54,percent of total billed charges,
asenapine 5 MG SL Tab 60 Each Bottle,63700001,CDM,,,250,RC,42794001610,NDC,facility,both,1,EA,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904513559,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536132601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00067200091,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,46122038278,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896022601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896021601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24385036578,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 24 Each Bottle,63700001,CDM,,,250,RC,00067203924,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aspirin-acetaminophen-caffeine 250-250-65 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,24385036571,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687030533,NDC,facility,both,1,EA,36.75,26.02,Aetna First Health,Commercial,,31.24,85,,,16.29,31.24,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,60687030532,NDC,facility,both,1,EA,36.75,26.02,Aetna First Health,Commercial,,31.24,85,,,16.29,31.24,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,42291011660,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,62559085060,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,68462040560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,43598033960,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,65162059606,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00093306406,NDC,facility,both,1,EA,11.25,7.96,Aetna First Health,Commercial,,9.56,85,,,4.99,9.56,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,49884000702,NDC,facility,both,1,EA,17.45,12.35,Aetna First Health,Commercial,,14.83,85,,,7.73,14.83,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00054057521,NDC,facility,both,1,EA,19.39,13.73,Aetna First Health,Commercial,,16.48,85,,,8.59,16.48,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00093304006,NDC,facility,both,1,EA,19.39,13.73,Aetna First Health,Commercial,,16.48,85,,,8.59,16.48,percent of total billed charges,
aspirin-dipyridamole 25-200 MG Capsule Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00597000160,NDC,facility,both,1,EA,32.89,23.29,Aetna First Health,Commercial,,27.96,85,,,14.58,27.96,percent of total billed charges,
atazanavir 150 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,65862071160,NDC,facility,both,1,EA,10.4,7.36,Aetna First Health,Commercial,,8.84,85,,,4.61,8.84,percent of total billed charges,
atazanavir 150 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,42385092060,NDC,facility,both,1,EA,10.4,7.36,Aetna First Health,Commercial,,8.84,85,,,4.61,8.84,percent of total billed charges,
atazanavir 150 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00003362412,NDC,facility,both,1,EA,74.63,52.84,Aetna First Health,Commercial,,63.44,85,,,33.08,63.44,percent of total billed charges,
atenolol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079075901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781107801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904539261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atenolol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079068420,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atomoxetine 10 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,68462026530,NDC,facility,both,1,EA,5.55,3.93,Aetna First Health,Commercial,,4.72,85,,,2.46,4.72,percent of total billed charges,
atomoxetine 10 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,64980037303,NDC,facility,both,1,EA,5.7,4.04,Aetna First Health,Commercial,,4.84,85,,,2.53,4.84,percent of total billed charges,
atomoxetine 10 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,55111051930,NDC,facility,both,1,EA,5.7,4.04,Aetna First Health,Commercial,,4.84,85,,,2.53,4.84,percent of total billed charges,
atomoxetine 10 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00093354256,NDC,facility,both,1,EA,12.95,9.17,Aetna First Health,Commercial,,11.01,85,,,5.74,11.01,percent of total billed charges,
atomoxetine 10 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714075501,NDC,facility,both,1,EA,13.73,9.72,Aetna First Health,Commercial,,11.67,85,,,6.09,11.67,percent of total billed charges,
atomoxetine 10 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00002322730,NDC,facility,both,1,EA,46.13,32.66,Aetna First Health,Commercial,,39.21,85,,,20.44,39.21,percent of total billed charges,
atomoxetine 18 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00002323830,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
atomoxetine 80 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,55111056330,NDC,facility,both,1,EA,6.7,4.74,Aetna First Health,Commercial,,5.7,85,,,2.97,5.7,percent of total billed charges,
atomoxetine 80 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,64980037803,NDC,facility,both,1,EA,6.7,4.74,Aetna First Health,Commercial,,5.7,85,,,2.97,5.7,percent of total billed charges,
atomoxetine 80 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00002325030,NDC,facility,both,1,EA,54.08,38.29,Aetna First Health,Commercial,,45.97,85,,,23.97,45.97,percent of total billed charges,
atorvaSTATin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00071015540,NDC,facility,both,1,EA,22.25,15.75,Aetna First Health,Commercial,,18.91,85,,,9.86,18.91,percent of total billed charges,
atorvaSTATin 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00071015640,NDC,facility,both,1,EA,64.69,45.8,Aetna First Health,Commercial,,54.99,85,,,28.67,54.99,percent of total billed charges,
atorvaSTATin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084009911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
atorvaSTATin 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00071015723,NDC,facility,both,1,EA,30.23,21.4,Aetna First Health,Commercial,,25.7,85,,,13.4,25.7,percent of total billed charges,
atorvaSTATin 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00071015823,NDC,facility,both,1,EA,64.69,45.8,Aetna First Health,Commercial,,54.99,85,,,28.67,54.99,percent of total billed charges,
atovaquone-proguanil 250-100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68001024514,NDC,facility,both,1,EA,20.43,14.46,Aetna First Health,Commercial,,17.37,85,,,9.05,17.37,percent of total billed charges,
atovaquone-proguanil 250-100 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,68001024515,NDC,facility,both,1,EA,20.43,14.46,Aetna First Health,Commercial,,17.37,85,,,9.05,17.37,percent of total billed charges,
atovaquone-proguanil 250-100 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,00173067502,NDC,facility,both,1,EA,24.03,17.01,Aetna First Health,Commercial,,20.43,85,,,10.65,20.43,percent of total billed charges,
B complex vitamin capsule 100 Each Bottle,63700001,CDM,,,250,RC,00536478701,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
B complex vitamin capsule 100 Each Bottle,63700001,CDM,,,250,RC,00536137801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
b complex with vit C + folic acid Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904026252,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
baclofen 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084059911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084085511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714007104,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739047910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084059901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084085501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084086811,NDC,facility,both,1,EA,3.29,2.33,Aetna First Health,Commercial,,2.8,85,,,1.46,2.8,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832102500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739048010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904647661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268010511,NDC,facility,both,1,EA,4.97,3.52,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
baclofen 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52817031910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115101101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
baclofen 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268010515,NDC,facility,both,1,EA,4.99,3.53,Aetna First Health,Commercial,,4.24,85,,,2.21,4.24,percent of total billed charges,
balsalazide 750 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084079933,NDC,facility,both,1,EA,4.84,3.43,Aetna First Health,Commercial,,4.11,85,,,2.15,4.11,percent of total billed charges,
balsalazide 750 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268010211,NDC,facility,both,1,EA,7.05,4.99,Aetna First Health,Commercial,,5.99,85,,,3.12,5.99,percent of total billed charges,
balsalazide 750 MG capsule 280 Each Bottle,63700001,CDM,,,250,RC,00054007928,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
balsalazide 750 MG capsule 280 Each Bottle,63700001,CDM,,,250,RC,60505257507,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
balsalazide 750 MG capsule 30 Each Box,63700001,CDM,,,250,RC,50268010213,NDC,facility,both,1,EA,7.05,4.99,Aetna First Health,Commercial,,5.99,85,,,3.12,5.99,percent of total billed charges,
Banatrol Plus Packet 75 Each Box,63700001,CDM,,,250,RC,94688008475,NDC,facility,both,1,EA,3.41,2.41,Aetna First Health,Commercial,,2.9,85,,,1.51,2.9,percent of total billed charges,
baricitinib 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002473230,NDC,facility,both,1,EA,319.67,226.33,Aetna First Health,Commercial,,271.72,85,,,141.68,271.72,percent of total billed charges,
B-complex with vitamin C Tablet 130 Each Bottle,63700001,CDM,,,250,RC,00904026013,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
B-complex with vitamin C Tablet 130 Each Bottle,63700001,CDM,,,250,RC,80681012600,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
b-complex-C-folic acid 1 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,58526000540,NDC,facility,both,1,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
b-complex-C-folic acid 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60258016201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
b-complex-C-folic acid 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63044062201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
b-complex-C-folic acid 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,13811052501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
b-complex-C-folic acid 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69367031401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
b-complex-C-folic acid 1 MG capsule 100 Each Box,63700001,CDM,,,250,RC,58526000541,NDC,facility,both,1,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
benzocaine-menthol 15-2.6 MG Lozenge 16 Each Box,63700001,CDM,,,250,RC,63824073216,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
benzocaine-menthol 15-3.6 MG Lozenge 16 Each Box,63700001,CDM,,,250,RC,63824071016,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
benzocaine-menthol 15-3.6 MG Lozenge 16 Each Box,63700001,CDM,,,250,RC,63824071316,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
benzocaine-menthol 15-3.6 MG Lozenge 16 Each Box,63700001,CDM,,,250,RC,63824071516,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
benzocaine-menthol 15-3.6 MG Lozenge 18 Each Box,63700001,CDM,,,250,RC,00904625549,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
benzonatate 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084021411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687011511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687034611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68382024701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67877010501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69387011901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42291016401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42806071401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162053610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,64380071206,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69452014320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67877057301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62332042631,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00904590460,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084021401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687011501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739002910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687034601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904656461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904715361,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benzonatate 100 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,51224001060,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084038111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687035611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603243321,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10135060601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315013601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603243721,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832108000,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
benztropine 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084038101,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
benztropine 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084038811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832051000,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162057110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bethanechol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111032301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bictegravir-Emtricitab-Tenofov 50-200-25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,61958250101,NDC,facility,both,1,EA,464.47,328.84,Aetna First Health,Commercial,,394.8,85,,,205.85,394.8,percent of total billed charges,
bictegravir-Emtricitab-Tenofov 50-200-25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,61958250103,NDC,facility,both,1,EA,464.47,328.84,Aetna First Health,Commercial,,394.8,85,,,205.85,394.8,percent of total billed charges,
Biotene Dry Mouth Lozenge 27 Each Box,63700001,CDM,,,250,RC,48582015942,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisacodyl 10 MG Suppository 1 Each Blister,63700001,CDM,,,250,RC,58980041501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisacodyl 10 MG Suppository 1 Each Box,63700001,CDM,,,250,RC,00713010906,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 100 Each Box,63700001,CDM,,,250,RC,00713010901,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 100 Each Box,63700001,CDM,,,250,RC,00536135501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 100 Each Box,63700001,CDM,,,250,RC,00904505860,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 100 Each Box,63700001,CDM,,,250,RC,57896044401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00713010912,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00904505812,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,68784010212,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00574705012,NDC,facility,both,1,EA,0.53,0.38,Aetna First Health,Commercial,,0.45,85,,,0.23,0.45,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,58980041512,NDC,facility,both,1,EA,1.27,0.9,Aetna First Health,Commercial,,1.08,85,,,0.56,1.08,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00904698112,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,71399846002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisacodyl 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00904714212,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisacodyl 10 MG Suppository 16 Each Box,63700001,CDM,,,250,RC,81421002103,NDC,facility,both,1,EA,1.23,0.87,Aetna First Health,Commercial,,1.05,85,,,0.55,1.05,percent of total billed charges,
bisacodyl 10 MG Suppository 4 Each Box,63700001,CDM,,,250,RC,81421002101,NDC,facility,both,1,EA,1.66,1.18,Aetna First Health,Commercial,,1.41,85,,,0.74,1.41,percent of total billed charges,
bisacodyl 10 MG Suppository 50 Each Box,63700001,CDM,,,250,RC,00574705050,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 50 Each Box,63700001,CDM,,,250,RC,00713010950,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl 10 MG Suppository 50 Each Box,63700001,CDM,,,250,RC,71399846005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisacodyl 10 MG Suppository 8 Each Box,63700001,CDM,,,250,RC,46122060851,NDC,facility,both,1,EA,0.79,0.56,Aetna First Health,Commercial,,0.67,85,,,0.35,0.67,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00904792760,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,57896044101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00536338101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00904674860,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00904792761,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00904640761,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,46122052978,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bisacodyl EC 5 MG Tablet Delayed Release 25 Each Box,63700001,CDM,,,250,RC,00904792717,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,00904131546,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,24385002465,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,46122070165,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,00904720546,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bismuth subsalicylate 262 MG Tablet Chewable 48 Each Box,63700001,CDM,,,250,RC,37000047710,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
bismuth subsalicylate 262 MG Tablet Chewable 48 Each Box,63700001,CDM,,,250,RC,01490032642,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisoprolol 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084048711,NDC,facility,both,1,EA,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
bisoprolol 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268012711,NDC,facility,both,1,EA,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
bisoprolol 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067911,NDC,facility,both,1,EA,4.55,3.22,Aetna First Health,Commercial,,3.87,85,,,2.02,3.87,percent of total billed charges,
bisoprolol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300012601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisoprolol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185077101,NDC,facility,both,1,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
bisoprolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,29300012613,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisoprolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332060330,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bisoprolol 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00185077130,NDC,facility,both,1,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
bisoprolol 5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084048721,NDC,facility,both,1,EA,3.98,2.82,Aetna First Health,Commercial,,3.38,85,,,1.76,3.38,percent of total billed charges,
bisoprolol 5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687067921,NDC,facility,both,1,EA,4.55,3.22,Aetna First Health,Commercial,,3.87,85,,,2.02,3.87,percent of total billed charges,
bisoprolol 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268012715,NDC,facility,both,1,EA,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
brexpiprazole 0.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148003613,NDC,facility,both,1,EA,171.68,121.55,Aetna First Health,Commercial,,145.93,85,,,76.09,145.93,percent of total billed charges,
bromocriptine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687028611,NDC,facility,both,1,EA,24.15,17.1,Aetna First Health,Commercial,,20.53,85,,,10.7,20.53,percent of total billed charges,
bromocriptine 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574010601,NDC,facility,both,1,EA,10.51,7.44,Aetna First Health,Commercial,,8.93,85,,,4.66,8.93,percent of total billed charges,
bromocriptine 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304096201,NDC,facility,both,1,EA,10.51,7.44,Aetna First Health,Commercial,,8.93,85,,,4.66,8.93,percent of total billed charges,
bromocriptine 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00574010603,NDC,facility,both,1,EA,11.59,8.21,Aetna First Health,Commercial,,9.85,85,,,5.14,9.85,percent of total billed charges,
bromocriptine 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63304096230,NDC,facility,both,1,EA,11.59,8.21,Aetna First Health,Commercial,,9.85,85,,,5.14,9.85,percent of total billed charges,
bromocriptine 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378204293,NDC,facility,both,1,EA,15.45,10.94,Aetna First Health,Commercial,,13.13,85,,,6.85,13.13,percent of total billed charges,
bromocriptine 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00781532531,NDC,facility,both,1,EA,17.55,12.43,Aetna First Health,Commercial,,14.92,85,,,7.78,14.92,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,60687059633,NDC,facility,both,1,EA,47.25,33.45,Aetna First Health,Commercial,,40.16,85,,,20.94,40.16,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,51079002001,NDC,facility,both,1,EA,63.84,45.2,Aetna First Health,Commercial,,54.26,85,,,28.29,54.26,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00574985510,NDC,facility,both,1,EA,3.45,2.44,Aetna First Health,Commercial,,2.93,85,,,1.53,2.93,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,68382072001,NDC,facility,both,1,EA,7.79,5.52,Aetna First Health,Commercial,,6.62,85,,,3.45,6.62,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,65162077810,NDC,facility,both,1,EA,7.79,5.52,Aetna First Health,Commercial,,6.62,85,,,3.45,6.62,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,16714082901,NDC,facility,both,1,EA,10.97,7.77,Aetna First Health,Commercial,,9.32,85,,,4.86,9.32,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00378715501,NDC,facility,both,1,EA,15.58,11.03,Aetna First Health,Commercial,,13.24,85,,,6.91,13.24,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,47781014601,NDC,facility,both,1,EA,38.5,27.26,Aetna First Health,Commercial,,32.72,85,,,17.06,32.72,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,49884050101,NDC,facility,both,1,EA,48.86,34.59,Aetna First Health,Commercial,,41.53,85,,,21.65,41.53,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 20 Each Box,63700001,CDM,,,250,RC,60687059632,NDC,facility,both,1,EA,47.25,33.45,Aetna First Health,Commercial,,40.16,85,,,20.94,40.16,percent of total billed charges,
budesonide 3 MG Capsule Delayed Release Particles 30 Each Box,63700001,CDM,,,250,RC,51079002003,NDC,facility,both,1,EA,63.85,45.21,Aetna First Health,Commercial,,54.27,85,,,28.3,54.27,percent of total billed charges,
bumetanide 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268013011,NDC,facility,both,1,EA,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
bumetanide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093423201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42799011901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714083101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185012801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832054011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
bumetanide 0.5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268013015,NDC,facility,both,1,EA,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
bumetanide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093423401,NDC,facility,both,1,EA,4.53,3.21,Aetna First Health,Commercial,,3.85,85,,,2.01,3.85,percent of total billed charges,
buprenorphine 10 MCG/HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,42858049340,NDC,facility,both,1,EA,281.87,199.56,Aetna First Health,Commercial,,239.59,85,,,124.92,239.59,percent of total billed charges,
buprenorphine 15 MCG/HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00093365821,NDC,facility,both,1,EA,401.03,283.93,Aetna First Health,Commercial,,340.88,85,,,177.74,340.88,percent of total billed charges,
buprenorphine 15 MCG/HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00093365840,NDC,facility,both,1,EA,401.03,283.93,Aetna First Health,Commercial,,340.88,85,,,177.74,340.88,percent of total billed charges,
buprenorphine 15 MCG/HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,69238120402,NDC,facility,both,1,EA,401.03,283.93,Aetna First Health,Commercial,,340.88,85,,,177.74,340.88,percent of total billed charges,
buprenorphine 15 MCG/HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,42858058640,NDC,facility,both,1,EA,406.61,287.88,Aetna First Health,Commercial,,345.62,85,,,180.21,345.62,percent of total billed charges,
buprenorphine 5 MCG/HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00093365621,NDC,facility,both,1,EA,185.34,131.22,Aetna First Health,Commercial,,157.54,85,,,82.14,157.54,percent of total billed charges,
buprenorphine 5 MCG/HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00093365640,NDC,facility,both,1,EA,185.34,131.22,Aetna First Health,Commercial,,157.54,85,,,82.14,157.54,percent of total billed charges,
buprenorphine 5 MCG/HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,42858075040,NDC,facility,both,1,EA,187.92,133.05,Aetna First Health,Commercial,,159.73,85,,,83.29,159.73,percent of total billed charges,
buprenorphine 75 MCG FILM 1 Each Package,63700001,CDM,,,250,RC,59385002101,NDC,facility,both,1,EA,24.96,17.67,Aetna First Health,Commercial,,21.22,85,,,11.06,21.22,percent of total billed charges,
buprenorphine-naloxone 12-3 MG FILM 1 Each Package,63700001,CDM,,,250,RC,00378876816,NDC,facility,both,1,EA,27.93,19.77,Aetna First Health,Commercial,,23.74,85,,,12.38,23.74,percent of total billed charges,
buprenorphine-naloxone 12-3 MG FILM 1 Each Package,63700001,CDM,,,250,RC,43598058101,NDC,facility,both,1,EA,35.46,25.11,Aetna First Health,Commercial,,30.14,85,,,15.72,30.14,percent of total billed charges,
buprenorphine-naloxone 12-3 MG FILM 1 Each Package,63700001,CDM,,,250,RC,12496121201,NDC,facility,both,1,EA,62.86,44.5,Aetna First Health,Commercial,,53.43,85,,,27.86,53.43,percent of total billed charges,
buprenorphine-naloxone 12-3 MG FILM 30 Each Box,63700001,CDM,,,250,RC,00378876893,NDC,facility,both,1,EA,27.92,19.77,Aetna First Health,Commercial,,23.73,85,,,12.37,23.73,percent of total billed charges,
buprenorphine-naloxone 12-3 MG FILM 30 Each Box,63700001,CDM,,,250,RC,43598058130,NDC,facility,both,1,EA,35.47,25.11,Aetna First Health,Commercial,,30.15,85,,,15.72,30.15,percent of total billed charges,
buprenorphine-naloxone 12-3 MG FILM 30 Each Box,63700001,CDM,,,250,RC,12496121203,NDC,facility,both,1,EA,62.86,44.5,Aetna First Health,Commercial,,53.43,85,,,27.86,53.43,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 1 Each Package,63700001,CDM,,,250,RC,00378876516,NDC,facility,both,1,EA,7.81,5.53,Aetna First Health,Commercial,,6.64,85,,,3.46,6.64,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 1 Each Package,63700001,CDM,,,250,RC,43598057901,NDC,facility,both,1,EA,9.91,7.02,Aetna First Health,Commercial,,8.42,85,,,4.39,8.42,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 1 Each Package,63700001,CDM,,,250,RC,47781035511,NDC,facility,both,1,EA,12.37,8.76,Aetna First Health,Commercial,,10.51,85,,,5.48,10.51,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 1 Each Package,63700001,CDM,,,250,RC,12496120201,NDC,facility,both,1,EA,17.54,12.42,Aetna First Health,Commercial,,14.91,85,,,7.77,14.91,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 30 Each Box,63700001,CDM,,,250,RC,00378876593,NDC,facility,both,1,EA,7.79,5.52,Aetna First Health,Commercial,,6.62,85,,,3.45,6.62,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 30 Each Box,63700001,CDM,,,250,RC,43598057930,NDC,facility,both,1,EA,9.89,7,Aetna First Health,Commercial,,8.41,85,,,4.38,8.41,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 30 Each Box,63700001,CDM,,,250,RC,47781035503,NDC,facility,both,1,EA,12.37,8.76,Aetna First Health,Commercial,,10.51,85,,,5.48,10.51,percent of total billed charges,
buprenorphine-naloxone 2-0.5 MG FILM 30 Each Box,63700001,CDM,,,250,RC,00781721664,NDC,facility,both,1,EA,14.33,10.15,Aetna First Health,Commercial,,12.18,85,,,6.35,12.18,percent of total billed charges,
buprenorphine-naloxone 4-1 MG FILM 1 Each Package,63700001,CDM,,,250,RC,00378876616,NDC,facility,both,1,EA,13.97,9.89,Aetna First Health,Commercial,,11.87,85,,,6.19,11.87,percent of total billed charges,
buprenorphine-naloxone 4-1 MG FILM 1 Each Package,63700001,CDM,,,250,RC,43598058001,NDC,facility,both,1,EA,17.75,12.57,Aetna First Health,Commercial,,15.09,85,,,7.87,15.09,percent of total billed charges,
buprenorphine-naloxone 4-1 MG FILM 1 Each Package,63700001,CDM,,,250,RC,47781035611,NDC,facility,both,1,EA,22.17,15.7,Aetna First Health,Commercial,,18.84,85,,,9.83,18.84,percent of total billed charges,
buprenorphine-naloxone 4-1 MG FILM 30 Each Box,63700001,CDM,,,250,RC,00378876693,NDC,facility,both,1,EA,13.96,9.88,Aetna First Health,Commercial,,11.87,85,,,6.19,11.87,percent of total billed charges,
buprenorphine-naloxone 4-1 MG FILM 30 Each Box,63700001,CDM,,,250,RC,43598058030,NDC,facility,both,1,EA,17.73,12.55,Aetna First Health,Commercial,,15.07,85,,,7.86,15.07,percent of total billed charges,
buprenorphine-naloxone 4-1 MG FILM 30 Each Box,63700001,CDM,,,250,RC,47781035603,NDC,facility,both,1,EA,22.17,15.7,Aetna First Health,Commercial,,18.84,85,,,9.83,18.84,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 1 Each Package,63700001,CDM,,,250,RC,00378876716,NDC,facility,both,1,EA,13.97,9.89,Aetna First Health,Commercial,,11.87,85,,,6.19,11.87,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 1 Each Package,63700001,CDM,,,250,RC,43598058201,NDC,facility,both,1,EA,17.73,12.55,Aetna First Health,Commercial,,15.07,85,,,7.86,15.07,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 1 Each Package,63700001,CDM,,,250,RC,47781035711,NDC,facility,both,1,EA,22.17,15.7,Aetna First Health,Commercial,,18.84,85,,,9.83,18.84,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 1 Each Package,63700001,CDM,,,250,RC,12496120801,NDC,facility,both,1,EA,31.43,22.25,Aetna First Health,Commercial,,26.72,85,,,13.93,26.72,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 30 Each Box,63700001,CDM,,,250,RC,00378876793,NDC,facility,both,1,EA,13.96,9.88,Aetna First Health,Commercial,,11.87,85,,,6.19,11.87,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 30 Each Box,63700001,CDM,,,250,RC,43598058230,NDC,facility,both,1,EA,17.73,12.55,Aetna First Health,Commercial,,15.07,85,,,7.86,15.07,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 30 Each Box,63700001,CDM,,,250,RC,47781035703,NDC,facility,both,1,EA,22.17,15.7,Aetna First Health,Commercial,,18.84,85,,,9.83,18.84,percent of total billed charges,
buprenorphine-naloxone 8-2 MG FILM 30 Each Box,63700001,CDM,,,250,RC,12496120803,NDC,facility,both,1,EA,31.43,22.25,Aetna First Health,Commercial,,26.72,85,,,13.93,26.72,percent of total billed charges,
buPROPion 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079094401,NDC,facility,both,1,EA,5.74,4.06,Aetna First Health,Commercial,,4.88,85,,,2.54,4.88,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079039101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084047011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084069711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43547028810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,70436005801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00093550101,NDC,facility,both,1,EA,4.43,3.14,Aetna First Health,Commercial,,3.77,85,,,1.96,3.77,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,51079039120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,68084047001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,68084069701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,00904727061,NDC,facility,both,1,EA,3.04,2.15,Aetna First Health,Commercial,,2.58,85,,,1.35,2.58,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 500 Each Bottle,63700001,CDM,,,250,RC,00185041005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00185041060,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 100 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00591354060,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion SR 150 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079039201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268014011,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084025111,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687031211,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687078211,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079004701,NDC,facility,both,1,EA,11.07,7.84,Aetna First Health,Commercial,,9.41,85,,,4.91,9.41,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084025101,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687031201,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904708461,NDC,facility,both,1,EA,6.49,4.59,Aetna First Health,Commercial,,5.52,85,,,2.88,5.52,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,51079004720,NDC,facility,both,1,EA,11.07,7.84,Aetna First Health,Commercial,,9.41,85,,,4.91,9.41,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10370010103,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68180031906,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,43598065530,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,16729044310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,63304072330,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68001051904,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00591333130,NDC,facility,both,1,EA,4.57,3.24,Aetna First Health,Commercial,,3.88,85,,,2.03,3.88,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68001026104,NDC,facility,both,1,EA,4.57,3.24,Aetna First Health,Commercial,,3.88,85,,,2.03,3.88,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68001028704,NDC,facility,both,1,EA,4.57,3.24,Aetna First Health,Commercial,,3.88,85,,,2.03,3.88,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00187073030,NDC,facility,both,1,EA,95.42,67.56,Aetna First Health,Commercial,,81.11,85,,,42.29,81.11,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00904708404,NDC,facility,both,1,EA,4.61,3.26,Aetna First Health,Commercial,,3.92,85,,,2.04,3.92,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,50268014013,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,10370010150,NDC,facility,both,1,EA,4.57,3.24,Aetna First Health,Commercial,,3.88,85,,,2.03,3.88,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68001032205,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,16729044315,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00115681110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68180031909,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68382035316,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68001051905,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,69097087505,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,70436001006,NDC,facility,both,1,EA,3.01,2.13,Aetna First Health,Commercial,,2.56,85,,,1.33,2.56,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00591333119,NDC,facility,both,1,EA,4.57,3.24,Aetna First Health,Commercial,,3.88,85,,,2.03,3.88,percent of total billed charges,
buPROPion XL 150 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00378200877,NDC,facility,both,1,EA,4.57,3.24,Aetna First Health,Commercial,,3.88,85,,,2.03,3.88,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084025211,NDC,facility,both,1,EA,8.86,6.27,Aetna First Health,Commercial,,7.53,85,,,3.93,7.53,percent of total billed charges,
buPROPion XL 300 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,68084025221,NDC,facility,both,1,EA,8.86,6.27,Aetna First Health,Commercial,,7.53,85,,,3.93,7.53,percent of total billed charges,
busPIRone 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084002911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084002901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084003011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079096001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084003001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079098501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093005301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591065701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380074106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729020001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115169001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69584009110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079098520,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904712261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093005305,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16729020016,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
busPIRone 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00115169002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067211,NDC,facility,both,1,EA,5.69,4.03,Aetna First Health,Commercial,,4.84,85,,,2.52,4.84,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084039611,NDC,facility,both,1,EA,11.38,8.06,Aetna First Health,Commercial,,9.67,85,,,5.04,9.67,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143178701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527169501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591336901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702025301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904653860,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603254421,NDC,facility,both,1,EA,3.93,2.78,Aetna First Health,Commercial,,3.34,85,,,1.74,3.34,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084039601,NDC,facility,both,1,EA,3.65,2.58,Aetna First Health,Commercial,,3.1,85,,,1.62,3.1,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,68084039665,NDC,facility,both,1,EA,5.69,4.03,Aetna First Health,Commercial,,4.84,85,,,2.52,4.84,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,60687067265,NDC,facility,both,1,EA,5.69,4.03,Aetna First Health,Commercial,,4.84,85,,,2.52,4.84,percent of total billed charges,
butalbital-acetaminophen-caffeine 50-325-40 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,46672005350,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
butalbital-acetaminophen-caffeine-codeine 50-325-40-30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591322001,NDC,facility,both,1,EA,3.81,2.7,Aetna First Health,Commercial,,3.24,85,,,1.69,3.24,percent of total billed charges,
butalbital-acetaminophen-caffeine-codeine 50-325-40-30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054300001,NDC,facility,both,1,EA,3.81,2.7,Aetna First Health,Commercial,,3.24,85,,,1.69,3.24,percent of total billed charges,
butalbital-aspirin-caffeine 50-325-40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591321901,NDC,facility,both,1,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
butalbital-aspirin-caffeine 50-325-40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527155201,NDC,facility,both,1,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
butalbital-aspirin-caffeine-codeine 50-325-40-30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527131201,NDC,facility,both,1,EA,7.67,5.43,Aetna First Health,Commercial,,6.52,85,,,3.4,6.52,percent of total billed charges,
butalbital-aspirin-caffeine-codeine 50-325-40-30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591354601,NDC,facility,both,1,EA,7.67,5.43,Aetna First Health,Commercial,,6.52,85,,,3.4,6.52,percent of total billed charges,
butalbital-aspirin-caffeine-codeine 50-325-40-30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51991007401,NDC,facility,both,1,EA,7.99,5.66,Aetna First Health,Commercial,,6.79,85,,,3.54,6.79,percent of total billed charges,
butalbital-aspirin-caffeine-codeine 50-325-40-30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,52544095601,NDC,facility,both,1,EA,22.44,15.89,Aetna First Health,Commercial,,19.07,85,,,9.95,19.07,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687034511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,64380072306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054000725,NDC,facility,both,1,EA,3.31,2.34,Aetna First Health,Commercial,,2.81,85,,,1.47,2.81,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63304023901,NDC,facility,both,1,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093735201,NDC,facility,both,1,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093065701,NDC,facility,both,1,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 100 Each Bottle,63700001,CDM,,,250,RC,23155011801,NDC,facility,both,1,EA,3.39,2.4,Aetna First Health,Commercial,,2.88,85,,,1.5,2.88,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 100 Each Box,63700001,CDM,,,250,RC,60687034501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,64380072304,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,69452020713,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,62756096783,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00054000713,NDC,facility,both,1,EA,3.58,2.53,Aetna First Health,Commercial,,3.04,85,,,1.59,3.04,percent of total billed charges,
calcitRIOL 0.25 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,23155011803,NDC,facility,both,1,EA,3.58,2.53,Aetna First Health,Commercial,,3.04,85,,,1.59,3.04,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268014811,NDC,facility,both,1,EA,4.89,3.46,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084047911,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68094000261,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084047901,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,00054008826,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,00781267202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,00781208102,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,69097086283,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,29033002602,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,00904666825,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,16571081320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,62135019122,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,42291018920,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 200 Each Bottle,63700001,CDM,,,250,RC,24689079302,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00054008813,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
calcium acetate (Phos Binder) 667 MG capsule 50 Each Box,63700001,CDM,,,250,RC,00904654606,NDC,facility,both,1,EA,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
calcium carbonate 1250 (500 Ca) MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,50268014911,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 1250 (500 Ca) MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,50268014913,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 1 Each Box,63700001,CDM,,,250,RC,68084098833,NDC,facility,both,1,EA,1.1,0.78,Aetna First Health,Commercial,,0.94,85,,,0.49,0.94,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 150 Each Bottle,63700001,CDM,,,250,RC,00904125892,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 150 Each Bottle,63700001,CDM,,,250,RC,24385047847,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 150 Each Bottle,63700001,CDM,,,250,RC,57896076315,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 150 Each Bottle,63700001,CDM,,,250,RC,00904641292,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 150 Each Bottle,63700001,CDM,,,250,RC,69618002015,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 20 Each Box,63700001,CDM,,,250,RC,68084098832,NDC,facility,both,1,EA,1.1,0.78,Aetna First Health,Commercial,,0.94,85,,,0.49,0.94,percent of total billed charges,
calcium carbonate 500 MG Tablet Chewable 500 Each Box,63700001,CDM,,,250,RC,66553000401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate 750 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,68084099433,NDC,facility,both,1,EA,1.15,0.81,Aetna First Health,Commercial,,0.98,85,,,0.51,0.98,percent of total billed charges,
calcium carbonate 750 MG Tablet Chewable 20 Each Box,63700001,CDM,,,250,RC,68084099432,NDC,facility,both,1,EA,1.15,0.81,Aetna First Health,Commercial,,0.98,85,,,0.51,0.98,percent of total billed charges,
calcium carbonate-cholecalciferol 500-5 mg-mcg (500-200 mg-unit) Tablet 100 Each Box,63700001,CDM,,,250,RC,10006070038,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-cholecalciferol 500-5 mg-mcg (500-200 mg-unit) Tablet 100 Each Box,63700001,CDM,,,250,RC,00904546061,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-cholecalciferol 500-5 mg-mcg (500-200 mg-unit) Tablet 100 Each Box,63700001,CDM,,,250,RC,37864008289,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-cholecalciferol 500-5 mg-mcg (500-200 mg-unit) Tablet 150 Each Bottle,63700001,CDM,,,250,RC,00904546092,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-cholecalciferol 500-5 mg-mcg (500-200 mg-unit) Tablet 300 Each Bottle,63700001,CDM,,,250,RC,00904546072,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-cholecalciferol 500-5 mg-mcg (500-200 mg-unit) Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00536781708,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-cholecalciferol 500-5 mg-mcg (500-200 mg-unit) Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904546052,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-vitamin D3 600-5 mg-mcg (600-200 mg-unit) Tablet 150 Each Bottle,63700001,CDM,,,250,RC,00904585692,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-vitamin D3 600-5 mg-mcg (600-200 mg-unit) Tablet 150 Each Bottle,63700001,CDM,,,250,RC,80681013801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-vitamin D3 600-5 mg-mcg (600-200 mg-unit) Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00761081212,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-vitamin D3 600-5 mg-mcg (600-200 mg-unit) Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904585652,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-vitamin D3 600-5 mg-mcg (600-200 mg-unit) Tablet 60 Each Bottle,63700001,CDM,,,250,RC,37864000019,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium carbonate-vitamin D3 600-5 mg-mcg (600-200 mg-unit) Tablet 60 Each Bottle,63700001,CDM,,,250,RC,80681013800,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333011825,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333012025,NDC,facility,both,1,EA,1.03,0.73,Aetna First Health,Commercial,,0.88,85,,,0.46,0.88,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333011810,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 36 Each Box,63700001,CDM,,,250,RC,00005250002,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00536430608,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00536430611,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00904250091,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,24385012576,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,87701070558,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00224050090,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,49348019013,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
calcium polycarbophil 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,50024043002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
canagliflozin 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,50458014030,NDC,facility,both,1,EA,69.83,49.44,Aetna First Health,Commercial,,59.36,85,,,30.95,59.36,percent of total billed charges,
candesartan 16 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00186001631,NDC,facility,both,1,EA,11.31,8.01,Aetna First Health,Commercial,,9.61,85,,,5.01,9.61,percent of total billed charges,
candesartan 4 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342011407,NDC,facility,both,1,EA,4.43,3.14,Aetna First Health,Commercial,,3.77,85,,,1.96,3.77,percent of total billed charges,
candesartan 4 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378322493,NDC,facility,both,1,EA,4.43,3.14,Aetna First Health,Commercial,,3.77,85,,,1.96,3.77,percent of total billed charges,
candesartan 4 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378322477,NDC,facility,both,1,EA,4.43,3.14,Aetna First Health,Commercial,,3.77,85,,,1.96,3.77,percent of total billed charges,
captopril 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079086301,NDC,facility,both,1,EA,3.92,2.78,Aetna First Health,Commercial,,3.33,85,,,1.74,3.33,percent of total billed charges,
captopril 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079086320,NDC,facility,both,1,EA,3.93,2.78,Aetna First Health,Commercial,,3.34,85,,,1.74,3.34,percent of total billed charges,
captopril 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079086401,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,51079087001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,60687047911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00093077801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,51672404101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,13668027101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,51079087020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,00904385461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 100 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,60687047901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084044411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079038501,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
carBAMazepine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079038517,NDC,facility,both,1,EA,3.36,2.38,Aetna First Health,Commercial,,2.86,85,,,1.49,2.86,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672400501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,75834022101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505018300,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60429003201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093010901,NDC,facility,both,1,EA,4.48,3.17,Aetna First Health,Commercial,,3.81,85,,,1.99,3.81,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078050905,NDC,facility,both,1,EA,6.05,4.28,Aetna First Health,Commercial,,5.14,85,,,2.68,5.14,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084044401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079038520,NDC,facility,both,1,EA,3.14,2.22,Aetna First Health,Commercial,,2.67,85,,,1.39,2.67,percent of total billed charges,
carBAMazepine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904617261,NDC,facility,both,1,EA,3.14,2.22,Aetna First Health,Commercial,,2.67,85,,,1.39,2.67,percent of total billed charges,
carBAMazepine CR 200 MG Capsule Extended Release 12 Hour 120 Each Bottle,63700001,CDM,,,250,RC,66993040832,NDC,facility,both,1,EA,5.73,4.06,Aetna First Health,Commercial,,4.87,85,,,2.54,4.87,percent of total billed charges,
carBAMazepine CR 200 MG Capsule Extended Release 12 Hour 120 Each Bottle,63700001,CDM,,,250,RC,29033002012,NDC,facility,both,1,EA,5.73,4.06,Aetna First Health,Commercial,,4.87,85,,,2.54,4.87,percent of total billed charges,
carBAMazepine CR 200 MG Capsule Extended Release 12 Hour 120 Each Bottle,63700001,CDM,,,250,RC,60505280607,NDC,facility,both,1,EA,5.73,4.06,Aetna First Health,Commercial,,4.87,85,,,2.54,4.87,percent of total billed charges,
carBAMazepine XR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51672412301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00832602211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carBAMazepine XR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781598601,NDC,facility,both,1,EA,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
carBAMazepine XR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781801601,NDC,facility,both,1,EA,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
carBAMazepine XR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078051005,NDC,facility,both,1,EA,5.64,3.99,Aetna First Health,Commercial,,4.79,85,,,2.5,4.79,percent of total billed charges,
carbidopa 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42799012301,NDC,facility,both,1,EA,5.11,3.62,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
carbidopa 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43975022010,NDC,facility,both,1,EA,30.63,21.69,Aetna First Health,Commercial,,26.04,85,,,13.58,26.04,percent of total billed charges,
carbidopa-levodopa 10-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739004610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739001710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739004710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,47335018788,NDC,facility,both,1,EA,3.07,2.17,Aetna First Health,Commercial,,2.61,85,,,1.36,2.61,percent of total billed charges,
carbidopa-levodopa 25-100 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,00378505201,NDC,facility,both,1,EA,3.07,2.17,Aetna First Health,Commercial,,2.61,85,,,1.36,2.61,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,51079097801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084028111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378008801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62756046188,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68001017100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,50228046001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,51079097820,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 25-100 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084028101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carbidopa-levodopa CR 50-200 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,51079092301,NDC,facility,both,1,EA,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
carbidopa-levodopa CR 50-200 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,51079092320,NDC,facility,both,1,EA,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
Carbidopa-Levodopa ER 23.75-95 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,64896066101,NDC,facility,both,1,EA,14.54,10.29,Aetna First Health,Commercial,,12.36,85,,,6.44,12.36,percent of total billed charges,
carbidopa-levodopa-entacapone 12.5-50-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078040705,NDC,facility,both,1,EA,26.76,18.95,Aetna First Health,Commercial,,22.75,85,,,11.86,22.75,percent of total billed charges,
carbidopa-levodopa-entacapone 25-100-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781563701,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
carbidopa-levodopa-entacapone 25-100-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,47335000388,NDC,facility,both,1,EA,10.82,7.66,Aetna First Health,Commercial,,9.2,85,,,4.8,9.2,percent of total billed charges,
carbidopa-levodopa-entacapone 25-100-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078040805,NDC,facility,both,1,EA,26.76,18.95,Aetna First Health,Commercial,,22.75,85,,,11.86,22.75,percent of total billed charges,
carbidopa-levodopa-entacapone 31.25-125-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679078504,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
carbidopa-levodopa-entacapone 31.25-125-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781564101,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
carbidopa-levodopa-entacapone 37.5-150-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679078604,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
carbidopa-levodopa-entacapone 37.5-150-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781565401,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
carbidopa-levodopa-entacapone 37.5-150-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078040905,NDC,facility,both,1,EA,19.36,13.71,Aetna First Health,Commercial,,16.46,85,,,8.58,16.46,percent of total billed charges,
carbidopa-levodopa-entacapone 50-200-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781566901,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
carbidopa-levodopa-entacapone 50-200-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,47335000688,NDC,facility,both,1,EA,10.82,7.66,Aetna First Health,Commercial,,9.2,85,,,4.8,9.2,percent of total billed charges,
cariprazine 1.5 MG capsule 10 Each Blister,63700001,CDM,,,250,RC,61874011511,NDC,facility,both,1,EA,160.73,113.8,Aetna First Health,Commercial,,136.62,85,,,71.24,136.62,percent of total billed charges,
cariprazine 1.5 MG capsule 20 Each Box,63700001,CDM,,,250,RC,61874011520,NDC,facility,both,1,EA,168.77,119.49,Aetna First Health,Commercial,,143.45,85,,,74.8,143.45,percent of total billed charges,
cariprazine 1.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,61874011530,NDC,facility,both,1,EA,168.76,119.48,Aetna First Health,Commercial,,143.45,85,,,74.79,143.45,percent of total billed charges,
cariprazine 3 MG capsule 10 Each Blister,63700001,CDM,,,250,RC,61874013011,NDC,facility,both,1,EA,160.73,113.8,Aetna First Health,Commercial,,136.62,85,,,71.24,136.62,percent of total billed charges,
cariprazine 3 MG capsule 20 Each Box,63700001,CDM,,,250,RC,61874013020,NDC,facility,both,1,EA,168.77,119.49,Aetna First Health,Commercial,,143.45,85,,,74.8,143.45,percent of total billed charges,
cariprazine 3 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,61874013030,NDC,facility,both,1,EA,168.76,119.48,Aetna First Health,Commercial,,143.45,85,,,74.79,143.45,percent of total billed charges,
cariprazine 4.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,61874014530,NDC,facility,both,1,EA,168.76,119.48,Aetna First Health,Commercial,,143.45,85,,,74.79,143.45,percent of total billed charges,
carisoprodol 350 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084038011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 10 Each Bottle,63700001,CDM,,,250,RC,55289004910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62756044602,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714051001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69584011110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603258221,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50228010901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58657064501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591551301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00037200101,NDC,facility,both,1,EA,37.49,26.54,Aetna First Health,Commercial,,31.87,85,,,16.62,31.87,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739004910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084038001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carisoprodol 350 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,58657064550,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 10 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00007337013,NDC,facility,both,1,EA,23.29,16.49,Aetna First Health,Commercial,,19.8,85,,,10.32,19.8,percent of total billed charges,
carvedilol 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079093101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084026311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084026411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084026111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 3.125 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079077101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00007414020,NDC,facility,both,1,EA,11.6,8.21,Aetna First Health,Commercial,,9.86,85,,,5.14,9.86,percent of total billed charges,
carvedilol 6.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079093020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefaDROXil 1 g Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00093405953,NDC,facility,both,1,EA,18.77,13.29,Aetna First Health,Commercial,,15.95,85,,,8.32,15.95,percent of total billed charges,
cefaDROXil 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862008501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefaDROXil 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68180018001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefaDROXil 500 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00093319653,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefaDROXil 500 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,68180018008,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefaDROXil 500 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,16714038801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefdinir 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687069911,NDC,facility,both,1,EA,11.81,8.36,Aetna First Health,Commercial,,10.04,85,,,5.23,10.04,percent of total billed charges,
cefdinir 300 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714039101,NDC,facility,both,1,EA,5.4,3.82,Aetna First Health,Commercial,,4.59,85,,,2.39,4.59,percent of total billed charges,
cefdinir 300 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687069921,NDC,facility,both,1,EA,11.81,8.36,Aetna First Health,Commercial,,10.04,85,,,5.23,10.04,percent of total billed charges,
cefdinir 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,65862017760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefdinir 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,57237009960,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefdinir 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68180071160,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefdinir 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00781217660,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefdinir 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001036206,NDC,facility,both,1,EA,4.23,2.99,Aetna First Health,Commercial,,3.6,85,,,1.87,3.6,percent of total billed charges,
cefdinir 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16714039102,NDC,facility,both,1,EA,5.4,3.82,Aetna First Health,Commercial,,4.59,85,,,2.39,4.59,percent of total billed charges,
cefdinir 300 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001015006,NDC,facility,both,1,EA,13.43,9.51,Aetna First Health,Commercial,,11.42,85,,,5.95,11.42,percent of total billed charges,
cefprozil 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180040301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687027211,NDC,facility,both,1,EA,13.23,9.37,Aetna First Health,Commercial,,11.25,85,,,5.86,11.25,percent of total billed charges,
cefUROXime 250 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,67877021520,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 250 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,65862069920,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 250 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,57237005820,NDC,facility,both,1,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
cefUROXime 250 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,16714040001,NDC,facility,both,1,EA,5.92,4.19,Aetna First Health,Commercial,,5.03,85,,,2.62,5.03,percent of total billed charges,
cefUROXime 250 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,68180030220,NDC,facility,both,1,EA,6.43,4.55,Aetna First Health,Commercial,,5.47,85,,,2.85,5.47,percent of total billed charges,
cefUROXime 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,67877021560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862069960,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cefUROXime 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,57237005860,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
cefUROXime 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68180030260,NDC,facility,both,1,EA,5.91,4.18,Aetna First Health,Commercial,,5.02,85,,,2.62,5.02,percent of total billed charges,
celecoxib 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687043611,NDC,facility,both,1,EA,5.08,3.6,Aetna First Health,Commercial,,4.32,85,,,2.25,4.32,percent of total billed charges,
celecoxib 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079019901,NDC,facility,both,1,EA,8.21,5.81,Aetna First Health,Commercial,,6.98,85,,,3.64,6.98,percent of total billed charges,
celecoxib 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084096911,NDC,facility,both,1,EA,8.21,5.81,Aetna First Health,Commercial,,6.98,85,,,3.64,6.98,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62332014131,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862090801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,13811065910,NDC,facility,both,1,EA,3.16,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378716001,NDC,facility,both,1,EA,3.38,2.39,Aetna First Health,Commercial,,2.87,85,,,1.5,2.87,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714073201,NDC,facility,both,1,EA,3.46,2.45,Aetna First Health,Commercial,,2.94,85,,,1.53,2.94,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093716501,NDC,facility,both,1,EA,4.21,2.98,Aetna First Health,Commercial,,3.58,85,,,1.87,3.58,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00025152031,NDC,facility,both,1,EA,16.39,11.6,Aetna First Health,Commercial,,13.93,85,,,7.26,13.93,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904650261,NDC,facility,both,1,EA,4.22,2.99,Aetna First Health,Commercial,,3.59,85,,,1.87,3.59,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687043601,NDC,facility,both,1,EA,5.08,3.6,Aetna First Health,Commercial,,4.32,85,,,2.25,4.32,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079019920,NDC,facility,both,1,EA,8.21,5.81,Aetna First Health,Commercial,,6.98,85,,,3.64,6.98,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084096901,NDC,facility,both,1,EA,8.21,5.81,Aetna First Health,Commercial,,6.98,85,,,3.64,6.98,percent of total billed charges,
celecoxib 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00025152034,NDC,facility,both,1,EA,16.39,11.6,Aetna First Health,Commercial,,13.93,85,,,7.26,13.93,percent of total billed charges,
celecoxib 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268016815,NDC,facility,both,1,EA,3.84,2.72,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
celecoxib 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084097633,NDC,facility,both,1,EA,17.61,12.47,Aetna First Health,Commercial,,14.97,85,,,7.8,14.97,percent of total billed charges,
celecoxib 200 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00025152534,NDC,facility,both,1,EA,57.46,40.68,Aetna First Health,Commercial,,48.84,85,,,25.47,48.84,percent of total billed charges,
celecoxib 50 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,62332014060,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268015111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687015211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093314501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68180012101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67877022001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862001801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687015201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 100 Each Box,63700001,CDM,,,250,RC,62584023501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268015115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 250 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,68180012102,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cephALEXin 500 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268015211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cetirizine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378363501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cetirizine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571040110,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cevimeline 30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16571065710,NDC,facility,both,1,EA,7.51,5.32,Aetna First Health,Commercial,,6.38,85,,,3.33,6.38,percent of total billed charges,
cevimeline 30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63304047901,NDC,facility,both,1,EA,9.04,6.4,Aetna First Health,Commercial,,7.68,85,,,4.01,7.68,percent of total billed charges,
cevimeline 30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054033425,NDC,facility,both,1,EA,9.04,6.4,Aetna First Health,Commercial,,7.68,85,,,4.01,7.68,percent of total billed charges,
cevimeline 30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63395020113,NDC,facility,both,1,EA,17.43,12.34,Aetna First Health,Commercial,,14.82,85,,,7.72,14.82,percent of total billed charges,
charcoal activated 25 g Recon Susp 1 Each Bottle,63700001,CDM,,,250,RC,00574012225,NDC,facility,both,1,EA,21.18,15,Aetna First Health,Commercial,,18,85,,,9.39,18,percent of total billed charges,
chlordiazePOXIDE 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079037501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00555003302,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00555015902,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079014120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079037401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00555015802,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE 5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079037420,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE-clidinium 5-2.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68682040910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE-clidinium 5-2.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,76439030210,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE-clidinium 5-2.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60219167701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
chlordiazePOXIDE-clidinium 5-2.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42494040901,NDC,facility,both,1,EA,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
chlorpheniramine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904001259,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
chlorpheniramine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69618002201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
chlorthalidone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079005801,NDC,facility,both,1,EA,6.69,4.74,Aetna First Health,Commercial,,5.69,85,,,2.97,5.69,percent of total billed charges,
cholecalciferol (vitamin D3) 125 MCG (5000 UT) capsule 1 Each Blister,63700001,CDM,,,250,RC,50268086811,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cholecalciferol (vitamin D3) 125 MCG (5000 UT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,10006070127,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cholecalciferol (vitamin D3) 125 MCG (5000 UT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,80681013100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cholecalciferol (vitamin D3) 125 MCG (5000 UT) capsule 50 Each Bottle,63700001,CDM,,,250,RC,11845015339,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cholecalciferol (vitamin D3) 125 MCG (5000 UT) capsule 50 Each Box,63700001,CDM,,,250,RC,50268086815,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Cholecalciferol 1.25 MG (50000 UT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,53191036201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Cholecalciferol 1.25 MG (50000 UT) capsule 24 Each Bottle,63700001,CDM,,,250,RC,75834016724,NDC,facility,both,1,EA,1.19,0.84,Aetna First Health,Commercial,,1.01,85,,,0.53,1.01,percent of total billed charges,
cholestyramine 4 g Packet 1 Each Packet,63700001,CDM,,,250,RC,67877029809,NDC,facility,both,1,EA,3.38,2.39,Aetna First Health,Commercial,,2.87,85,,,1.5,2.87,percent of total billed charges,
cholestyramine 4 g Packet 1 Each Packet,63700001,CDM,,,250,RC,42806026698,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
cholestyramine 4 g Packet 1 Each Packet,63700001,CDM,,,250,RC,49884046564,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cholestyramine 4 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00245053689,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cholestyramine 4 g Packet 60 Each Box,63700001,CDM,,,250,RC,68382052860,NDC,facility,both,1,EA,7.14,5.06,Aetna First Health,Commercial,,6.07,85,,,3.16,6.07,percent of total billed charges,
cholestyramine 4 g Packet 60 Each Box,63700001,CDM,,,250,RC,00185094098,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cholestyramine 4 g Packet 60 Each Box,63700001,CDM,,,250,RC,49884046565,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cholestyramine 4 g Packet 60 Each Box,63700001,CDM,,,250,RC,00245053660,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cholestyramine light 4 g Packet 1 Each Packet,63700001,CDM,,,250,RC,42806027098,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
cholestyramine light 4 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00245003689,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cholestyramine light 4 g Packet 42 Each Box,63700001,CDM,,,250,RC,00245003642,NDC,facility,both,1,EA,7.19,5.09,Aetna First Health,Commercial,,6.11,85,,,3.19,6.11,percent of total billed charges,
cholestyramine light 4 g Packet 60 Each Box,63700001,CDM,,,250,RC,42806027095,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
cholestyramine light 4 g Packet 60 Each Box,63700001,CDM,,,250,RC,00245003660,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cholestyramine light 4 g Packet 60 Each Box,63700001,CDM,,,250,RC,68382052960,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
cilostazol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084077995,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cilostazol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268017611,NDC,facility,both,1,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
cilostazol 50 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268017615,NDC,facility,both,1,EA,3.31,2.34,Aetna First Health,Commercial,,2.81,85,,,1.47,2.81,percent of total billed charges,
cilostazol 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054002821,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cilostazol 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093206506,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 0.2 % Solution 1 Each Plas Cont,63700001,CDM,,,250,RC,42195055014,NDC,facility,both,1,EA,10.65,7.54,Aetna First Health,Commercial,,9.05,85,,,4.72,9.05,percent of total billed charges,
ciprofloxacin 100 MG Tablet 6 Each Disp Pack,63700001,CDM,,,250,RC,55111012506,NDC,facility,both,1,EA,42.61,30.17,Aetna First Health,Commercial,,36.22,85,,,18.88,36.22,percent of total billed charges,
ciprofloxacin 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084006911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739070010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ciprofloxacin 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084007011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093474019,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162005210,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862000501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13668000901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378623101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505251803,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904608461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00093474093,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
citalopram 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904608561,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clarithromycin 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268017811,NDC,facility,both,1,EA,10.01,7.09,Aetna First Health,Commercial,,8.51,85,,,4.44,8.51,percent of total billed charges,
clarithromycin 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862022560,NDC,facility,both,1,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
clarithromycin 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00527193106,NDC,facility,both,1,EA,3.28,2.32,Aetna First Health,Commercial,,2.79,85,,,1.45,2.79,percent of total billed charges,
clarithromycin 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00781196160,NDC,facility,both,1,EA,3.42,2.42,Aetna First Health,Commercial,,2.91,85,,,1.52,2.91,percent of total billed charges,
clarithromycin 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054003621,NDC,facility,both,1,EA,3.42,2.42,Aetna First Health,Commercial,,2.91,85,,,1.52,2.91,percent of total billed charges,
clarithromycin 250 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382076114,NDC,facility,both,1,EA,12.66,8.96,Aetna First Health,Commercial,,10.76,85,,,5.61,10.76,percent of total billed charges,
clindamycin 150 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079059801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clindamycin 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079059820,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00832063011,NDC,facility,both,1,EA,15.9,11.26,Aetna First Health,Commercial,,13.52,85,,,7.05,13.52,percent of total billed charges,
clomiPRAMINE 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,51672401106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,27241021030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clomiPRAMINE 25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714084901,NDC,facility,both,1,EA,23.89,16.91,Aetna First Health,Commercial,,20.31,85,,,10.59,20.31,percent of total billed charges,
clomiPRAMINE 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,51672401105,NDC,facility,both,1,EA,31.48,22.29,Aetna First Health,Commercial,,26.76,85,,,13.95,26.76,percent of total billed charges,
clomiPRAMINE 50 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,51672401206,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 0.25 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884030752,NDC,facility,both,1,EA,3.23,2.29,Aetna First Health,Commercial,,2.75,85,,,1.43,2.75,percent of total billed charges,
clonazePAM 0.25 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00093929119,NDC,facility,both,1,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
clonazePAM 0.25 MG Tablet Disintegrating 60 Each Bottle,63700001,CDM,,,250,RC,57664078486,NDC,facility,both,1,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
clonazePAM 0.25 MG Tablet Disintegrating 60 Each Box,63700001,CDM,,,250,RC,49884030702,NDC,facility,both,1,EA,3.23,2.29,Aetna First Health,Commercial,,2.75,85,,,1.43,2.75,percent of total billed charges,
clonazePAM 0.25 MG Tablet Disintegrating 60 Each Box,63700001,CDM,,,250,RC,00555009596,NDC,facility,both,1,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
clonazePAM 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739026310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonazePAM 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079088220,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228212710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001023700,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300013501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079029920,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904565661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584065701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687011301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739006010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,29300013505,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00228212750,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68001023703,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,51862045301,NDC,facility,both,1,EA,46.41,32.86,Aetna First Health,Commercial,,39.45,85,,,20.57,39.45,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00591350854,NDC,facility,both,1,EA,92.74,65.66,Aetna First Health,Commercial,,78.83,85,,,41.1,78.83,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00378087116,NDC,facility,both,1,EA,92.74,65.66,Aetna First Health,Commercial,,78.83,85,,,41.1,78.83,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 1 Each Package,63700001,CDM,,,250,RC,00555100901,NDC,facility,both,1,EA,92.84,65.73,Aetna First Health,Commercial,,78.91,85,,,41.15,78.91,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,51862045304,NDC,facility,both,1,EA,46.42,32.87,Aetna First Health,Commercial,,39.46,85,,,20.57,39.46,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00378087199,NDC,facility,both,1,EA,92.74,65.66,Aetna First Health,Commercial,,78.83,85,,,41.1,78.83,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00591350804,NDC,facility,both,1,EA,92.74,65.66,Aetna First Health,Commercial,,78.83,85,,,41.1,78.83,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00555100916,NDC,facility,both,1,EA,92.84,65.73,Aetna First Health,Commercial,,78.91,85,,,41.15,78.91,percent of total billed charges,
cloNIDine 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00597003134,NDC,facility,both,1,EA,253.96,179.8,Aetna First Health,Commercial,,215.87,85,,,112.56,215.87,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00591350954,NDC,facility,both,1,EA,156.15,110.55,Aetna First Health,Commercial,,132.73,85,,,69.21,132.73,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00378087216,NDC,facility,both,1,EA,156.15,110.55,Aetna First Health,Commercial,,132.73,85,,,69.21,132.73,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 1 Each Package,63700001,CDM,,,250,RC,51862045401,NDC,facility,both,1,EA,78.16,55.34,Aetna First Health,Commercial,,66.44,85,,,34.64,66.44,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 1 Each Package,63700001,CDM,,,250,RC,00555101001,NDC,facility,both,1,EA,156.32,110.67,Aetna First Health,Commercial,,132.87,85,,,69.28,132.87,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,51862045404,NDC,facility,both,1,EA,78.16,55.34,Aetna First Health,Commercial,,66.44,85,,,34.64,66.44,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00378087299,NDC,facility,both,1,EA,156.15,110.55,Aetna First Health,Commercial,,132.73,85,,,69.21,132.73,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00591350904,NDC,facility,both,1,EA,156.15,110.55,Aetna First Health,Commercial,,132.73,85,,,69.21,132.73,percent of total billed charges,
cloNIDine 0.2 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,82089010234,NDC,facility,both,1,EA,488.71,346.01,Aetna First Health,Commercial,,415.4,85,,,216.6,415.4,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00591351054,NDC,facility,both,1,EA,216.62,153.37,Aetna First Health,Commercial,,184.13,85,,,96.01,184.13,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00378087316,NDC,facility,both,1,EA,216.62,153.37,Aetna First Health,Commercial,,184.13,85,,,96.01,184.13,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 1 Each Package,63700001,CDM,,,250,RC,51862045501,NDC,facility,both,1,EA,123.92,87.74,Aetna First Health,Commercial,,105.33,85,,,54.92,105.33,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 1 Each Package,63700001,CDM,,,250,RC,00555101101,NDC,facility,both,1,EA,216.85,153.53,Aetna First Health,Commercial,,184.32,85,,,96.11,184.32,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,51862045504,NDC,facility,both,1,EA,123.92,87.74,Aetna First Health,Commercial,,105.33,85,,,54.92,105.33,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00378087399,NDC,facility,both,1,EA,216.62,153.37,Aetna First Health,Commercial,,184.13,85,,,96.01,184.13,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00591351004,NDC,facility,both,1,EA,216.62,153.37,Aetna First Health,Commercial,,184.13,85,,,96.01,184.13,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00555101116,NDC,facility,both,1,EA,216.85,153.53,Aetna First Health,Commercial,,184.32,85,,,96.11,184.32,percent of total billed charges,
cloNIDine 0.3 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00597003334,NDC,facility,both,1,EA,593.19,419.98,Aetna First Health,Commercial,,504.21,85,,,262.9,504.21,percent of total billed charges,
clonidine ER 0.1 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687046211,NDC,facility,both,1,EA,17.84,12.63,Aetna First Health,Commercial,,15.16,85,,,7.91,15.16,percent of total billed charges,
clonidine ER 0.1 MG Tablet Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,60687046221,NDC,facility,both,1,EA,17.84,12.63,Aetna First Health,Commercial,,15.16,85,,,7.91,15.16,percent of total billed charges,
clonidine ER 0.1 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,50742024760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clonidine ER 0.1 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,27241010806,NDC,facility,both,1,EA,4.96,3.51,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
clonidine ER 0.1 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,10370025702,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
clonidine ER 0.1 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00228424106,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
clopidogrel 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,63653133202,NDC,facility,both,1,EA,90.23,63.88,Aetna First Health,Commercial,,76.7,85,,,39.99,76.7,percent of total billed charges,
clopidogrel 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079055701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084060911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079055720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904629461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63653117103,NDC,facility,both,1,EA,22.56,15.97,Aetna First Health,Commercial,,19.18,85,,,10,19.18,percent of total billed charges,
clopidogrel 75 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862035730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111019630,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63653117106,NDC,facility,both,1,EA,22.55,15.97,Aetna First Health,Commercial,,19.17,85,,,9.99,19.17,percent of total billed charges,
clopidogrel 75 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65862035705,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,55111019605,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378362777,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,55111019690,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505025302,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862035790,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clopidogrel 75 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16729021815,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clorazepate 3.75 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084078411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clorazepate 3.75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378003001,NDC,facility,both,1,EA,3.48,2.46,Aetna First Health,Commercial,,2.96,85,,,1.54,2.96,percent of total billed charges,
clorazepate 3.75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672404201,NDC,facility,both,1,EA,3.48,2.46,Aetna First Health,Commercial,,2.96,85,,,1.54,2.96,percent of total billed charges,
clorazepate 3.75 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107031901,NDC,facility,both,1,EA,3.48,2.46,Aetna First Health,Commercial,,2.96,85,,,1.54,2.96,percent of total billed charges,
clorazepate 3.75 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084078421,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
clotrimazole 10 MG Troche 140 Each Bottle,63700001,CDM,,,250,RC,00054414623,NDC,facility,both,1,EA,6.08,4.3,Aetna First Health,Commercial,,5.17,85,,,2.69,5.17,percent of total billed charges,
clotrimazole 10 MG Troche 70 Each Bottle,63700001,CDM,,,250,RC,00574010770,NDC,facility,both,1,EA,4.5,3.19,Aetna First Health,Commercial,,3.82,85,,,1.99,3.82,percent of total billed charges,
clotrimazole 10 MG Troche 70 Each Bottle,63700001,CDM,,,250,RC,00054414622,NDC,facility,both,1,EA,6.93,4.91,Aetna First Health,Commercial,,5.89,85,,,3.07,5.89,percent of total billed charges,
clotrimazole 10 MG Troche 70 Each Box,63700001,CDM,,,250,RC,00574010777,NDC,facility,both,1,EA,4,2.83,Aetna First Health,Commercial,,3.4,85,,,1.77,3.4,percent of total billed charges,
clotrimazole 10 MG Troche 70 Each Box,63700001,CDM,,,250,RC,00054814622,NDC,facility,both,1,EA,9.62,6.81,Aetna First Health,Commercial,,8.18,85,,,4.26,8.18,percent of total billed charges,
cloZAPine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093777219,NDC,facility,both,1,EA,5.79,4.1,Aetna First Health,Commercial,,4.92,85,,,2.57,4.92,percent of total billed charges,
cloZAPine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079092101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687040411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093435919,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093435901,NDC,facility,both,1,EA,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
cloZAPine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079092120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00093435993,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687040401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloZAPine 25 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00093541719,NDC,facility,both,1,EA,8.39,5.94,Aetna First Health,Commercial,,7.13,85,,,3.72,7.13,percent of total billed charges,
cloZAPine 25 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,00093541701,NDC,facility,both,1,EA,8.39,5.94,Aetna First Health,Commercial,,7.13,85,,,3.72,7.13,percent of total billed charges,
cloZAPine 25 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,18860010210,NDC,facility,both,1,EA,12.85,9.1,Aetna First Health,Commercial,,10.92,85,,,5.7,10.92,percent of total billed charges,
cloZAPine 25 MG Tablet Disintegrating 48 Each Box,63700001,CDM,,,250,RC,00093541784,NDC,facility,both,1,EA,8.39,5.94,Aetna First Health,Commercial,,7.13,85,,,3.72,7.13,percent of total billed charges,
codeine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054024324,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Coenzyme Q10 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,87701040816,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Coenzyme Q-10 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00904588246,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
colchicine 0.6 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687035895,NDC,facility,both,1,EA,23.8,16.85,Aetna First Health,Commercial,,20.23,85,,,10.55,20.23,percent of total billed charges,
colchicine 0.6 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00143301801,NDC,facility,both,1,EA,20.99,14.86,Aetna First Health,Commercial,,17.84,85,,,9.3,17.84,percent of total billed charges,
colchicine 0.6 MG capsule 30 Each Box,63700001,CDM,,,250,RC,00904673204,NDC,facility,both,1,EA,19.49,13.8,Aetna First Health,Commercial,,16.57,85,,,8.64,16.57,percent of total billed charges,
colchicine 0.6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268018711,NDC,facility,both,1,EA,13.02,9.22,Aetna First Health,Commercial,,11.07,85,,,5.77,11.07,percent of total billed charges,
colchicine 0.6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038911,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
colchicine 0.6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292005401,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
colchicine 0.6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687072711,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
colchicine 0.6 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687032011,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
colchicine 0.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591256201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
colchicine 0.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378108601,NDC,facility,both,1,EA,7.07,5.01,Aetna First Health,Commercial,,6.01,85,,,3.13,6.01,percent of total billed charges,
colchicine 0.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,66993016502,NDC,facility,both,1,EA,19.65,13.91,Aetna First Health,Commercial,,16.7,85,,,8.71,16.7,percent of total billed charges,
colchicine 0.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00254200801,NDC,facility,both,1,EA,19.65,13.91,Aetna First Health,Commercial,,16.7,85,,,8.71,16.7,percent of total billed charges,
colchicine 0.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64764011901,NDC,facility,both,1,EA,20.96,14.84,Aetna First Health,Commercial,,17.82,85,,,9.29,17.82,percent of total billed charges,
colchicine 0.6 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00591256230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
colchicine 0.6 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378108693,NDC,facility,both,1,EA,7.07,5.01,Aetna First Health,Commercial,,6.01,85,,,3.13,6.01,percent of total billed charges,
colchicine 0.6 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00254200811,NDC,facility,both,1,EA,19.65,13.91,Aetna First Health,Commercial,,16.7,85,,,8.71,16.7,percent of total billed charges,
colchicine 0.6 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764011907,NDC,facility,both,1,EA,25.17,17.82,Aetna First Health,Commercial,,21.39,85,,,11.16,21.39,percent of total billed charges,
colchicine 0.6 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687038921,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
colchicine 0.6 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687072721,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
colchicine 0.6 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,42292005403,NDC,facility,both,1,EA,32.52,23.02,Aetna First Health,Commercial,,27.64,85,,,14.41,27.64,percent of total billed charges,
colchicine 0.6 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268018715,NDC,facility,both,1,EA,13.02,9.22,Aetna First Health,Commercial,,11.07,85,,,5.77,11.07,percent of total billed charges,
colchicine 0.6 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65162071009,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
colesevelam 625 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038595,NDC,facility,both,1,EA,11.65,8.25,Aetna First Health,Commercial,,9.9,85,,,5.16,9.9,percent of total billed charges,
colesevelam 625 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,00115132019,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
colesevelam 625 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,27808019001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
colesevelam 625 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,67877050651,NDC,facility,both,1,EA,3.13,2.22,Aetna First Health,Commercial,,2.66,85,,,1.39,2.66,percent of total billed charges,
colesevelam 625 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,51660099628,NDC,facility,both,1,EA,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
colesevelam 625 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,68462043318,NDC,facility,both,1,EA,3.88,2.75,Aetna First Health,Commercial,,3.3,85,,,1.72,3.3,percent of total billed charges,
colesevelam 625 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,65597070118,NDC,facility,both,1,EA,13.02,9.22,Aetna First Health,Commercial,,11.07,85,,,5.77,11.07,percent of total billed charges,
colestipol 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687071511,NDC,facility,both,1,EA,14.6,10.34,Aetna First Health,Commercial,,12.41,85,,,6.47,12.41,percent of total billed charges,
colestipol 1 GM Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00115521116,NDC,facility,both,1,EA,3.61,2.56,Aetna First Health,Commercial,,3.07,85,,,1.6,3.07,percent of total billed charges,
colestipol 1 GM Tablet 120 Each Bottle,63700001,CDM,,,250,RC,59762045001,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
colestipol 1 GM Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00009045003,NDC,facility,both,1,EA,7.86,5.56,Aetna First Health,Commercial,,6.68,85,,,3.48,6.68,percent of total billed charges,
colestipol 5 g Packet 30 Each Box,63700001,CDM,,,250,RC,00115521218,NDC,facility,both,1,EA,11,7.79,Aetna First Health,Commercial,,9.35,85,,,4.88,9.35,percent of total billed charges,
colestipol 5 g Packet 30 Each Box,63700001,CDM,,,250,RC,59762026001,NDC,facility,both,1,EA,11,7.79,Aetna First Health,Commercial,,9.35,85,,,4.88,9.35,percent of total billed charges,
colestipol 5 g Packet 30 Each Box,63700001,CDM,,,250,RC,00009026001,NDC,facility,both,1,EA,24.82,17.57,Aetna First Health,Commercial,,21.1,85,,,11,21.1,percent of total billed charges,
Culturelle Kids Packet 30 Each Box,63700001,CDM,,,250,RC,49100040008,NDC,facility,both,1,EA,0.9,0.64,Aetna First Health,Commercial,,0.76,85,,,0.4,0.76,percent of total billed charges,
cyanocobalamin 250 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268085311,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 250 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,54629058001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 250 MCG Tablet 130 Each Bottle,63700001,CDM,,,250,RC,00904421813,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 250 MCG Tablet 130 Each Bottle,63700001,CDM,,,250,RC,80681016500,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 250 MCG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268085315,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084039711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079064420,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268019011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084075395,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084075311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59746021106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702000601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300041301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547039910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52817033010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097084507,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862019001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603307821,NDC,facility,both,1,EA,5.74,4.06,Aetna First Health,Commercial,,4.88,85,,,2.54,4.88,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084075325,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268019015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyclobenzaprine 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,43547039950,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268018911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,00093292919,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60258085001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51991083801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742019001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70710111001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10135063801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115175701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093292901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52817021010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904114561,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cyproheptadine 4 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268018915,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dabigatran 75 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,00597035561,NDC,facility,both,1,EA,11.59,8.21,Aetna First Health,Commercial,,9.85,85,,,5.14,9.85,percent of total billed charges,
dabigatran 75 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687074411,NDC,facility,both,1,EA,41.91,29.67,Aetna First Health,Commercial,,35.62,85,,,18.57,35.62,percent of total billed charges,
dabigatran 75 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,31722062160,NDC,facility,both,1,EA,10.56,7.48,Aetna First Health,Commercial,,8.98,85,,,4.68,8.98,percent of total billed charges,
dabigatran 75 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00597035509,NDC,facility,both,1,EA,11.57,8.19,Aetna First Health,Commercial,,9.83,85,,,5.13,9.83,percent of total billed charges,
dabigatran 75 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00597014954,NDC,facility,both,1,EA,18.36,13,Aetna First Health,Commercial,,15.61,85,,,8.14,15.61,percent of total billed charges,
dabigatran 75 MG capsule 60 Each Box,63700001,CDM,,,250,RC,00597035556,NDC,facility,both,1,EA,11.57,8.19,Aetna First Health,Commercial,,9.83,85,,,5.13,9.83,percent of total billed charges,
dabigatran 75 MG capsule 60 Each Box,63700001,CDM,,,250,RC,00597014960,NDC,facility,both,1,EA,18.36,13,Aetna First Health,Commercial,,15.61,85,,,8.14,15.61,percent of total billed charges,
danazol 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00555063302,NDC,facility,both,1,EA,8.88,6.29,Aetna First Health,Commercial,,7.55,85,,,3.94,7.55,percent of total billed charges,
dantrolene 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084030011,NDC,facility,both,1,EA,5.71,4.04,Aetna First Health,Commercial,,4.85,85,,,2.53,4.85,percent of total billed charges,
dantrolene 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00115441101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dantrolene 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,49884036201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dantrolene 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527321937,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dantrolene 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42023012401,NDC,facility,both,1,EA,3.75,2.66,Aetna First Health,Commercial,,3.19,85,,,1.66,3.19,percent of total billed charges,
dantrolene 25 MG capsule 30 Each Box,63700001,CDM,,,250,RC,68084030021,NDC,facility,both,1,EA,5.7,4.04,Aetna First Health,Commercial,,4.84,85,,,2.53,4.84,percent of total billed charges,
dapagliflozin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66993045630,NDC,facility,both,1,EA,44.15,31.26,Aetna First Health,Commercial,,37.53,85,,,19.57,37.53,percent of total billed charges,
dapagliflozin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00310620530,NDC,facility,both,1,EA,67.93,48.09,Aetna First Health,Commercial,,57.74,85,,,30.11,57.74,percent of total billed charges,
dapsone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70954013520,NDC,facility,both,1,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
dapsone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49938010201,NDC,facility,both,1,EA,7.13,5.05,Aetna First Health,Commercial,,6.06,85,,,3.16,6.06,percent of total billed charges,
dapsone 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69543015030,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
dapsone 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70954013510,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
dapsone 25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,13925050430,NDC,facility,both,1,EA,6.9,4.89,Aetna First Health,Commercial,,5.86,85,,,3.06,5.86,percent of total billed charges,
dapsone 25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,49938010230,NDC,facility,both,1,EA,7.99,5.66,Aetna First Health,Commercial,,6.79,85,,,3.54,6.79,percent of total billed charges,
darifenacin 7.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00078041915,NDC,facility,both,1,EA,17.4,12.32,Aetna First Health,Commercial,,14.79,85,,,7.71,14.79,percent of total billed charges,
darunavir 600 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00480773606,NDC,facility,both,1,EA,40.96,29,Aetna First Health,Commercial,,34.82,85,,,18.15,34.82,percent of total billed charges,
darunavir 600 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59676056201,NDC,facility,both,1,EA,125.89,89.13,Aetna First Health,Commercial,,107.01,85,,,55.79,107.01,percent of total billed charges,
darunavir 800 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68180034606,NDC,facility,both,1,EA,11.55,8.18,Aetna First Health,Commercial,,9.82,85,,,5.12,9.82,percent of total billed charges,
darunavir 800 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59676056630,NDC,facility,both,1,EA,251.78,178.26,Aetna First Health,Commercial,,214.01,85,,,111.59,214.01,percent of total billed charges,
darunavir-cobicistat 800-150 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59676057530,NDC,facility,both,1,EA,287.78,203.75,Aetna First Health,Commercial,,244.61,85,,,127.54,244.61,percent of total billed charges,
deferasirox 360 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722001330,NDC,facility,both,1,EA,19.13,13.54,Aetna First Health,Commercial,,16.26,85,,,8.48,16.26,percent of total billed charges,
deferasirox 360 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70710127703,NDC,facility,both,1,EA,22.96,16.26,Aetna First Health,Commercial,,19.52,85,,,10.18,19.52,percent of total billed charges,
deferasirox 360 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714099501,NDC,facility,both,1,EA,176.83,125.2,Aetna First Health,Commercial,,150.31,85,,,78.37,150.31,percent of total billed charges,
demeclocycline 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162055410,NDC,facility,both,1,EA,22.16,15.69,Aetna First Health,Commercial,,18.84,85,,,9.82,18.84,percent of total billed charges,
denture tablets Effer Tab 40 Each Box,63700001,CDM,,,250,RC,00904774439,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
denture tablets Effer Tab 40 Each Box,63700001,CDM,,,250,RC,10158005306,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
denture tablets Effer Tab 84 Each Box,63700001,CDM,,,250,RC,10158005308,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
denture tablets Effer Tab 90 Each Box,63700001,CDM,,,250,RC,12547063639,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
desipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238105301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742011201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45963034102,NDC,facility,both,1,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
desipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781521801,NDC,facility,both,1,EA,4.25,3.01,Aetna First Health,Commercial,,3.61,85,,,1.88,3.61,percent of total billed charges,
desipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45963034202,NDC,facility,both,1,EA,3.92,2.78,Aetna First Health,Commercial,,3.33,85,,,1.74,3.33,percent of total billed charges,
desmopressin 0.1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084060621,NDC,facility,both,1,EA,6.65,4.71,Aetna First Health,Commercial,,5.65,85,,,2.95,5.65,percent of total billed charges,
desvenlafaxine 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,63304019130,NDC,facility,both,1,EA,16.25,11.5,Aetna First Health,Commercial,,13.81,85,,,7.2,13.81,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687060711,NDC,facility,both,1,EA,7.5,5.31,Aetna First Health,Commercial,,6.38,85,,,3.32,6.38,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 14 Each Bottle,63700001,CDM,,,250,RC,00008121114,NDC,facility,both,1,EA,27.02,19.13,Aetna First Health,Commercial,,22.97,85,,,11.98,22.97,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,51991031133,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00591365930,NDC,facility,both,1,EA,3.41,2.41,Aetna First Health,Commercial,,2.9,85,,,1.51,2.9,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00054040013,NDC,facility,both,1,EA,3.72,2.63,Aetna First Health,Commercial,,3.16,85,,,1.65,3.16,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00008121130,NDC,facility,both,1,EA,51.1,36.18,Aetna First Health,Commercial,,43.44,85,,,22.65,43.44,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,60687060721,NDC,facility,both,1,EA,7.5,5.31,Aetna First Health,Commercial,,6.38,85,,,3.32,6.38,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,51991031190,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
desvenlafaxine succinate ER 50 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00054040022,NDC,facility,both,1,EA,3.72,2.63,Aetna First Health,Commercial,,3.16,85,,,1.65,3.16,percent of total billed charges,
dexAMETHasone 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054817425,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,31722022901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dexmethylphenidate 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527810637,NDC,facility,both,1,EA,4.23,2.99,Aetna First Health,Commercial,,3.6,85,,,1.87,3.6,percent of total billed charges,
dexmethylphenidate 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115991801,NDC,facility,both,1,EA,7.89,5.59,Aetna First Health,Commercial,,6.71,85,,,3.5,6.71,percent of total billed charges,
dexmethylphenidate 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00093555001,NDC,facility,both,1,EA,21.85,15.47,Aetna First Health,Commercial,,18.57,85,,,9.68,18.57,percent of total billed charges,
dexmethylphenidate 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781268201,NDC,facility,both,1,EA,22.76,16.11,Aetna First Health,Commercial,,19.35,85,,,10.09,19.35,percent of total billed charges,
dexmethylphenidate 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078043005,NDC,facility,both,1,EA,30.3,21.45,Aetna First Health,Commercial,,25.76,85,,,13.43,25.76,percent of total billed charges,
dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107003501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406895801,NDC,facility,both,1,EA,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
dextroamphetamine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555095202,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
dextroamphetamine SR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00555095402,NDC,facility,both,1,EA,10.21,7.23,Aetna First Health,Commercial,,8.68,85,,,4.53,8.68,percent of total billed charges,
dextroamphetamine SR 5 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00406896001,NDC,facility,both,1,EA,10.21,7.23,Aetna First Health,Commercial,,8.68,85,,,4.53,8.68,percent of total billed charges,
dextromethorphan-guaifenesin 30-600 MG Tablet Extended Release 12 Hour 20 Each Bottle,63700001,CDM,,,250,RC,63824005620,NDC,facility,both,1,EA,0.63,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
dextromethorphan-guaiFENesin SR 30-600 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,63824005601,NDC,facility,both,1,EA,0.65,0.46,Aetna First Health,Commercial,,0.55,85,,,0.29,0.55,percent of total billed charges,
dextromethorphan-guaiFENesin SR 30-600 MG Tablet Extended Release 12 Hour 20 Each Bottle,63700001,CDM,,,250,RC,63824005620,NDC,facility,both,1,EA,0.63,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
dextromethorphan-guaiFENesin SR 30-600 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,00536116134,NDC,facility,both,1,EA,0.79,0.56,Aetna First Health,Commercial,,0.67,85,,,0.35,0.67,percent of total billed charges,
dextromethorphan-guaiFENesin SR 30-600 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,63824005632,NDC,facility,both,1,EA,0.97,0.69,Aetna First Health,Commercial,,0.82,85,,,0.43,0.82,percent of total billed charges,
dextromethorphan-guaiFENesin SR 30-600 MG Tablet Extended Release 12 Hour 40 Each Bottle,63700001,CDM,,,250,RC,63824005640,NDC,facility,both,1,EA,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
dextromethorphan-guaiFENesin SR 30-600 MG Tablet Extended Release 12 Hour 40 Each Box,63700001,CDM,,,250,RC,00536116137,NDC,facility,both,1,EA,0.76,0.54,Aetna First Health,Commercial,,0.65,85,,,0.34,0.65,percent of total billed charges,
dextromethorphan-quinidine 20-10 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,64597030160,NDC,facility,both,1,EA,91.81,65,Aetna First Health,Commercial,,78.04,85,,,40.69,78.04,percent of total billed charges,
dialyvite Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10542001010,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dialyvite Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60258016101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dialyvite Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52544097701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dialyvite Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13811051510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079028401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378027101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00172392560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862006201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079028420,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084035911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac 1.3 % Patch 30 Each Box,63700001,CDM,,,250,RC,59762070702,NDC,facility,both,1,EA,26.11,18.49,Aetna First Health,Commercial,,22.19,85,,,11.57,22.19,percent of total billed charges,
diclofenac 1.3 % Patch 30 Each Box,63700001,CDM,,,250,RC,00093372755,NDC,facility,both,1,EA,37.59,26.61,Aetna First Health,Commercial,,31.95,85,,,16.66,31.95,percent of total billed charges,
diclofenac 1.3 % Patch 5 Each Box,63700001,CDM,,,250,RC,60793041105,NDC,facility,both,1,EA,43.51,30.81,Aetna First Health,Commercial,,36.98,85,,,19.28,36.98,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687060611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,51079046601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00228255011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00781178701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00378628001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,16571020210,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,68001028000,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,51079046620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,16571020206,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,68001020106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,61442010260,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,68001028006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 50 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,00228255006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac EC 75 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,68084033301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac potassium 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,72888007301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diclofenac potassium 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093094801,NDC,facility,both,1,EA,3.66,2.59,Aetna First Health,Commercial,,3.11,85,,,1.62,3.11,percent of total billed charges,
diclofenac potassium 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378247401,NDC,facility,both,1,EA,3.66,2.59,Aetna First Health,Commercial,,3.11,85,,,1.62,3.11,percent of total billed charges,
diclofenac-misoprostol 50-0.2 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,00025141160,NDC,facility,both,1,EA,16.72,11.84,Aetna First Health,Commercial,,14.21,85,,,7.41,14.21,percent of total billed charges,
dicloxacillin 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093312301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079011801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687036911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527058601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591079401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,10135052001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378161001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00143312601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079011820,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dicyclomine 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687036901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
digoxin 125 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084036611,NDC,facility,both,1,EA,7.25,5.13,Aetna First Health,Commercial,,6.16,85,,,3.21,6.16,percent of total billed charges,
digoxin 250 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084068011,NDC,facility,both,1,EA,7.25,5.13,Aetna First Health,Commercial,,6.16,85,,,3.21,6.16,percent of total billed charges,
dilTIAZem 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079074501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687056211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687071711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093031801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378002301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68682000610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42799012901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079074520,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739007910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687056201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687071701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68682000650,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093031805,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 30 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378002305,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079074601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 60 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079074620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem 90 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,51079074701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084005211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687019511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084005201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687019501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,63739001410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,63739028310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904721761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,49884082911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10370082911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,42291018490,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,24979002607,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,49884082909,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 120 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,50742024890,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CD 240 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084005411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dilTIAZem CR 60 MG Capsule Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079092401,NDC,facility,both,1,EA,11.59,8.21,Aetna First Health,Commercial,,9.85,85,,,5.14,9.85,percent of total billed charges,
dilTIAZem CR 60 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378606001,NDC,facility,both,1,EA,8.88,6.29,Aetna First Health,Commercial,,7.55,85,,,3.94,7.55,percent of total billed charges,
dilTIAZem CR 60 MG Capsule Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68462085001,NDC,facility,both,1,EA,9.68,6.85,Aetna First Health,Commercial,,8.23,85,,,4.29,8.23,percent of total billed charges,
dilTIAZem CR 60 MG Capsule Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,51079092420,NDC,facility,both,1,EA,11.59,8.21,Aetna First Health,Commercial,,9.85,85,,,5.14,9.85,percent of total billed charges,
dilTIAZem XR 120 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,60505001406,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Dimethyl Fumarate 240 MG CAPSULE DELAYED RELEASE 60 Each Bottle,63700001,CDM,,,250,RC,43598043060,NDC,facility,both,1,EA,11.11,7.87,Aetna First Health,Commercial,,9.44,85,,,4.92,9.44,percent of total billed charges,
diphenhydrAMINE 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904530661,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904723761,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68094001859,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904555159,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24385047978,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536101601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536121429,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69618002501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50580022650,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68094001861,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,00904555124,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
diphenhydrAMINE 25 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,24385047962,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079006701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687056911,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378041501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762106101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559049001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832059011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406123601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00025006131,NDC,facility,both,1,EA,10.55,7.47,Aetna First Health,Commercial,,8.97,85,,,4.68,8.97,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687056901,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
dipyridamole 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115107001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382018701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054043425,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dipyridamole 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980013301,NDC,facility,both,1,EA,4.14,2.93,Aetna First Health,Commercial,,3.52,85,,,1.83,3.52,percent of total billed charges,
disulfiram 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378414001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
disulfiram 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980017101,NDC,facility,both,1,EA,10.44,7.39,Aetna First Health,Commercial,,8.87,85,,,4.63,8.87,percent of total billed charges,
disulfiram 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51285052302,NDC,facility,both,1,EA,30.7,21.74,Aetna First Health,Commercial,,26.1,85,,,13.61,26.1,percent of total billed charges,
disulfiram 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42794002808,NDC,facility,both,1,EA,8.34,5.9,Aetna First Health,Commercial,,7.09,85,,,3.7,7.09,percent of total billed charges,
disulfiram 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,47781060730,NDC,facility,both,1,EA,9.9,7.01,Aetna First Health,Commercial,,8.42,85,,,4.39,8.42,percent of total billed charges,
disulfiram 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00054035613,NDC,facility,both,1,EA,9.9,7.01,Aetna First Health,Commercial,,8.42,85,,,4.39,8.42,percent of total billed charges,
disulfiram 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62135043130,NDC,facility,both,1,EA,33.83,23.95,Aetna First Health,Commercial,,28.76,85,,,14.99,28.76,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 1 Each Blister,63700001,CDM,,,250,RC,68084031311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 1 Each Blister,63700001,CDM,,,250,RC,50268025811,NDC,facility,both,1,EA,3.7,2.62,Aetna First Health,Commercial,,3.14,85,,,1.64,3.14,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Bottle,63700001,CDM,,,250,RC,68382010601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Bottle,63700001,CDM,,,250,RC,27241011501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Bottle,63700001,CDM,,,250,RC,00781224301,NDC,facility,both,1,EA,3.13,2.22,Aetna First Health,Commercial,,2.66,85,,,1.39,2.66,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Bottle,63700001,CDM,,,250,RC,55111053201,NDC,facility,both,1,EA,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Bottle,63700001,CDM,,,250,RC,00074611413,NDC,facility,both,1,EA,6.53,4.62,Aetna First Health,Commercial,,5.55,85,,,2.89,5.55,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Box,63700001,CDM,,,250,RC,68084031301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Box,63700001,CDM,,,250,RC,00904661561,NDC,facility,both,1,EA,3.13,2.22,Aetna First Health,Commercial,,2.66,85,,,1.39,2.66,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 100 Each Box,63700001,CDM,,,250,RC,00074611411,NDC,facility,both,1,EA,6.29,4.45,Aetna First Health,Commercial,,5.35,85,,,2.79,5.35,percent of total billed charges,
divalproex 125 MG Capsule Delayed Release Sprinkle 30 Each Box,63700001,CDM,,,250,RC,50268025813,NDC,facility,both,1,EA,3.7,2.62,Aetna First Health,Commercial,,3.14,85,,,1.64,3.14,percent of total billed charges,
divalproex 125 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687021111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,62756079688,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00093743901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,29300013801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,68001047200,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 125 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00074621213,NDC,facility,both,1,EA,5.19,3.67,Aetna First Health,Commercial,,4.41,85,,,2.3,4.41,percent of total billed charges,
divalproex 250 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00074621413,NDC,facility,both,1,EA,10.19,7.21,Aetna First Health,Commercial,,8.66,85,,,4.52,8.66,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,51079047501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00074621513,NDC,facility,both,1,EA,18.78,13.3,Aetna First Health,Commercial,,15.96,85,,,8.32,15.96,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268025911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079076601,NDC,facility,both,1,EA,5.15,3.65,Aetna First Health,Commercial,,4.38,85,,,2.28,4.38,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084031011,NDC,facility,both,1,EA,5.15,3.65,Aetna First Health,Commercial,,4.38,85,,,2.28,4.38,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378047201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001010500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,65862059401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,55111053301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,16714048401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00074382613,NDC,facility,both,1,EA,9.26,6.56,Aetna First Health,Commercial,,7.87,85,,,4.1,7.87,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904636361,NDC,facility,both,1,EA,4.53,3.21,Aetna First Health,Commercial,,3.85,85,,,2.01,3.85,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084031001,NDC,facility,both,1,EA,5.15,3.65,Aetna First Health,Commercial,,4.38,85,,,2.28,4.38,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 100 Each Disp Pack,63700001,CDM,,,250,RC,00074382611,NDC,facility,both,1,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 80 Each Box,63700001,CDM,,,250,RC,51079076608,NDC,facility,both,1,EA,5.15,3.65,Aetna First Health,Commercial,,4.38,85,,,2.28,4.38,percent of total billed charges,
divalproex ER 250 MG Tablet Extended Release 24 Hour 80 Each Box,63700001,CDM,,,250,RC,00904636345,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
divalproex ER 500 MG Tablet Extended Release 24 Hour 100 Each Disp Pack,63700001,CDM,,,250,RC,00074712611,NDC,facility,both,1,EA,22.73,16.09,Aetna First Health,Commercial,,19.32,85,,,10.07,19.32,percent of total billed charges,
docusate calcium 240 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00536106501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate calcium 240 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00904645959,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate calcium 240 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,46122068878,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate calcium 240 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00904699760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
docusate sodium 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,62584068311,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687012911,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57896040101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00904699860,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,46122045178,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,46122069278,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00904645760,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,10135011101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00603015021,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904224461,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,62584068301,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739047810,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904645561,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687012901,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904711561,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904718361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 100 MG capsule 750 Each Box,63700001,CDM,,,250,RC,63739047801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
docusate sodium 250 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68094005259,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dofetilide 125 MCG capsule 40 Each Box,63700001,CDM,,,250,RC,00904668108,NDC,facility,both,1,EA,18.07,12.79,Aetna First Health,Commercial,,15.36,85,,,8.01,15.36,percent of total billed charges,
dofetilide 125 MCG capsule 40 Each Box,63700001,CDM,,,250,RC,00069580043,NDC,facility,both,1,EA,38.78,27.46,Aetna First Health,Commercial,,32.96,85,,,17.19,32.96,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,69452013117,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,72205003960,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,42291041160,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,47335006186,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16729049012,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,59651011860,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,42794004410,NDC,facility,both,1,EA,10.94,7.75,Aetna First Health,Commercial,,9.3,85,,,4.85,9.3,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,59762003702,NDC,facility,both,1,EA,14.58,10.32,Aetna First Health,Commercial,,12.39,85,,,6.46,12.39,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00069580060,NDC,facility,both,1,EA,17.61,12.47,Aetna First Health,Commercial,,14.97,85,,,7.8,14.97,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16714084001,NDC,facility,both,1,EA,18.79,13.3,Aetna First Health,Commercial,,15.97,85,,,8.33,15.97,percent of total billed charges,
dofetilide 125 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,51862012560,NDC,facility,both,1,EA,23.95,16.96,Aetna First Health,Commercial,,20.36,85,,,10.61,20.36,percent of total billed charges,
dolasetron 100 MG Tablet 10 Each Box,63700001,CDM,,,250,RC,00088120343,NDC,facility,both,1,EA,222.37,157.44,Aetna First Health,Commercial,,189.01,85,,,98.55,189.01,percent of total billed charges,
donepezil 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084073411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084072511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687029211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687017111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904640861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687029201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904647761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59762024503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687017101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084072501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13668010230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547027503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62856024530,NDC,facility,both,1,EA,59.05,41.81,Aetna First Health,Commercial,,50.19,85,,,26.17,50.19,percent of total billed charges,
donepezil 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,33342002715,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668010290,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,43547027509,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
donepezil 5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,00781527664,NDC,facility,both,1,EA,5.84,4.13,Aetna First Health,Commercial,,4.96,85,,,2.59,4.96,percent of total billed charges,
Doravirine 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00006306901,NDC,facility,both,1,EA,205.42,145.44,Aetna First Health,Commercial,,174.61,85,,,91.04,174.61,percent of total billed charges,
doxazosin 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084083695,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084083611,NDC,facility,both,1,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
doxazosin 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079095701,NDC,facility,both,1,EA,10.99,7.78,Aetna First Health,Commercial,,9.34,85,,,4.87,9.34,percent of total billed charges,
doxazosin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505009300,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904552261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084083601,NDC,facility,both,1,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
doxazosin 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079095720,NDC,facility,both,1,EA,10.98,7.77,Aetna First Health,Commercial,,9.33,85,,,4.87,9.33,percent of total billed charges,
doxazosin 1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084083625,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxazosin 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079095801,NDC,facility,both,1,EA,3.22,2.28,Aetna First Health,Commercial,,2.74,85,,,1.43,2.74,percent of total billed charges,
doxazosin 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079095901,NDC,facility,both,1,EA,3.29,2.33,Aetna First Health,Commercial,,2.8,85,,,1.46,2.8,percent of total billed charges,
doxazosin 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079095920,NDC,facility,both,1,EA,3.28,2.32,Aetna First Health,Commercial,,2.79,85,,,1.45,2.79,percent of total billed charges,
doxepin 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079043601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378104901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,27241016701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079043620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904705261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 10 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69238116609,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079043701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079043720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxepin 3 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378539093,NDC,facility,both,1,EA,45.71,32.36,Aetna First Health,Commercial,,38.85,85,,,20.26,38.85,percent of total billed charges,
doxycycline (rosacea) 40 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,00299382230,NDC,facility,both,1,EA,70.55,49.95,Aetna First Health,Commercial,,59.97,85,,,31.27,59.97,percent of total billed charges,
doxycycline hyclate 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527133601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268027711,NDC,facility,both,1,EA,8.89,6.29,Aetna First Health,Commercial,,7.56,85,,,3.94,7.56,percent of total billed charges,
doxycycline hyclate 50 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,53489011802,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 50 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,47781048950,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 50 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00143980250,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxycycline hyclate 50 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00143314150,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
doxylamine 25 MG Tablet 16 Each Box,63700001,CDM,,,250,RC,41167000607,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
doxylamine 25 MG Tablet 32 Each Bottle,63700001,CDM,,,250,RC,41167000609,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
doxylamine 25 MG Tablet 32 Each Box,63700001,CDM,,,250,RC,24385044164,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
doxylamine 25 MG Tablet 32 Each Box,63700001,CDM,,,250,RC,87701082676,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
doxylamine 25 MG Tablet 32 Each Box,63700001,CDM,,,250,RC,70677006801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
dressing Misc 20 Each Box,63700001,CDM,,,250,RC,08333950505,NDC,facility,both,1,EA,0.8,0.57,Aetna First Health,Commercial,,0.68,85,,,0.35,0.68,percent of total billed charges,
dressing Misc 20 Each Box,63700001,CDM,,,250,RC,68455010278,NDC,facility,both,1,EA,5.85,4.14,Aetna First Health,Commercial,,4.97,85,,,2.59,4.97,percent of total billed charges,
dressing Misc 20 Each Box,63700001,CDM,,,250,RC,68455010693,NDC,facility,both,1,EA,21.77,15.41,Aetna First Health,Commercial,,18.5,85,,,9.65,18.5,percent of total billed charges,
droNABinol 2.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084017411,NDC,facility,both,1,EA,18.03,12.77,Aetna First Health,Commercial,,15.33,85,,,7.99,15.33,percent of total billed charges,
droNABinol 2.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687037511,NDC,facility,both,1,EA,24.77,17.54,Aetna First Health,Commercial,,21.05,85,,,10.98,21.05,percent of total billed charges,
droNABinol 2.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904674561,NDC,facility,both,1,EA,16.53,11.7,Aetna First Health,Commercial,,14.05,85,,,7.33,14.05,percent of total billed charges,
droNABinol 2.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904659761,NDC,facility,both,1,EA,16.53,11.7,Aetna First Health,Commercial,,14.05,85,,,7.33,14.05,percent of total billed charges,
droNABinol 2.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084017401,NDC,facility,both,1,EA,18.03,12.77,Aetna First Health,Commercial,,15.33,85,,,7.99,15.33,percent of total billed charges,
droNABinol 2.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687037501,NDC,facility,both,1,EA,18.03,12.77,Aetna First Health,Commercial,,15.33,85,,,7.99,15.33,percent of total billed charges,
droNABinol 2.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,17478076106,NDC,facility,both,1,EA,5.91,4.18,Aetna First Health,Commercial,,5.02,85,,,2.62,5.02,percent of total billed charges,
droNABinol 2.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,49884086702,NDC,facility,both,1,EA,16.49,11.67,Aetna First Health,Commercial,,14.02,85,,,7.31,14.02,percent of total billed charges,
droNABinol 2.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00591359160,NDC,facility,both,1,EA,16.5,11.68,Aetna First Health,Commercial,,14.02,85,,,7.31,14.02,percent of total billed charges,
dronedarone 400 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00024414260,NDC,facility,both,1,EA,46.55,32.96,Aetna First Health,Commercial,,39.57,85,,,20.63,39.57,percent of total billed charges,
droxidopa 100 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,67386082019,NDC,facility,both,1,EA,142.14,100.64,Aetna First Health,Commercial,,120.82,85,,,63,120.82,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,60687072311,NDC,facility,both,1,EA,6.18,4.38,Aetna First Health,Commercial,,5.25,85,,,2.74,5.25,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,68084067511,NDC,facility,both,1,EA,6.2,4.39,Aetna First Health,Commercial,,5.27,85,,,2.75,5.27,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,47335038188,NDC,facility,both,1,EA,20.39,14.44,Aetna First Health,Commercial,,17.33,85,,,9.04,17.33,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 100 Each Box,63700001,CDM,,,250,RC,00904704361,NDC,facility,both,1,EA,5.61,3.97,Aetna First Health,Commercial,,4.77,85,,,2.49,4.77,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 30 Each Box,63700001,CDM,,,250,RC,00904645204,NDC,facility,both,1,EA,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 30 Each Box,63700001,CDM,,,250,RC,00904704304,NDC,facility,both,1,EA,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 30 Each Box,63700001,CDM,,,250,RC,68084067521,NDC,facility,both,1,EA,6.18,4.38,Aetna First Health,Commercial,,5.25,85,,,2.74,5.25,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 30 Each Box,63700001,CDM,,,250,RC,60687072321,NDC,facility,both,1,EA,6.18,4.38,Aetna First Health,Commercial,,5.25,85,,,2.74,5.25,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,47335038186,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,57237001760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,67877026360,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,68001041306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,31722058160,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,27241009706,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,68001059406,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,68001025506,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 60 Each Bottle,63700001,CDM,,,250,RC,00002323560,NDC,facility,both,1,EA,29.19,20.67,Aetna First Health,Commercial,,24.81,85,,,12.94,24.81,percent of total billed charges,
DULoxetine 20 MG Capsule Delayed Release Particles 90 Each Bottle,63700001,CDM,,,250,RC,51991074690,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,68084068311,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
DULoxetine 30 MG Capsule Delayed Release Particles 30 Each Bottle,63700001,CDM,,,250,RC,47335038283,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
DULoxetine 60 MG Capsule Delayed Release Particles 1 Each Blister,63700001,CDM,,,250,RC,68084069211,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
dutasteride 0.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268028211,NDC,facility,both,1,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
dutasteride 0.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,65162075003,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,60505387703,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,31722013130,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,42806054930,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00173071215,NDC,facility,both,1,EA,32.1,22.73,Aetna First Health,Commercial,,27.28,85,,,14.23,27.28,percent of total billed charges,
dutasteride 0.5 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,65162075009,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,31722013190,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,42806054909,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,51991074990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
dutasteride 0.5 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00173071204,NDC,facility,both,1,EA,32.1,22.73,Aetna First Health,Commercial,,27.28,85,,,14.23,27.28,percent of total billed charges,
efavirenz 200 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00056047492,NDC,facility,both,1,EA,38.14,27,Aetna First Health,Commercial,,32.42,85,,,16.9,32.42,percent of total billed charges,
efavirenz 600 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722050430,NDC,facility,both,1,EA,9.33,6.61,Aetna First Health,Commercial,,7.93,85,,,4.14,7.93,percent of total billed charges,
efavirenz 600 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69097030102,NDC,facility,both,1,EA,9.33,6.61,Aetna First Health,Commercial,,7.93,85,,,4.14,7.93,percent of total billed charges,
efavirenz 600 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00056051030,NDC,facility,both,1,EA,114.4,81,Aetna First Health,Commercial,,97.24,85,,,50.7,97.24,percent of total billed charges,
eletriptan 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,59762232108,NDC,facility,both,1,EA,41.83,29.62,Aetna First Health,Commercial,,35.56,85,,,18.54,35.56,percent of total billed charges,
eletriptan 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00378428732,NDC,facility,both,1,EA,41.83,29.62,Aetna First Health,Commercial,,35.56,85,,,18.54,35.56,percent of total billed charges,
eletriptan 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093831019,NDC,facility,both,1,EA,64.53,45.69,Aetna First Health,Commercial,,54.85,85,,,28.6,54.85,percent of total billed charges,
eletriptan 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00049233079,NDC,facility,both,1,EA,282.7,200.15,Aetna First Health,Commercial,,240.3,85,,,125.29,240.3,percent of total billed charges,
eletriptan 20 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,65162004280,NDC,facility,both,1,EA,37.63,26.64,Aetna First Health,Commercial,,31.99,85,,,16.68,31.99,percent of total billed charges,
eletriptan 20 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,59762232101,NDC,facility,both,1,EA,41.83,29.62,Aetna First Health,Commercial,,35.56,85,,,18.54,35.56,percent of total billed charges,
eletriptan 20 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,00093831018,NDC,facility,both,1,EA,64.53,45.69,Aetna First Health,Commercial,,54.85,85,,,28.6,54.85,percent of total billed charges,
eletriptan 20 MG Tablet 6 Each Box,63700001,CDM,,,250,RC,00049233045,NDC,facility,both,1,EA,126.26,89.39,Aetna First Health,Commercial,,107.32,85,,,55.96,107.32,percent of total billed charges,
elvitegravir-cobicistat-emtricitabine-tenofovir ALAFENAMIDE 150-150-200-10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,61958190101,NDC,facility,both,1,EA,464.47,328.84,Aetna First Health,Commercial,,394.8,85,,,205.85,394.8,percent of total billed charges,
empagliflozin 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00597015230,NDC,facility,both,1,EA,71.3,50.48,Aetna First Health,Commercial,,60.6,85,,,31.6,60.6,percent of total billed charges,
empagliflozin 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00597015237,NDC,facility,both,1,EA,71.3,50.48,Aetna First Health,Commercial,,60.6,85,,,31.6,60.6,percent of total billed charges,
empagliflozin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00597015290,NDC,facility,both,1,EA,71.3,50.48,Aetna First Health,Commercial,,60.6,85,,,31.6,60.6,percent of total billed charges,
emtricitabine 200 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,69097064202,NDC,facility,both,1,EA,54.08,38.29,Aetna First Health,Commercial,,45.97,85,,,23.97,45.97,percent of total billed charges,
emtricitabine 200 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,65862030130,NDC,facility,both,1,EA,56.23,39.81,Aetna First Health,Commercial,,47.8,85,,,24.92,47.8,percent of total billed charges,
emtricitabine 200 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,61958060101,NDC,facility,both,1,EA,62.59,44.31,Aetna First Health,Commercial,,53.2,85,,,27.74,53.2,percent of total billed charges,
emtricitabine-tenofovir 200-300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42385095330,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
emtricitabine-tenofovir 200-300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378193093,NDC,facility,both,1,EA,8.49,6.01,Aetna First Health,Commercial,,7.22,85,,,3.76,7.22,percent of total billed charges,
emtricitabine-tenofovir 200-300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,61958070101,NDC,facility,both,1,EA,214.93,152.17,Aetna First Health,Commercial,,182.69,85,,,95.26,182.69,percent of total billed charges,
emtricitabine-tenofovir 200-300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904717207,NDC,facility,both,1,EA,6.81,4.82,Aetna First Health,Commercial,,5.79,85,,,3.02,5.79,percent of total billed charges,
Emtricitab-Rilpivir-Tenofov AF 200-25-25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,61958210101,NDC,facility,both,1,EA,422.71,299.28,Aetna First Health,Commercial,,359.3,85,,,187.35,359.3,percent of total billed charges,
enalapril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378105101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672403701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679092302,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714044201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904560961,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
enalapril 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084039011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
entacapone 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079027301,NDC,facility,both,1,EA,11.42,8.09,Aetna First Health,Commercial,,9.71,85,,,5.06,9.71,percent of total billed charges,
entacapone 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687018811,NDC,facility,both,1,EA,14.42,10.21,Aetna First Health,Commercial,,12.26,85,,,6.39,12.26,percent of total billed charges,
entacapone 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64679078102,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
entacapone 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862065401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
entacapone 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,27241004910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
entacapone 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781557801,NDC,facility,both,1,EA,11.06,7.83,Aetna First Health,Commercial,,9.4,85,,,4.9,9.4,percent of total billed charges,
entacapone 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378908001,NDC,facility,both,1,EA,11.07,7.84,Aetna First Health,Commercial,,9.41,85,,,4.91,9.41,percent of total billed charges,
entacapone 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078032705,NDC,facility,both,1,EA,19.53,13.83,Aetna First Health,Commercial,,16.6,85,,,8.66,16.6,percent of total billed charges,
entacapone 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687018821,NDC,facility,both,1,EA,14.41,10.2,Aetna First Health,Commercial,,12.25,85,,,6.39,12.25,percent of total billed charges,
entacapone 200 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,51079027303,NDC,facility,both,1,EA,19.86,14.06,Aetna First Health,Commercial,,16.88,85,,,8.8,16.88,percent of total billed charges,
entecavir 0.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42806065830,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
entecavir 0.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722083330,NDC,facility,both,1,EA,4.67,3.31,Aetna First Health,Commercial,,3.97,85,,,2.07,3.97,percent of total billed charges,
entecavir 0.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714071701,NDC,facility,both,1,EA,33.36,23.62,Aetna First Health,Commercial,,28.36,85,,,14.79,28.36,percent of total billed charges,
entecavir 0.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093578656,NDC,facility,both,1,EA,124.42,88.09,Aetna First Health,Commercial,,105.76,85,,,55.14,105.76,percent of total billed charges,
eplerenone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084094895,NDC,facility,both,1,EA,10.66,7.55,Aetna First Health,Commercial,,9.06,85,,,4.72,9.06,percent of total billed charges,
eplerenone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687045111,NDC,facility,both,1,EA,14.58,10.32,Aetna First Health,Commercial,,12.39,85,,,6.46,12.39,percent of total billed charges,
eplerenone 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59762171001,NDC,facility,both,1,EA,10.85,7.68,Aetna First Health,Commercial,,9.22,85,,,4.81,9.22,percent of total billed charges,
eplerenone 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378103093,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
eplerenone 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,51991087733,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
eplerenone 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729029310,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
eplerenone 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59762171002,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
eplerenone 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00185536830,NDC,facility,both,1,EA,12.15,8.6,Aetna First Health,Commercial,,10.33,85,,,5.38,10.33,percent of total billed charges,
eplerenone 25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687045121,NDC,facility,both,1,EA,14.58,10.32,Aetna First Health,Commercial,,12.39,85,,,6.46,12.39,percent of total billed charges,
eplerenone 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00185536930,NDC,facility,both,1,EA,12.15,8.6,Aetna First Health,Commercial,,10.33,85,,,5.38,10.33,percent of total billed charges,
ergotamine-caffeine 1-100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781540501,NDC,facility,both,1,EA,28.82,20.4,Aetna First Health,Commercial,,24.5,85,,,12.77,24.5,percent of total billed charges,
erythromycin base 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24338010213,NDC,facility,both,1,EA,27.05,19.15,Aetna First Health,Commercial,,22.99,85,,,11.99,22.99,percent of total billed charges,
erythromycin base 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,75834024230,NDC,facility,both,1,EA,19.69,13.94,Aetna First Health,Commercial,,16.74,85,,,8.73,16.74,percent of total billed charges,
erythromycin base 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093557156,NDC,facility,both,1,EA,23.15,16.39,Aetna First Health,Commercial,,19.68,85,,,10.26,19.68,percent of total billed charges,
erythromycin base 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,52536010303,NDC,facility,both,1,EA,32.9,23.29,Aetna First Health,Commercial,,27.96,85,,,14.58,27.96,percent of total billed charges,
erythromycin base 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69238148403,NDC,facility,both,1,EA,37.04,26.22,Aetna First Health,Commercial,,31.48,85,,,16.42,31.48,percent of total billed charges,
erythromycin base 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,24338010203,NDC,facility,both,1,EA,40.61,28.75,Aetna First Health,Commercial,,34.52,85,,,18,34.52,percent of total billed charges,
erythromycin base EC 333 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,24338012413,NDC,facility,both,1,EA,21.6,15.29,Aetna First Health,Commercial,,18.36,85,,,9.57,18.36,percent of total billed charges,
erythromycin delayed release 250 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,69238147101,NDC,facility,both,1,EA,23.49,16.63,Aetna First Health,Commercial,,19.97,85,,,10.41,19.97,percent of total billed charges,
erythromycin delayed release 250 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,24338012213,NDC,facility,both,1,EA,25.75,18.23,Aetna First Health,Commercial,,21.89,85,,,11.41,21.89,percent of total billed charges,
erythromycin delayed release 250 MG Tablet Delayed Release 30 Each Bottle,63700001,CDM,,,250,RC,69238147103,NDC,facility,both,1,EA,23.49,16.63,Aetna First Health,Commercial,,19.97,85,,,10.41,19.97,percent of total billed charges,
erythromycin delayed release 250 MG Tablet Delayed Release 30 Each Bottle,63700001,CDM,,,250,RC,24338012203,NDC,facility,both,1,EA,29.88,21.16,Aetna First Health,Commercial,,25.4,85,,,13.24,25.4,percent of total billed charges,
erythromycin ethylsuccinate 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24338010013,NDC,facility,both,1,EA,42.61,30.17,Aetna First Health,Commercial,,36.22,85,,,18.88,36.22,percent of total billed charges,
erythromycin ethylsuccinate 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,24338011003,NDC,facility,both,1,EA,42.61,30.17,Aetna First Health,Commercial,,36.22,85,,,18.88,36.22,percent of total billed charges,
escitalopram 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084061711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079054301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093585001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180013701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59746027901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001019500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547028010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001045400,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001059100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
escitalopram 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862037301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estazolam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591074401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
esterified estrogens 0.625 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61570007301,NDC,facility,both,1,EA,9.31,6.59,Aetna First Health,Commercial,,7.91,85,,,4.13,7.91,percent of total billed charges,
estradiol 0.025 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,47781020411,NDC,facility,both,1,EA,58.02,41.08,Aetna First Health,Commercial,,49.32,85,,,25.71,49.32,percent of total billed charges,
estradiol 0.025 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,00378334916,NDC,facility,both,1,EA,74.26,52.58,Aetna First Health,Commercial,,63.12,85,,,32.91,63.12,percent of total billed charges,
estradiol 0.025 MG/24HR PATCH WEEKLY 1 Each Packet,63700001,CDM,,,250,RC,50419045401,NDC,facility,both,1,EA,103.93,73.58,Aetna First Health,Commercial,,88.34,85,,,46.06,88.34,percent of total billed charges,
estradiol 0.025 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00378334999,NDC,facility,both,1,EA,64.98,46.01,Aetna First Health,Commercial,,55.23,85,,,28.8,55.23,percent of total billed charges,
estradiol 0.025 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,47781020404,NDC,facility,both,1,EA,66.31,46.95,Aetna First Health,Commercial,,56.36,85,,,29.39,56.36,percent of total billed charges,
estradiol 0.025 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,50419045404,NDC,facility,both,1,EA,103.93,73.58,Aetna First Health,Commercial,,88.34,85,,,46.06,88.34,percent of total billed charges,
estradiol 0.0375 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,00078034362,NDC,facility,both,1,EA,64.02,45.33,Aetna First Health,Commercial,,54.42,85,,,28.37,54.42,percent of total billed charges,
estradiol 0.0375 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,00378464316,NDC,facility,both,1,EA,31.74,22.47,Aetna First Health,Commercial,,26.98,85,,,14.07,26.98,percent of total billed charges,
estradiol 0.0375 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,00781713858,NDC,facility,both,1,EA,38.05,26.94,Aetna First Health,Commercial,,32.34,85,,,16.86,32.34,percent of total billed charges,
estradiol 0.0375 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,00378464326,NDC,facility,both,1,EA,36.25,25.66,Aetna First Health,Commercial,,30.81,85,,,16.07,30.81,percent of total billed charges,
estradiol 0.0375 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,00781713883,NDC,facility,both,1,EA,38.05,26.94,Aetna First Health,Commercial,,32.34,85,,,16.86,32.34,percent of total billed charges,
estradiol 0.0375 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,00078034342,NDC,facility,both,1,EA,48.26,34.17,Aetna First Health,Commercial,,41.02,85,,,21.39,41.02,percent of total billed charges,
estradiol 0.0375 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,00078034345,NDC,facility,both,1,EA,48.26,34.17,Aetna First Health,Commercial,,41.02,85,,,21.39,41.02,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,00378464216,NDC,facility,both,1,EA,31.74,22.47,Aetna First Health,Commercial,,26.98,85,,,14.07,26.98,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,52544047154,NDC,facility,both,1,EA,34.96,24.75,Aetna First Health,Commercial,,29.72,85,,,15.49,29.72,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,00078034462,NDC,facility,both,1,EA,48.24,34.15,Aetna First Health,Commercial,,41,85,,,21.38,41,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,00781714458,NDC,facility,both,1,EA,38.06,26.95,Aetna First Health,Commercial,,32.35,85,,,16.87,32.35,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,65162014904,NDC,facility,both,1,EA,57.08,40.41,Aetna First Health,Commercial,,48.52,85,,,25.3,48.52,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,00378462116,NDC,facility,both,1,EA,62.32,44.12,Aetna First Health,Commercial,,52.97,85,,,27.62,52.97,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,68968345001,NDC,facility,both,1,EA,71.34,50.51,Aetna First Health,Commercial,,60.64,85,,,31.62,60.64,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,65162099308,NDC,facility,both,1,EA,31.74,22.47,Aetna First Health,Commercial,,26.98,85,,,14.07,26.98,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,52544047108,NDC,facility,both,1,EA,34.96,24.75,Aetna First Health,Commercial,,29.72,85,,,15.49,29.72,percent of total billed charges,
estradiol 0.05 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,00378464226,NDC,facility,both,1,EA,36.28,25.69,Aetna First Health,Commercial,,30.84,85,,,16.08,30.84,percent of total billed charges,
estradiol 0.05 MG/24HR PATCH WEEKLY 1 Each Packet,63700001,CDM,,,250,RC,47781020611,NDC,facility,both,1,EA,66.31,46.95,Aetna First Health,Commercial,,56.36,85,,,29.39,56.36,percent of total billed charges,
estradiol 0.05 MG/24HR PATCH WEEKLY 1 Each Packet,63700001,CDM,,,250,RC,00378335016,NDC,facility,both,1,EA,74.26,52.58,Aetna First Health,Commercial,,63.12,85,,,32.91,63.12,percent of total billed charges,
estradiol 0.05 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00378335099,NDC,facility,both,1,EA,64.98,46.01,Aetna First Health,Commercial,,55.23,85,,,28.8,55.23,percent of total billed charges,
estradiol 0.05 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,47781020604,NDC,facility,both,1,EA,66.31,46.95,Aetna First Health,Commercial,,56.36,85,,,29.39,56.36,percent of total billed charges,
estradiol 0.075 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,52544047254,NDC,facility,both,1,EA,35.68,25.26,Aetna First Health,Commercial,,30.33,85,,,15.81,30.33,percent of total billed charges,
estradiol 0.075 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,00078034562,NDC,facility,both,1,EA,48.48,34.32,Aetna First Health,Commercial,,41.21,85,,,21.49,41.21,percent of total billed charges,
estradiol 0.075 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,00378464116,NDC,facility,both,1,EA,36.32,25.71,Aetna First Health,Commercial,,30.87,85,,,16.1,30.87,percent of total billed charges,
estradiol 0.075 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,52544047208,NDC,facility,both,1,EA,35.68,25.26,Aetna First Health,Commercial,,30.33,85,,,15.81,30.33,percent of total billed charges,
estradiol 0.075 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,00378464126,NDC,facility,both,1,EA,36.32,25.71,Aetna First Health,Commercial,,30.87,85,,,16.1,30.87,percent of total billed charges,
estradiol 0.075 MG/24HR PATCH WEEKLY 1 Each,63700001,CDM,,,250,RC,47781020811,NDC,facility,both,1,EA,66.31,46.95,Aetna First Health,Commercial,,56.36,85,,,29.39,56.36,percent of total billed charges,
estradiol 0.075 MG/24HR PATCH WEEKLY 1 Each Packet,63700001,CDM,,,250,RC,00378335116,NDC,facility,both,1,EA,74.26,52.58,Aetna First Health,Commercial,,63.12,85,,,32.91,63.12,percent of total billed charges,
estradiol 0.075 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00378335199,NDC,facility,both,1,EA,64.98,46.01,Aetna First Health,Commercial,,55.23,85,,,28.8,55.23,percent of total billed charges,
estradiol 0.075 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,47781020804,NDC,facility,both,1,EA,66.31,46.95,Aetna First Health,Commercial,,56.36,85,,,29.39,56.36,percent of total billed charges,
estradiol 0.075 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,50419045304,NDC,facility,both,1,EA,66.76,47.27,Aetna First Health,Commercial,,56.75,85,,,29.59,56.75,percent of total billed charges,
estradiol 0.1 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,52544047354,NDC,facility,both,1,EA,36.48,25.83,Aetna First Health,Commercial,,31.01,85,,,16.17,31.01,percent of total billed charges,
estradiol 0.1 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,00078034662,NDC,facility,both,1,EA,48.36,34.24,Aetna First Health,Commercial,,41.11,85,,,21.43,41.11,percent of total billed charges,
estradiol 0.1 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,00378464016,NDC,facility,both,1,EA,31.79,22.51,Aetna First Health,Commercial,,27.02,85,,,14.09,27.02,percent of total billed charges,
estradiol 0.1 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,65162099704,NDC,facility,both,1,EA,31.79,22.51,Aetna First Health,Commercial,,27.02,85,,,14.09,27.02,percent of total billed charges,
estradiol 0.1 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,00378464026,NDC,facility,both,1,EA,31.79,22.51,Aetna First Health,Commercial,,27.02,85,,,14.09,27.02,percent of total billed charges,
estradiol 0.1 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,52544047308,NDC,facility,both,1,EA,58.94,41.73,Aetna First Health,Commercial,,50.1,85,,,26.12,50.1,percent of total billed charges,
estradiol 0.1 MG/24HR PATCH WEEKLY 1 Each Box,63700001,CDM,,,250,RC,50419045201,NDC,facility,both,1,EA,103.92,73.58,Aetna First Health,Commercial,,88.33,85,,,46.06,88.33,percent of total billed charges,
estradiol 0.1 MG/24HR PATCH WEEKLY 1 Each Package,63700001,CDM,,,250,RC,47781020911,NDC,facility,both,1,EA,66.31,46.95,Aetna First Health,Commercial,,56.36,85,,,29.39,56.36,percent of total billed charges,
estradiol 0.1 MG/24HR PATCH WEEKLY 1 Each Packet,63700001,CDM,,,250,RC,00378335216,NDC,facility,both,1,EA,74.26,52.58,Aetna First Health,Commercial,,63.12,85,,,32.91,63.12,percent of total billed charges,
estradiol 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,47781020904,NDC,facility,both,1,EA,66.31,46.95,Aetna First Health,Commercial,,56.36,85,,,29.39,56.36,percent of total billed charges,
estradiol 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,00378335299,NDC,facility,both,1,EA,74.26,52.58,Aetna First Health,Commercial,,63.12,85,,,32.91,63.12,percent of total billed charges,
estradiol 0.1 MG/24HR PATCH WEEKLY 4 Each Box,63700001,CDM,,,250,RC,50419045204,NDC,facility,both,1,EA,103.93,73.58,Aetna First Health,Commercial,,88.34,85,,,46.06,88.34,percent of total billed charges,
estradiol 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268029011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555089902,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862033201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378145201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42806008701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00430072024,NDC,facility,both,1,EA,11.26,7.97,Aetna First Health,Commercial,,9.57,85,,,4.99,9.57,percent of total billed charges,
estradiol 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378145401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
estradiol 1 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268029115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Estradiol 10 MCG Tablet 8 Each Box,63700001,CDM,,,250,RC,00169517603,NDC,facility,both,1,EA,59.5,42.13,Aetna First Health,Commercial,,50.58,85,,,26.37,50.58,percent of total billed charges,
Estradiol 10 MCG Tablet 8 Each Box,63700001,CDM,,,250,RC,65162022621,NDC,facility,both,1,EA,67.89,48.07,Aetna First Health,Commercial,,57.71,85,,,30.09,57.71,percent of total billed charges,
estradiol-norethindrone 0.05-0.14 MG/DAY Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,68968051401,NDC,facility,both,1,EA,123.98,87.78,Aetna First Health,Commercial,,105.38,85,,,54.95,105.38,percent of total billed charges,
estradiol-norethindrone 0.05-0.14 MG/DAY Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,68968051408,NDC,facility,both,1,EA,123.98,87.78,Aetna First Health,Commercial,,105.38,85,,,54.95,105.38,percent of total billed charges,
estrogen (conjugated)-medroxyprogesterone 0.3-1.5 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00046110511,NDC,facility,both,1,EA,30.23,21.4,Aetna First Health,Commercial,,25.7,85,,,13.4,25.7,percent of total billed charges,
estrogen (conjugated)-medroxyprogesterone 0.45-1.5 MG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00046110611,NDC,facility,both,1,EA,30.23,21.4,Aetna First Health,Commercial,,25.7,85,,,13.4,25.7,percent of total billed charges,
estrogens (esterified)-methyltestosterone 0.625-1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527141001,NDC,facility,both,1,EA,3.92,2.78,Aetna First Health,Commercial,,3.33,85,,,1.74,3.33,percent of total billed charges,
estrogens (esterified)-methyltestosterone 0.625-1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746007701,NDC,facility,both,1,EA,3.92,2.78,Aetna First Health,Commercial,,3.33,85,,,1.74,3.33,percent of total billed charges,
estrogens (esterified)-methyltestosterone 1.25-2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746007801,NDC,facility,both,1,EA,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
estrogens (esterified)-methyltestosterone 1.25-2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58657040501,NDC,facility,both,1,EA,10.48,7.42,Aetna First Health,Commercial,,8.91,85,,,4.64,8.91,percent of total billed charges,
eszopiclone 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111062930,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
eszopiclone 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63402019030,NDC,facility,both,1,EA,43.47,30.78,Aetna First Health,Commercial,,36.95,85,,,19.27,36.95,percent of total billed charges,
ethacrynic acid 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68682001110,NDC,facility,both,1,EA,7.88,5.58,Aetna First Health,Commercial,,6.7,85,,,3.49,6.7,percent of total billed charges,
ethacrynic acid 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238112601,NDC,facility,both,1,EA,7.88,5.58,Aetna First Health,Commercial,,6.7,85,,,3.49,6.7,percent of total billed charges,
ethacrynic acid 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42799040501,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
ethacrynic acid 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832169011,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
ethacrynic acid 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,25010021515,NDC,facility,both,1,EA,85.55,60.57,Aetna First Health,Commercial,,72.72,85,,,37.92,72.72,percent of total billed charges,
ethambutol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61748001101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
etodolac 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62559025001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
etodolac 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51672401601,NDC,facility,both,1,EA,3.77,2.67,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
etodolac 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60505003901,NDC,facility,both,1,EA,3.77,2.67,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
etodolac 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084083895,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
etodolac 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385011801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
etodolac 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238134201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
etodolac 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672401801,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
etodolac 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093089201,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
etodolac 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185067501,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
etodolac 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68084083825,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
etodolac XL 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00093717201,NDC,facility,both,1,EA,8.63,6.11,Aetna First Health,Commercial,,7.34,85,,,3.82,7.34,percent of total billed charges,
etravirine 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59676057101,NDC,facility,both,1,EA,87.38,61.87,Aetna First Health,Commercial,,74.27,85,,,38.73,74.27,percent of total billed charges,
ezetimibe 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268029811,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
ezetimibe 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,66582041429,NDC,facility,both,1,EA,25.1,17.77,Aetna First Health,Commercial,,21.34,85,,,11.12,21.34,percent of total billed charges,
ezetimibe 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687037311,NDC,facility,both,1,EA,36.16,25.6,Aetna First Health,Commercial,,30.74,85,,,16.03,30.74,percent of total billed charges,
ezetimibe 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687028411,NDC,facility,both,1,EA,36.16,25.6,Aetna First Health,Commercial,,30.74,85,,,16.03,30.74,percent of total billed charges,
ezetimibe 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,66582041428,NDC,facility,both,1,EA,25.11,17.78,Aetna First Health,Commercial,,21.34,85,,,11.13,21.34,percent of total billed charges,
ezetimibe 10 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,50268029812,NDC,facility,both,1,EA,17.49,12.38,Aetna First Health,Commercial,,14.87,85,,,7.75,14.87,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00591371330,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69238115403,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877049030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382077306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,51660020030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42291031430,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59651005230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00781569031,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00904666404,NDC,facility,both,1,EA,38.53,27.28,Aetna First Health,Commercial,,32.75,85,,,17.08,32.75,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66582041431,NDC,facility,both,1,EA,40.25,28.5,Aetna First Health,Commercial,,34.21,85,,,17.84,34.21,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904710304,NDC,facility,both,1,EA,32.08,22.71,Aetna First Health,Commercial,,27.27,85,,,14.22,27.27,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687037321,NDC,facility,both,1,EA,36.16,25.6,Aetna First Health,Commercial,,30.74,85,,,16.03,30.74,percent of total billed charges,
ezetimibe 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687028421,NDC,facility,both,1,EA,36.16,25.6,Aetna First Health,Commercial,,30.74,85,,,16.03,30.74,percent of total billed charges,
ezetimibe 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,67877049005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,66582041474,NDC,facility,both,1,EA,40.25,28.5,Aetna First Health,Commercial,,34.21,85,,,17.84,34.21,percent of total billed charges,
ezetimibe 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00591371319,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59651005290,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781569092,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42291031490,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,67877049090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382077316,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,66582041454,NDC,facility,both,1,EA,25.11,17.78,Aetna First Health,Commercial,,21.34,85,,,11.13,21.34,percent of total billed charges,
ezetimibe-simvastatin 10-10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69238115503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe-simvastatin 10-10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62559070030,NDC,facility,both,1,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
ezetimibe-simvastatin 10-10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66582031131,NDC,facility,both,1,EA,39.87,28.23,Aetna First Health,Commercial,,33.89,85,,,17.67,33.89,percent of total billed charges,
ezetimibe-simvastatin 10-20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68462032230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe-simvastatin 10-20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877050830,NDC,facility,both,1,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
ezetimibe-simvastatin 10-20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,45963056630,NDC,facility,both,1,EA,11.36,8.04,Aetna First Health,Commercial,,9.66,85,,,5.03,9.66,percent of total billed charges,
ezetimibe-simvastatin 10-20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66582031231,NDC,facility,both,1,EA,24.88,17.62,Aetna First Health,Commercial,,21.15,85,,,11.03,21.15,percent of total billed charges,
ezetimibe-simvastatin 10-40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69238115703,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe-simvastatin 10-40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68462032330,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe-simvastatin 10-40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,45963056730,NDC,facility,both,1,EA,11.36,8.04,Aetna First Health,Commercial,,9.66,85,,,5.03,9.66,percent of total billed charges,
ezetimibe-simvastatin 10-40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66582031331,NDC,facility,both,1,EA,24.88,17.62,Aetna First Health,Commercial,,21.15,85,,,11.03,21.15,percent of total billed charges,
ezetimibe-simvastatin 10-80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69238115803,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ezetimibe-simvastatin 10-80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877051030,NDC,facility,both,1,EA,3.73,2.64,Aetna First Health,Commercial,,3.17,85,,,1.65,3.17,percent of total billed charges,
ezetimibe-simvastatin 10-80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,45963056830,NDC,facility,both,1,EA,11.36,8.04,Aetna First Health,Commercial,,9.66,85,,,5.03,9.66,percent of total billed charges,
ezetimibe-simvastatin 10-80 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66582031531,NDC,facility,both,1,EA,24.88,17.62,Aetna First Health,Commercial,,21.15,85,,,11.03,21.15,percent of total billed charges,
famciclovir 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00591327230,NDC,facility,both,1,EA,5.63,3.99,Aetna First Health,Commercial,,4.79,85,,,2.5,4.79,percent of total billed charges,
famotidine 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904552987,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,46122020565,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00093274865,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,49348012844,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00093274892,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904552952,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68001049406,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,49348012812,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,46122020572,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 10 MG Tablet 70 Each Box,63700001,CDM,,,250,RC,00172266272,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 70 Each Box,63700001,CDM,,,250,RC,00093274894,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 10 MG Tablet 90 Each Box,63700001,CDM,,,250,RC,46122039475,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
famotidine 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079096601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079096620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
famotidine-calcium carb-mag hydroxide 10-800-165 MG Tablet Chewable 50 Each Bottle,63700001,CDM,,,250,RC,16837029150,NDC,facility,both,1,EA,0.54,0.38,Aetna First Health,Commercial,,0.46,85,,,0.24,0.46,percent of total billed charges,
febuxostat 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687053811,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
febuxostat 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,72205002830,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
febuxostat 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111079630,NDC,facility,both,1,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
febuxostat 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332019030,NDC,facility,both,1,EA,6.18,4.38,Aetna First Health,Commercial,,5.25,85,,,2.74,5.25,percent of total billed charges,
febuxostat 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378392593,NDC,facility,both,1,EA,8.86,6.27,Aetna First Health,Commercial,,7.53,85,,,3.93,7.53,percent of total billed charges,
febuxostat 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764091830,NDC,facility,both,1,EA,38.51,27.27,Aetna First Health,Commercial,,32.73,85,,,17.07,32.73,percent of total billed charges,
febuxostat 40 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687053821,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
felbamate 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,72578005701,NDC,facility,both,1,EA,6.33,4.48,Aetna First Health,Commercial,,5.38,85,,,2.81,5.38,percent of total billed charges,
felbamate 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51525043101,NDC,facility,both,1,EA,15.13,10.71,Aetna First Health,Commercial,,12.86,85,,,6.71,12.86,percent of total billed charges,
felbamate 600 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162073503,NDC,facility,both,1,EA,16.75,11.86,Aetna First Health,Commercial,,14.24,85,,,7.42,14.24,percent of total billed charges,
felodipine 2.5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68462023301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 2.5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,13668013201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 2.5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,57237010801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
felodipine 2.5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378501101,NDC,facility,both,1,EA,3.8,2.69,Aetna First Health,Commercial,,3.23,85,,,1.68,3.23,percent of total billed charges,
felodipine 2.5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,53489036801,NDC,facility,both,1,EA,3.8,2.69,Aetna First Health,Commercial,,3.23,85,,,1.68,3.23,percent of total billed charges,
fenofibrate 145 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687062911,NDC,facility,both,1,EA,8.17,5.78,Aetna First Health,Commercial,,6.94,85,,,3.62,6.94,percent of total billed charges,
fenofibrate 145 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084063695,NDC,facility,both,1,EA,11.55,8.18,Aetna First Health,Commercial,,9.82,85,,,5.12,9.82,percent of total billed charges,
fenofibrate 145 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079060801,NDC,facility,both,1,EA,11.55,8.18,Aetna First Health,Commercial,,9.82,85,,,5.12,9.82,percent of total billed charges,
fenofibrate 145 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268031111,NDC,facility,both,1,EA,13.46,9.53,Aetna First Health,Commercial,,11.44,85,,,5.97,11.44,percent of total billed charges,
fenofibrate 145 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687062901,NDC,facility,both,1,EA,11.55,8.18,Aetna First Health,Commercial,,9.82,85,,,5.12,9.82,percent of total billed charges,
fenofibrate 145 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079060820,NDC,facility,both,1,EA,11.55,8.18,Aetna First Health,Commercial,,9.82,85,,,5.12,9.82,percent of total billed charges,
fenofibrate 145 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904716104,NDC,facility,both,1,EA,5.17,3.66,Aetna First Health,Commercial,,4.39,85,,,2.29,4.39,percent of total billed charges,
fenofibrate 145 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687062921,NDC,facility,both,1,EA,8.17,5.78,Aetna First Health,Commercial,,6.94,85,,,3.62,6.94,percent of total billed charges,
fenofibrate 145 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084063625,NDC,facility,both,1,EA,11.55,8.18,Aetna First Health,Commercial,,9.82,85,,,5.12,9.82,percent of total billed charges,
fenofibrate 145 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378306677,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fenofibrate 145 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,63304044990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fenofibrate 145 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862076990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fenofibrate 145 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,45802013275,NDC,facility,both,1,EA,3.26,2.31,Aetna First Health,Commercial,,2.77,85,,,1.44,2.77,percent of total billed charges,
fenofibrate 145 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714073801,NDC,facility,both,1,EA,4.54,3.21,Aetna First Health,Commercial,,3.86,85,,,2.01,3.86,percent of total billed charges,
fenofibrate 145 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074612390,NDC,facility,both,1,EA,25.85,18.3,Aetna First Health,Commercial,,21.97,85,,,11.46,21.97,percent of total billed charges,
fenofibrate 160 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268031315,NDC,facility,both,1,EA,11.19,7.92,Aetna First Health,Commercial,,9.51,85,,,4.96,9.51,percent of total billed charges,
fenofibrate 48 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084063511,NDC,facility,both,1,EA,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
fenofibrate 48 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687061811,NDC,facility,both,1,EA,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
fenofibrate 48 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079059901,NDC,facility,both,1,EA,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
fenofibrate 48 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079059920,NDC,facility,both,1,EA,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
fenofibrate 48 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084063521,NDC,facility,both,1,EA,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
fenofibrate 48 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687061821,NDC,facility,both,1,EA,4.36,3.09,Aetna First Health,Commercial,,3.71,85,,,1.93,3.71,percent of total billed charges,
fenofibrate 48 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722059590,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fenofibrate 48 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074317390,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fenofibrate 48 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378306577,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fenofibrate 48 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,63304044890,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fenofibrate 48 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180036009,NDC,facility,both,1,EA,5.35,3.79,Aetna First Health,Commercial,,4.55,85,,,2.37,4.55,percent of total billed charges,
fenofibrate 48 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074612290,NDC,facility,both,1,EA,8.62,6.1,Aetna First Health,Commercial,,7.33,85,,,3.82,7.33,percent of total billed charges,
fenofibrate 54 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084082795,NDC,facility,both,1,EA,3.8,2.69,Aetna First Health,Commercial,,3.23,85,,,1.68,3.23,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505701400,NDC,facility,both,1,EA,47.22,33.43,Aetna First Health,Commercial,,40.14,85,,,20.93,40.14,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505700900,NDC,facility,both,1,EA,67.9,48.07,Aetna First Health,Commercial,,57.72,85,,,30.09,57.72,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00406900002,NDC,facility,both,1,EA,96.45,68.29,Aetna First Health,Commercial,,81.98,85,,,42.75,81.98,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00591321454,NDC,facility,both,1,EA,96.46,68.29,Aetna First Health,Commercial,,81.99,85,,,42.75,81.99,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,47781042811,NDC,facility,both,1,EA,110.23,78.04,Aetna First Health,Commercial,,93.7,85,,,48.85,93.7,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00378912416,NDC,facility,both,1,EA,110.24,78.05,Aetna First Health,Commercial,,93.7,85,,,48.86,93.7,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505701402,NDC,facility,both,1,EA,41.32,29.25,Aetna First Health,Commercial,,35.12,85,,,18.31,35.12,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505700902,NDC,facility,both,1,EA,67.9,48.07,Aetna First Health,Commercial,,57.72,85,,,30.09,57.72,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00378912498,NDC,facility,both,1,EA,96.45,68.29,Aetna First Health,Commercial,,81.98,85,,,42.75,81.98,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00591321472,NDC,facility,both,1,EA,96.45,68.29,Aetna First Health,Commercial,,81.98,85,,,42.75,81.98,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406900076,NDC,facility,both,1,EA,96.45,68.29,Aetna First Health,Commercial,,81.98,85,,,42.75,81.98,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406910076,NDC,facility,both,1,EA,96.45,68.29,Aetna First Health,Commercial,,81.98,85,,,42.75,81.98,percent of total billed charges,
fentaNYL 100 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,47781042847,NDC,facility,both,1,EA,110.23,78.04,Aetna First Health,Commercial,,93.7,85,,,48.85,93.7,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 1 Each Box,63700001,CDM,,,250,RC,60505701000,NDC,facility,both,1,EA,56.85,40.25,Aetna First Health,Commercial,,48.32,85,,,25.2,48.32,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00378911916,NDC,facility,both,1,EA,56.84,40.24,Aetna First Health,Commercial,,48.31,85,,,25.19,48.31,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505708000,NDC,facility,both,1,EA,56.84,40.24,Aetna First Health,Commercial,,48.31,85,,,25.19,48.31,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,47781042311,NDC,facility,both,1,EA,64.97,46,Aetna First Health,Commercial,,55.22,85,,,28.79,55.22,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00378911998,NDC,facility,both,1,EA,56.85,40.25,Aetna First Health,Commercial,,48.32,85,,,25.2,48.32,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00781724055,NDC,facility,both,1,EA,56.85,40.25,Aetna First Health,Commercial,,48.32,85,,,25.2,48.32,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406901276,NDC,facility,both,1,EA,56.85,40.25,Aetna First Health,Commercial,,48.32,85,,,25.2,48.32,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505708002,NDC,facility,both,1,EA,56.85,40.25,Aetna First Health,Commercial,,48.32,85,,,25.2,48.32,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406911276,NDC,facility,both,1,EA,56.85,40.25,Aetna First Health,Commercial,,48.32,85,,,25.2,48.32,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505701002,NDC,facility,both,1,EA,56.85,40.25,Aetna First Health,Commercial,,48.32,85,,,25.2,48.32,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,47781042347,NDC,facility,both,1,EA,64.97,46,Aetna First Health,Commercial,,55.22,85,,,28.79,55.22,percent of total billed charges,
fentaNYL 12 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,50458009005,NDC,facility,both,1,EA,131.3,92.96,Aetna First Health,Commercial,,111.6,85,,,58.19,111.6,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505701100,NDC,facility,both,1,EA,12.72,9.01,Aetna First Health,Commercial,,10.81,85,,,5.64,10.81,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505700600,NDC,facility,both,1,EA,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505708100,NDC,facility,both,1,EA,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00378912116,NDC,facility,both,1,EA,24.96,17.67,Aetna First Health,Commercial,,21.22,85,,,11.06,21.22,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,47781042411,NDC,facility,both,1,EA,24.96,17.67,Aetna First Health,Commercial,,21.22,85,,,11.06,21.22,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00591319854,NDC,facility,both,1,EA,28.52,20.19,Aetna First Health,Commercial,,24.24,85,,,12.64,24.24,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505701102,NDC,facility,both,1,EA,12.72,9.01,Aetna First Health,Commercial,,10.81,85,,,5.64,10.81,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505700602,NDC,facility,both,1,EA,15.99,11.32,Aetna First Health,Commercial,,13.59,85,,,7.09,13.59,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505708102,NDC,facility,both,1,EA,15.99,11.32,Aetna First Health,Commercial,,13.59,85,,,7.09,13.59,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505700102,NDC,facility,both,1,EA,18.27,12.94,Aetna First Health,Commercial,,15.53,85,,,8.1,15.53,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00378912198,NDC,facility,both,1,EA,24.96,17.67,Aetna First Health,Commercial,,21.22,85,,,11.06,21.22,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00591319872,NDC,facility,both,1,EA,24.96,17.67,Aetna First Health,Commercial,,21.22,85,,,11.06,21.22,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406902576,NDC,facility,both,1,EA,24.96,17.67,Aetna First Health,Commercial,,21.22,85,,,11.06,21.22,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406912576,NDC,facility,both,1,EA,24.96,17.67,Aetna First Health,Commercial,,21.22,85,,,11.06,21.22,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,47781042447,NDC,facility,both,1,EA,28.52,20.19,Aetna First Health,Commercial,,24.24,85,,,12.64,24.24,percent of total billed charges,
fentaNYL 25 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,50458009105,NDC,facility,both,1,EA,151.07,106.96,Aetna First Health,Commercial,,128.41,85,,,66.95,128.41,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505701200,NDC,facility,both,1,EA,23.33,16.52,Aetna First Health,Commercial,,19.83,85,,,10.34,19.83,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505700700,NDC,facility,both,1,EA,34.3,24.28,Aetna First Health,Commercial,,29.15,85,,,15.2,29.15,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00378912216,NDC,facility,both,1,EA,44.35,31.4,Aetna First Health,Commercial,,37.7,85,,,19.66,37.7,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,47781042611,NDC,facility,both,1,EA,50.64,35.85,Aetna First Health,Commercial,,43.04,85,,,22.44,43.04,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00591321254,NDC,facility,both,1,EA,50.68,35.88,Aetna First Health,Commercial,,43.08,85,,,22.46,43.08,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00591360154,NDC,facility,both,1,EA,50.68,35.88,Aetna First Health,Commercial,,43.08,85,,,22.46,43.08,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505700702,NDC,facility,both,1,EA,34.3,24.28,Aetna First Health,Commercial,,29.15,85,,,15.2,29.15,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505700202,NDC,facility,both,1,EA,39.2,27.75,Aetna First Health,Commercial,,33.32,85,,,17.37,33.32,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00378912298,NDC,facility,both,1,EA,44.33,31.39,Aetna First Health,Commercial,,37.68,85,,,19.65,37.68,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00591321272,NDC,facility,both,1,EA,44.33,31.39,Aetna First Health,Commercial,,37.68,85,,,19.65,37.68,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406905076,NDC,facility,both,1,EA,44.33,31.39,Aetna First Health,Commercial,,37.68,85,,,19.65,37.68,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,47781042647,NDC,facility,both,1,EA,44.33,31.39,Aetna First Health,Commercial,,37.68,85,,,19.65,37.68,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406915076,NDC,facility,both,1,EA,44.33,31.39,Aetna First Health,Commercial,,37.68,85,,,19.65,37.68,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00591360172,NDC,facility,both,1,EA,50.66,35.87,Aetna First Health,Commercial,,43.06,85,,,22.45,43.06,percent of total billed charges,
fentaNYL 50 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,50458009205,NDC,facility,both,1,EA,276.19,195.54,Aetna First Health,Commercial,,234.76,85,,,122.41,234.76,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505701300,NDC,facility,both,1,EA,35.58,25.19,Aetna First Health,Commercial,,30.24,85,,,15.77,30.24,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,60505700800,NDC,facility,both,1,EA,43.3,30.66,Aetna First Health,Commercial,,36.8,85,,,19.19,36.8,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00378912316,NDC,facility,both,1,EA,70.07,49.61,Aetna First Health,Commercial,,59.56,85,,,31.06,59.56,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,00591321354,NDC,facility,both,1,EA,80.08,56.7,Aetna First Health,Commercial,,68.07,85,,,35.49,68.07,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 1 Each Package,63700001,CDM,,,250,RC,47781042711,NDC,facility,both,1,EA,80.08,56.7,Aetna First Health,Commercial,,68.07,85,,,35.49,68.07,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505700802,NDC,facility,both,1,EA,43.3,30.66,Aetna First Health,Commercial,,36.8,85,,,19.19,36.8,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,60505700302,NDC,facility,both,1,EA,49.49,35.04,Aetna First Health,Commercial,,42.07,85,,,21.93,42.07,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00378912398,NDC,facility,both,1,EA,70.07,49.61,Aetna First Health,Commercial,,59.56,85,,,31.06,59.56,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00591321372,NDC,facility,both,1,EA,70.07,49.61,Aetna First Health,Commercial,,59.56,85,,,31.06,59.56,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406907576,NDC,facility,both,1,EA,70.07,49.61,Aetna First Health,Commercial,,59.56,85,,,31.06,59.56,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,00406917576,NDC,facility,both,1,EA,70.07,49.61,Aetna First Health,Commercial,,59.56,85,,,31.06,59.56,percent of total billed charges,
fentaNYL 75 MCG/HR Patch 72 Hour 5 Each Box,63700001,CDM,,,250,RC,47781042747,NDC,facility,both,1,EA,70.07,49.61,Aetna First Health,Commercial,,59.56,85,,,31.06,59.56,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00603017955,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904759160,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00677007001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904759060,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664007001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536589001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00603017929,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904759082,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904759161,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate 325 (65 Fe) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904759182,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate EC 324 (65 Fe) MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00574060811,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate EC 325 (65 Fe) MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,00245010889,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate EC 325 (65 Fe) MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00245010811,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate EC 325 (65 Fe) MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,69367016604,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate EC 325 (65 Fe) MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00245010801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ferrous sulfate EC 325 (65 Fe) MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,69367016620,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
fexofenadine 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45802042578,NDC,facility,both,1,EA,0.86,0.61,Aetna First Health,Commercial,,0.73,85,,,0.38,0.73,percent of total billed charges,
fiber (calcium polycarbophil) 625 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00904250091,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
finasteride 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722052630,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862092730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 1 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00006007131,NDC,facility,both,1,EA,10.74,7.6,Aetna First Health,Commercial,,9.13,85,,,4.76,9.13,percent of total billed charges,
finasteride 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722052690,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862092790,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268031411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687042811,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
finasteride 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268032311,NDC,facility,both,1,EA,3.57,2.53,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
finasteride 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079032101,NDC,facility,both,1,EA,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
finasteride 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084039911,NDC,facility,both,1,EA,6.41,4.54,Aetna First Health,Commercial,,5.45,85,,,2.84,5.45,percent of total billed charges,
finasteride 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729009001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45963050002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00006007258,NDC,facility,both,1,EA,16.29,11.53,Aetna First Health,Commercial,,13.85,85,,,7.22,13.85,percent of total billed charges,
finasteride 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687042801,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
finasteride 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904683061,NDC,facility,both,1,EA,3.61,2.56,Aetna First Health,Commercial,,3.07,85,,,1.6,3.07,percent of total billed charges,
finasteride 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079032120,NDC,facility,both,1,EA,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
finasteride 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084039901,NDC,facility,both,1,EA,6.41,4.54,Aetna First Health,Commercial,,5.45,85,,,2.84,5.45,percent of total billed charges,
finasteride 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729009010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722052530,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093735556,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862014930,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00006007231,NDC,facility,both,1,EA,16.49,11.67,Aetna First Health,Commercial,,14.02,85,,,7.31,14.02,percent of total billed charges,
finasteride 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904683006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268031415,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,60687042865,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268032315,NDC,facility,both,1,EA,3.58,2.53,Aetna First Health,Commercial,,3.04,85,,,1.59,3.04,percent of total billed charges,
finasteride 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862014990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16729009015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
finasteride 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722052590,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flavoxATE 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574011501,NDC,facility,both,1,EA,3.88,2.75,Aetna First Health,Commercial,,3.3,85,,,1.72,3.3,percent of total billed charges,
flecainide 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559038001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054001025,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162064110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054001020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
flecainide 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054001021,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluconazole 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084072811,NDC,facility,both,1,EA,6.55,4.64,Aetna First Health,Commercial,,5.57,85,,,2.9,5.57,percent of total billed charges,
fluconazole 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00172541146,NDC,facility,both,1,EA,6.16,4.36,Aetna First Health,Commercial,,5.24,85,,,2.73,5.24,percent of total billed charges,
fluconazole 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,16714069210,NDC,facility,both,1,EA,9.63,6.82,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
fluconazole 150 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,59762501701,NDC,facility,both,1,EA,8.27,5.86,Aetna First Health,Commercial,,7.03,85,,,3.67,7.03,percent of total billed charges,
flucytosine 500 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687036395,NDC,facility,both,1,EA,548.35,388.23,Aetna First Health,Commercial,,466.1,85,,,243.03,466.1,percent of total billed charges,
flucytosine 500 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687061011,NDC,facility,both,1,EA,548.35,388.23,Aetna First Health,Commercial,,466.1,85,,,243.03,466.1,percent of total billed charges,
flucytosine 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42494034001,NDC,facility,both,1,EA,84.99,60.17,Aetna First Health,Commercial,,72.24,85,,,37.67,72.24,percent of total billed charges,
flucytosine 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,64980018001,NDC,facility,both,1,EA,444.64,314.81,Aetna First Health,Commercial,,377.94,85,,,197.06,377.94,percent of total billed charges,
flucytosine 500 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054042825,NDC,facility,both,1,EA,444.65,314.81,Aetna First Health,Commercial,,377.95,85,,,197.07,377.95,percent of total billed charges,
flucytosine 500 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687036325,NDC,facility,both,1,EA,548.35,388.23,Aetna First Health,Commercial,,466.1,85,,,243.03,466.1,percent of total billed charges,
flucytosine 500 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687061021,NDC,facility,both,1,EA,548.35,388.23,Aetna First Health,Commercial,,466.1,85,,,243.03,466.1,percent of total billed charges,
fludrocortisone 0.1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084028811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268033311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079099701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,50111064701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001039900,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862019201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904578461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079099720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268033315,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884073401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59651030801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111015001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832040211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180099801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378073401,NDC,facility,both,1,EA,4.01,2.84,Aetna First Health,Commercial,,3.41,85,,,1.78,3.41,percent of total billed charges,
FLUoxetine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884033501,NDC,facility,both,1,EA,4.01,2.84,Aetna First Health,Commercial,,3.41,85,,,1.78,3.41,percent of total billed charges,
FLUoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,49884073411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111015030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00832040230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59651030830,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378073493,NDC,facility,both,1,EA,4.01,2.84,Aetna First Health,Commercial,,3.41,85,,,1.78,3.41,percent of total billed charges,
FLUoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093718856,NDC,facility,both,1,EA,4.01,2.84,Aetna First Health,Commercial,,3.41,85,,,1.78,3.41,percent of total billed charges,
FLUoxetine 20 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084060511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268033411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781282201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,50111064801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001040000,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862019301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904578561,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084060501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904734661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268033415,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,50111064802,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 40 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,49884087201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine DR 90 MG CAPSULE DELAYED RELEASE 4 Each Box,63700001,CDM,,,250,RC,55111028448,NDC,facility,both,1,EA,114.35,80.96,Aetna First Health,Commercial,,97.2,85,,,50.68,97.2,percent of total billed charges,
fluPHENAZine 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079048501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238167801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527178801,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
fluPHENAZine 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079048520,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluPHENAZine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079048701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluticasone (Inhalation) 200 MCG/ACT Aerosol Powder Breath Activated 14 Each Disp Pack,63700001,CDM,,,250,RC,00173087614,NDC,facility,both,1,EA,162.82,115.28,Aetna First Health,Commercial,,138.4,85,,,72.16,138.4,percent of total billed charges,
fluticasone-salmeterol 100-50 MCG/ACT Aerosol Powder Breath Activated 14 Each Disp Pack,63700001,CDM,,,250,RC,00173069504,NDC,facility,both,1,EA,56.89,40.28,Aetna First Health,Commercial,,48.36,85,,,25.21,48.36,percent of total billed charges,
fluticasone-salmeterol 250-50 MCG/ACT Aerosol Powder Breath Activated 14 Each Disp Pack,63700001,CDM,,,250,RC,00173069604,NDC,facility,both,1,EA,56.89,40.28,Aetna First Health,Commercial,,48.36,85,,,25.21,48.36,percent of total billed charges,
fluticasone-salmeterol 500-50 MCG/ACT Aerosol Powder Breath Activated 14 Each Disp Pack,63700001,CDM,,,250,RC,00173069704,NDC,facility,both,1,EA,92.73,65.65,Aetna First Health,Commercial,,78.82,85,,,41.1,78.82,percent of total billed charges,
fluvastatin 20 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00378802093,NDC,facility,both,1,EA,14.02,9.93,Aetna First Health,Commercial,,11.92,85,,,6.21,11.92,percent of total billed charges,
fluvastatin XL 80 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078035405,NDC,facility,both,1,EA,37.68,26.68,Aetna First Health,Commercial,,32.03,85,,,16.7,32.03,percent of total billed charges,
fluvastatin XL 80 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00078035415,NDC,facility,both,1,EA,26.24,18.58,Aetna First Health,Commercial,,22.3,85,,,11.63,22.3,percent of total billed charges,
fluvoxaMINE 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559016001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxamine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559015801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
fluvoxaMINE 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079099201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584089711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079010501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584089701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739053710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid 400 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904319760,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
folic acid-vit B6-vit B12 2.5-25-2 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,51991038490,NDC,facility,both,1,EA,1.16,0.82,Aetna First Health,Commercial,,0.99,85,,,0.51,0.99,percent of total billed charges,
folic acid-vit B6-vit B12 2.5-25-2 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69367022409,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
folic acid-vit B6-vit B12 2.5-25-2 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,75834008090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
frovatriptan 2.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,63481002501,NDC,facility,both,1,EA,108.51,76.83,Aetna First Health,Commercial,,92.23,85,,,48.09,92.23,percent of total billed charges,
frovatriptan 2.5 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,69238153909,NDC,facility,both,1,EA,46.67,33.04,Aetna First Health,Commercial,,39.67,85,,,20.68,39.67,percent of total billed charges,
frovatriptan 2.5 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,68462069497,NDC,facility,both,1,EA,99.61,70.52,Aetna First Health,Commercial,,84.67,85,,,44.15,84.67,percent of total billed charges,
frovatriptan 2.5 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,63481002509,NDC,facility,both,1,EA,499.02,353.31,Aetna First Health,Commercial,,424.17,85,,,221.17,424.17,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00039006710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739054110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054829925,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904579761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
furosemide 80 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054830125,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084007911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084059411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084078311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687058011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,53746010101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,67877022201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162010110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714066101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,45963055511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714050301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69097081307,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228266511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,14550051102,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904563161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904607861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084059401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084078301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739059110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904666561,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687058001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00172438110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60505011200,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,53746010105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 100 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,45963055550,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084056311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084076211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 400 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084077411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084062411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084079711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268035111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687050711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084012211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292002401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001000600,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714033001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382020401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762502301,NDC,facility,both,1,EA,6.69,4.74,Aetna First Health,Commercial,,5.69,85,,,2.97,5.69,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739056010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904682361,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687050701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084079701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292002420,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268035115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 600 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,16714033002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
galantamine 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079085201,NDC,facility,both,1,EA,11.17,7.91,Aetna First Health,Commercial,,9.49,85,,,4.95,9.49,percent of total billed charges,
galantamine 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084072911,NDC,facility,both,1,EA,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
galantamine 4 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,63739099933,NDC,facility,both,1,EA,5.3,3.75,Aetna First Health,Commercial,,4.5,85,,,2.35,4.5,percent of total billed charges,
galantamine 4 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,51079085203,NDC,facility,both,1,EA,6.53,4.62,Aetna First Health,Commercial,,5.55,85,,,2.89,5.55,percent of total billed charges,
galantamine 4 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084072921,NDC,facility,both,1,EA,7.06,5,Aetna First Health,Commercial,,6,85,,,3.13,6,percent of total billed charges,
galantamine 4 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,70436000406,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
galantamine 4 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862045860,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
galantamine 4 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,57237004960,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
galantamine 4 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00054009021,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
galantamine 4 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,60505254206,NDC,facility,both,1,EA,8.02,5.68,Aetna First Health,Commercial,,6.82,85,,,3.55,6.82,percent of total billed charges,
galantamine 4 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00378272191,NDC,facility,both,1,EA,8.9,6.3,Aetna First Health,Commercial,,7.56,85,,,3.94,7.56,percent of total billed charges,
galantamine 8 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,65862074430,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
galantamine 8 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00591349630,NDC,facility,both,1,EA,16.04,11.36,Aetna First Health,Commercial,,13.63,85,,,7.11,13.63,percent of total billed charges,
galantamine 8 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,47335083583,NDC,facility,both,1,EA,16.04,11.36,Aetna First Health,Commercial,,13.63,85,,,7.11,13.63,percent of total billed charges,
galantamine 8 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10147089103,NDC,facility,both,1,EA,17.8,12.6,Aetna First Health,Commercial,,15.13,85,,,7.89,15.13,percent of total billed charges,
galantamine 8 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,50458038730,NDC,facility,both,1,EA,33.99,24.06,Aetna First Health,Commercial,,28.89,85,,,15.06,28.89,percent of total billed charges,
gemfibrozil 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084047311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gemfibrozil 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268035011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084078895,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,45802077078,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093725401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729000101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001017700,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,55111032001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084078825,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079042501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084032611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glimepiride 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084032711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079081001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268036111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687069011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591046001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781145201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505014100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079081020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904612461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904663761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687069001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 25 Each Box,63700001,CDM,,,250,RC,51079081019,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268036115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084029511,NDC,facility,both,1,EA,3.96,2.8,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687048011,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687076811,NDC,facility,both,1,EA,5.58,3.95,Aetna First Health,Commercial,,4.74,85,,,2.47,4.74,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00591090030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59762054001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,64980027903,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59651026830,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,16714089401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,68084029521,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
glipiZIDE ER 2.5 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,60687048021,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
glipiZIDE ER 5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084011111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glucosamine sulfate 500 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268037511,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glucosamine sulfate 500 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268037515,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glucosamine sulfate 500 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00904529352,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glucosamine sulfate 500 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,43292055857,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glucosamine sulfate 500 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,54629007870,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glucose-vitamin C 4-6 GM-MG Tablet Chewable 10 Each Box,63700001,CDM,,,250,RC,38396050108,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glyBURIDE 1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093834201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155005601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 1.25 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00093947753,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093943301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079087301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079087320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 1.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378111301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glyBURIDE micronized 1.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253046010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glycerin 1 g Suppository 12 Each Box,63700001,CDM,,,250,RC,58980040912,NDC,facility,both,1,EA,0.74,0.52,Aetna First Health,Commercial,,0.63,85,,,0.33,0.63,percent of total billed charges,
glycerin 1.2 g Suppository 10 Each Box,63700001,CDM,,,250,RC,00713010209,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glycerin 2 g Suppository 1 Each Box,63700001,CDM,,,250,RC,00713010106,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
glycerin 2 g Suppository 10 Each Box,63700001,CDM,,,250,RC,00713010109,NDC,facility,both,1,EA,0.97,0.69,Aetna First Health,Commercial,,0.82,85,,,0.43,0.82,percent of total billed charges,
glycerin 2 g Suppository 12 Each Jar,63700001,CDM,,,250,RC,00132007912,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glycerin 2 g Suppository 24 Each Jar,63700001,CDM,,,250,RC,00132007924,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glycerin 2.1 g Suppository 12 Each Jar,63700001,CDM,,,250,RC,00713010113,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
glycerin 2.1 g Suppository 25 Each Jar,63700001,CDM,,,250,RC,46122022163,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glycopyrrolate 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084049911,NDC,facility,both,1,EA,3.07,2.17,Aetna First Health,Commercial,,2.61,85,,,1.36,2.61,percent of total billed charges,
glycopyrrolate 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687027011,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
glycopyrrolate 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687045811,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884006501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155060601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107001401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315013901,NDC,facility,both,1,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64125013901,NDC,facility,both,1,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084049901,NDC,facility,both,1,EA,3.07,2.17,Aetna First Health,Commercial,,2.61,85,,,1.36,2.61,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687027001,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687045801,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
glycopyrrolate 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904670961,NDC,facility,both,1,EA,3.79,2.68,Aetna First Health,Commercial,,3.22,85,,,1.68,3.22,percent of total billed charges,
glycopyrrolate 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16571074309,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
glycopyrrolate 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42291030390,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68001056116,NDC,facility,both,1,EA,1.13,0.8,Aetna First Health,Commercial,,0.96,85,,,0.5,0.96,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084057211,NDC,facility,both,1,EA,1.25,0.88,Aetna First Health,Commercial,,1.06,85,,,0.55,1.06,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,45802049878,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,46122002878,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,63824000813,NDC,facility,both,1,EA,0.56,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,63824000815,NDC,facility,both,1,EA,0.64,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,68084057201,NDC,facility,both,1,EA,1.25,0.88,Aetna First Health,Commercial,,1.06,85,,,0.55,1.06,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 100 Each Box,63700001,CDM,,,250,RC,00904671839,NDC,facility,both,1,EA,1.34,0.95,Aetna First Health,Commercial,,1.14,85,,,0.59,1.14,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 20 Each Bottle,63700001,CDM,,,250,RC,45802049860,NDC,facility,both,1,EA,0.54,0.38,Aetna First Health,Commercial,,0.46,85,,,0.24,0.46,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,70677004901,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,63824000832,NDC,facility,both,1,EA,0.88,0.62,Aetna First Health,Commercial,,0.75,85,,,0.39,0.75,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 40 Each Bottle,63700001,CDM,,,250,RC,46122002858,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 40 Each Bottle,63700001,CDM,,,250,RC,63824000840,NDC,facility,both,1,EA,0.54,0.38,Aetna First Health,Commercial,,0.46,85,,,0.24,0.46,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 40 Each Box,63700001,CDM,,,250,RC,63824000834,NDC,facility,both,1,EA,0.76,0.54,Aetna First Health,Commercial,,0.65,85,,,0.34,0.65,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 500 Each Bottle,63700001,CDM,,,250,RC,63824000850,NDC,facility,both,1,EA,0.56,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 68 Each Box,63700001,CDM,,,250,RC,63824000886,NDC,facility,both,1,EA,0.66,0.47,Aetna First Health,Commercial,,0.56,85,,,0.29,0.56,percent of total billed charges,
guaiFENesin 600 MG Tablet Extended Release 12 Hour 80 Each Box,63700001,CDM,,,250,RC,68001056117,NDC,facility,both,1,EA,1.13,0.8,Aetna First Health,Commercial,,0.96,85,,,0.5,0.96,percent of total billed charges,
GuanFACINE 1 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228285011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
GuanFACINE 1 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781545101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
GuanFACINE 1 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,24979053301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
GuanFACINE 1 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,63304092401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
GuanFACINE 1 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,60505392701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
GuanFACINE 1 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,54092051302,NDC,facility,both,1,EA,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
haloperidol 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079073301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378035101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832151011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781139101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382040701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079073320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
haloperidol 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781139113,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079007401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084044711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111039801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155000101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084044701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904644061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrALAZINE 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584073311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079077601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084039811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59746038206,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079077620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 12.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084039801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroCHLOROthiazide 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739012810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079077901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406036723,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084010011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406012523,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268040211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687041811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084088411,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746011001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591261201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406012501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664017688,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,52544016101,NDC,facility,both,1,EA,10.42,7.38,Aetna First Health,Commercial,,8.86,85,,,4.62,8.86,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406036762,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084035301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084010001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406012562,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904642161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079077920,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687041801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084088401,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268040815,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268040215,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00591261205,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 10-325 MG Tablet 80 Each Box,63700001,CDM,,,250,RC,68084088409,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079077701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084036811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406012323,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084089511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268040111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687039611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406036523,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746010901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406012301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591320201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603389021,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,27808003501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858020101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664012688,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591217201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079077721,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084036801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406012362,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084089501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079077720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904656761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739032610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904682461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687039601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406036562,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268040115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00591320205,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,53746010905,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00603389028,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,10702018950,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,31722094105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 5-325 MG Tablet 80 Each Box,63700001,CDM,,,250,RC,68084089509,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084060111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406012423,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084086311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268040011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687040711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603389121,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591260501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406012401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107002001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406036662,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406012462,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904642061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687040701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268040015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00603389128,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-ibuprofen 7.5-200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084084111,NDC,facility,both,1,EA,3.82,2.7,Aetna First Health,Commercial,,3.25,85,,,1.69,3.25,percent of total billed charges,
HYDROcodone-ibuprofen 7.5-200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746014501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROcodone-ibuprofen 7.5-200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084022701,NDC,facility,both,1,EA,3.22,2.28,Aetna First Health,Commercial,,2.74,85,,,1.43,2.74,percent of total billed charges,
hydrocortisone 25 MG Suppository 1 Each Blister,63700001,CDM,,,250,RC,00713050306,NDC,facility,both,1,EA,40.25,28.5,Aetna First Health,Commercial,,34.21,85,,,17.84,34.21,percent of total billed charges,
hydrocortisone 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00713050312,NDC,facility,both,1,EA,40.25,28.5,Aetna First Health,Commercial,,34.21,85,,,17.84,34.21,percent of total billed charges,
hydrocortisone 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00574709012,NDC,facility,both,1,EA,40.39,28.6,Aetna First Health,Commercial,,34.33,85,,,17.9,34.33,percent of total billed charges,
hydrocortisone 5 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00115169606,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 5 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00603389919,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 5 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,59762007301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrocortisone 5 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,54505033105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084042311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527135301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 3 MG Suppository 6 Each Box,63700001,CDM,,,250,RC,00574722406,NDC,facility,both,1,EA,34.35,24.32,Aetna First Health,Commercial,,29.2,85,,,15.22,29.2,percent of total billed charges,
HYDROmorphone 4 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59011045401,NDC,facility,both,1,EA,9.43,6.68,Aetna First Health,Commercial,,8.02,85,,,4.18,8.02,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268041211,NDC,facility,both,1,EA,5.17,3.66,Aetna First Health,Commercial,,4.39,85,,,2.29,4.39,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084026911,NDC,facility,both,1,EA,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292001101,NDC,facility,both,1,EA,10.18,7.21,Aetna First Health,Commercial,,8.65,85,,,4.51,8.65,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382009601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63304029601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781599401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238154401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664076188,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43598072101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385014401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378037301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,66993005702,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714075301,NDC,facility,both,1,EA,4.4,3.12,Aetna First Health,Commercial,,3.74,85,,,1.95,3.74,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904704661,NDC,facility,both,1,EA,4.86,3.44,Aetna First Health,Commercial,,4.13,85,,,2.15,4.13,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084026901,NDC,facility,both,1,EA,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904650861,NDC,facility,both,1,EA,10.18,7.21,Aetna First Health,Commercial,,8.65,85,,,4.51,8.65,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739077710,NDC,facility,both,1,EA,12.69,8.98,Aetna First Health,Commercial,,10.79,85,,,5.62,10.79,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904704606,NDC,facility,both,1,EA,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904650806,NDC,facility,both,1,EA,8.28,5.86,Aetna First Health,Commercial,,7.04,85,,,3.67,7.04,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,42292001106,NDC,facility,both,1,EA,10.18,7.21,Aetna First Health,Commercial,,8.65,85,,,4.51,8.65,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,66993005704,NDC,facility,both,1,EA,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
hydroxychloroquine 200 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00591304105,NDC,facility,both,1,EA,10.87,7.7,Aetna First Health,Commercial,,9.24,85,,,4.82,9.24,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084025311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079079601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687066411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702001001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155010501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093506001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714008110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378258601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462035201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084025301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079079620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739048310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine HCl 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084025411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,43199001101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,76439030910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,42192033901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,00574025001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,24486060110,NDC,facility,both,1,EA,3.01,2.13,Aetna First Health,Commercial,,2.56,85,,,1.33,2.56,percent of total billed charges,
hyoscyamine 0.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42192034001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43199001301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51525011201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70156010401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.125 MG Tablet Disintegrating 100 Each Bottle,63700001,CDM,,,250,RC,76439030710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.375 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51525011501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hyoscyamine 0.375 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43199001401,NDC,facility,both,1,EA,4.48,3.17,Aetna First Health,Commercial,,3.81,85,,,1.99,3.81,percent of total billed charges,
hyoscyamine 0.375 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,47781001401,NDC,facility,both,1,EA,4.48,3.17,Aetna First Health,Commercial,,3.81,85,,,1.99,3.81,percent of total billed charges,
hyoscyamine 0.375 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,57629020310,NDC,facility,both,1,EA,4.55,3.22,Aetna First Health,Commercial,,3.87,85,,,2.02,3.87,percent of total billed charges,
ibuprofen 100 MG Tablet Chewable 24 Each Bottle,63700001,CDM,,,250,RC,49348063904,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 100 MG Tablet Chewable 24 Each Bottle,63700001,CDM,,,250,RC,00573017920,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 100 MG Tablet Chewable 24 Each Bottle,63700001,CDM,,,250,RC,46122061762,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 100 MG Tablet Chewable 24 Each Bottle,63700001,CDM,,,250,RC,46122063262,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 100 MG Tablet Chewable 24 Each Bottle,63700001,CDM,,,250,RC,24385054662,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904791559,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896094101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904674759,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904791459,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904791461,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00904791251,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,49348072709,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00904791540,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,50580023006,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,49348070614,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50580023002,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50580011060,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ibuprofen 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084065811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084070311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 600 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584074701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084077211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584074801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884005401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315013301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781176201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64125013301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69584042510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884005501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
imipramine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00781176613,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559051001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228259711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378006901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 1.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43975021710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079086801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indapamide 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079086820,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indinavir 400 MG capsule 180 Each Bottle,63700001,CDM,,,250,RC,00006057362,NDC,facility,both,1,EA,8.88,6.29,Aetna First Health,Commercial,,7.55,85,,,3.94,7.55,percent of total billed charges,
indomethacin 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079019001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268043011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093402901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68462040601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,31722054201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378014301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079019020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indomethacin 25 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268043015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
irbesartan 75 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68180041006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
irbesartan 75 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342004707,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
irbesartan 75 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722072990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
iron heme polypeptide 12 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67181020130,NDC,facility,both,1,EA,0.95,0.67,Aetna First Health,Commercial,,0.81,85,,,0.42,0.81,percent of total billed charges,
iron polysaccharide complex-B12-FA 150-0.025-1 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51991019899,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
iron polysaccharide complex-B12-FA 150-0.025-1 MG capsule 1 Each Box,63700001,CDM,,,250,RC,60258018600,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
iron polysaccharide complex-B12-FA 150-0.025-1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60258018601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
iron polysaccharide complex-B12-FA 150-0.025-1 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51991019811,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
iron polysaccharide complex-B12-FA 50-100 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,51991079890,NDC,facility,both,1,EA,1.46,1.03,Aetna First Health,Commercial,,1.24,85,,,0.65,1.24,percent of total billed charges,
isosorbide dinitrate 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143177101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781169501,NDC,facility,both,1,EA,3.34,2.36,Aetna First Health,Commercial,,2.84,85,,,1.48,2.84,percent of total billed charges,
isosorbide dinitrate 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904634761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884000901,NDC,facility,both,1,EA,3.67,2.6,Aetna First Health,Commercial,,3.12,85,,,1.63,3.12,percent of total billed charges,
isosorbide dinitrate 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268044711,NDC,facility,both,1,EA,3.03,2.15,Aetna First Health,Commercial,,2.58,85,,,1.34,2.58,percent of total billed charges,
isosorbide dinitrate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143176901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781163501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001022300,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001037300,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide dinitrate 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268044715,NDC,facility,both,1,EA,3.03,2.15,Aetna First Health,Commercial,,2.58,85,,,1.34,2.58,percent of total billed charges,
isosorbide mononitrate 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228262011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084043511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084059111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268045111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175012837,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00143223001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,13668010401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742017501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,23155051901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00603411021,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084043501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904644961,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084059101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 30 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268045115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
isosorbide mononitrate CR 60 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084059211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
itraconazole 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268045011,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
itraconazole 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687029995,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
itraconazole 100 MG capsule 20 Each Box,63700001,CDM,,,250,RC,50268045012,NDC,facility,both,1,EA,10.49,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
itraconazole 100 MG capsule 28 Each Disp Pack,63700001,CDM,,,250,RC,10147170007,NDC,facility,both,1,EA,26.05,18.44,Aetna First Health,Commercial,,22.14,85,,,11.55,22.14,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,67877045430,NDC,facility,both,1,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,13668046330,NDC,facility,both,1,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16714074302,NDC,facility,both,1,EA,16.41,11.62,Aetna First Health,Commercial,,13.95,85,,,7.27,13.95,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,10147170003,NDC,facility,both,1,EA,25.98,18.39,Aetna First Health,Commercial,,22.08,85,,,11.51,22.08,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00185055030,NDC,facility,both,1,EA,26.95,19.08,Aetna First Health,Commercial,,22.91,85,,,11.94,22.91,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00378510093,NDC,facility,both,1,EA,44.03,31.17,Aetna First Health,Commercial,,37.43,85,,,19.51,37.43,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,50458029004,NDC,facility,both,1,EA,98.51,69.75,Aetna First Health,Commercial,,83.73,85,,,43.66,83.73,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687029925,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
itraconazole 100 MG capsule 30 Each Box,63700001,CDM,,,250,RC,50458029001,NDC,facility,both,1,EA,71.04,50.3,Aetna First Health,Commercial,,60.38,85,,,31.48,60.38,percent of total billed charges,
ivermectin 3 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,42799080601,NDC,facility,both,1,EA,14.49,10.26,Aetna First Health,Commercial,,12.32,85,,,6.42,12.32,percent of total billed charges,
ivermectin 3 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,00006003220,NDC,facility,both,1,EA,16.29,11.53,Aetna First Health,Commercial,,13.85,85,,,7.22,13.85,percent of total billed charges,
ketorolac 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687010411,NDC,facility,both,1,EA,21.33,15.1,Aetna First Health,Commercial,,18.13,85,,,9.45,18.13,percent of total billed charges,
ketorolac 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093031401,NDC,facility,both,1,EA,3.77,2.67,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
ketorolac 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69543038810,NDC,facility,both,1,EA,3.77,2.67,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
ketorolac 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378113401,NDC,facility,both,1,EA,6.34,4.49,Aetna First Health,Commercial,,5.39,85,,,2.81,5.39,percent of total billed charges,
ketorolac 10 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687010421,NDC,facility,both,1,EA,21.33,15.1,Aetna First Health,Commercial,,18.13,85,,,9.45,18.13,percent of total billed charges,
labetalol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079092801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687011411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687043911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00172436400,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884012201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382079801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001038100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185001001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591060501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001020500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079092820,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904592861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687011401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687043901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00172436410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
labetalol 100 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68001038103,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lacosamide 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687068711,NDC,facility,both,1,EA,10.75,7.61,Aetna First Health,Commercial,,9.14,85,,,4.76,9.14,percent of total billed charges,
lacosamide 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722081360,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lacosamide 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,67877073460,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lacosamide 100 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00131247835,NDC,facility,both,1,EA,64.45,45.63,Aetna First Health,Commercial,,54.78,85,,,28.56,54.78,percent of total billed charges,
lacosamide 100 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,00131247860,NDC,facility,both,1,EA,70.9,50.2,Aetna First Health,Commercial,,60.26,85,,,31.42,60.26,percent of total billed charges,
Lacosamide 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,67877073560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactase 3000 units Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333043025,NDC,facility,both,1,EA,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
lactase 3000 units Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00045008002,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactase 3000 units Tablet 120 Each Bottle,63700001,CDM,,,250,RC,87701028810,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactase 3000 units Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904522452,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Lactase 9000 units Tablet 32 Each Box,63700001,CDM,,,250,RC,00904590887,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactase 9000 units Tablet Chewable 32 Each Bottle,63700001,CDM,,,250,RC,00045093032,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactase 9000 units Tablet Chewable 32 Each Box,63700001,CDM,,,250,RC,46122014866,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactase 9000 units Tablet Chewable 60 Each Bottle,63700001,CDM,,,250,RC,00045093060,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Lactobacillus 0.05-0.05 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333044125,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactobacillus GG capsule 1 Each Blister,63700001,CDM,,,250,RC,49100038164,NDC,facility,both,1,EA,1.54,1.09,Aetna First Health,Commercial,,1.31,85,,,0.68,1.31,percent of total billed charges,
lactobacillus GG capsule 30 Each Box,63700001,CDM,,,250,RC,49100040009,NDC,facility,both,1,EA,0.75,0.53,Aetna First Health,Commercial,,0.64,85,,,0.33,0.64,percent of total billed charges,
lactobacillus GG capsule 30 Each Box,63700001,CDM,,,250,RC,49100036404,NDC,facility,both,1,EA,0.82,0.58,Aetna First Health,Commercial,,0.7,85,,,0.36,0.7,percent of total billed charges,
lactobacillus Packet 1 Each Box,63700001,CDM,,,250,RC,64980014698,NDC,facility,both,1,EA,1.95,1.38,Aetna First Health,Commercial,,1.66,85,,,0.86,1.66,percent of total billed charges,
lactobacillus Packet 1 Each Packet,63700001,CDM,,,250,RC,71351001399,NDC,facility,both,1,EA,5.69,4.03,Aetna First Health,Commercial,,4.84,85,,,2.52,4.84,percent of total billed charges,
lactobacillus Packet 12 Each Box,63700001,CDM,,,250,RC,64980014612,NDC,facility,both,1,EA,1.95,1.38,Aetna First Health,Commercial,,1.66,85,,,0.86,1.66,percent of total billed charges,
lactobacillus Packet 12 Each Box,63700001,CDM,,,250,RC,08290236712,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactobacillus Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333044125,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactobacillus Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536718101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactobacillus Tablet 50 Each Bottle,63700001,CDM,,,250,RC,64980012950,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactobacillus Tablet 50 Each Bottle,63700001,CDM,,,250,RC,10006073033,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lactobacillus Tablet 50 Each Bottle,63700001,CDM,,,250,RC,71351001250,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lamiVUDine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084057811,NDC,facility,both,1,EA,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
lamiVUDine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687036211,NDC,facility,both,1,EA,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
lamiVUDine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687072011,NDC,facility,both,1,EA,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
lamiVUDine 150 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687036221,NDC,facility,both,1,EA,26.25,18.58,Aetna First Health,Commercial,,22.31,85,,,11.63,22.31,percent of total billed charges,
lamiVUDine 150 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904658304,NDC,facility,both,1,EA,26.94,19.07,Aetna First Health,Commercial,,22.9,85,,,11.94,22.9,percent of total billed charges,
lamiVUDine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,64380071003,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamiVUDine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,33342000109,NDC,facility,both,1,EA,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
lamiVUDine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,60505325106,NDC,facility,both,1,EA,13.13,9.3,Aetna First Health,Commercial,,11.16,85,,,5.82,11.16,percent of total billed charges,
lamiVUDine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68180060207,NDC,facility,both,1,EA,20.05,14.2,Aetna First Health,Commercial,,17.04,85,,,8.89,17.04,percent of total billed charges,
lamiVUDine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862055260,NDC,facility,both,1,EA,20.89,14.79,Aetna First Health,Commercial,,17.76,85,,,9.26,17.76,percent of total billed charges,
lamiVUDine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00173047001,NDC,facility,both,1,EA,22.26,15.76,Aetna First Health,Commercial,,18.92,85,,,9.87,18.92,percent of total billed charges,
lamiVUDine 150 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,49702020318,NDC,facility,both,1,EA,24.25,17.17,Aetna First Health,Commercial,,20.61,85,,,10.75,20.61,percent of total billed charges,
lamiVUDine-zidovudine 150-300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084041695,NDC,facility,both,1,EA,37.35,26.44,Aetna First Health,Commercial,,31.75,85,,,16.55,31.75,percent of total billed charges,
lamiVUDine-zidovudine 150-300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084041625,NDC,facility,both,1,EA,37.33,26.43,Aetna First Health,Commercial,,31.73,85,,,16.54,31.73,percent of total billed charges,
lamiVUDine-zidovudine 150-300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722050660,NDC,facility,both,1,EA,7.79,5.52,Aetna First Health,Commercial,,6.62,85,,,3.45,6.62,percent of total billed charges,
lamiVUDine-zidovudine 150-300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093538506,NDC,facility,both,1,EA,22.61,16.01,Aetna First Health,Commercial,,19.22,85,,,10.02,19.22,percent of total billed charges,
lamiVUDine-zidovudine 150-300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862059760,NDC,facility,both,1,EA,43.17,30.56,Aetna First Health,Commercial,,36.69,85,,,19.13,36.69,percent of total billed charges,
lamiVUDine-zidovudine 150-300 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,49702020218,NDC,facility,both,1,EA,52.58,37.23,Aetna First Health,Commercial,,44.69,85,,,23.3,44.69,percent of total billed charges,
lamoTRIgine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084031911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739051610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084032011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00173064460,NDC,facility,both,1,EA,42.9,30.37,Aetna First Health,Commercial,,36.46,85,,,19.01,36.46,percent of total billed charges,
lamoTRIgine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079049801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084031811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093003901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382000601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300011101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097014807,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378425101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714070001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672413001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59746024501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079049820,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084031801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739067010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904700761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 5 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00093068801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lamoTRIgine chewable 5 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,68462022801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lansoprazole 15 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,55111039830,NDC,facility,both,1,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
lansoprazole 15 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,68001011104,NDC,facility,both,1,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
leflunomide 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268047711,NDC,facility,both,1,EA,8.66,6.13,Aetna First Health,Commercial,,7.36,85,,,3.84,7.36,percent of total billed charges,
leflunomide 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,23155004303,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
leflunomide 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70710115703,NDC,facility,both,1,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
leflunomide 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505250201,NDC,facility,both,1,EA,9.33,6.61,Aetna First Health,Commercial,,7.93,85,,,4.14,7.93,percent of total billed charges,
leflunomide 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00955173530,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
leflunomide 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332006130,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
leflunomide 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13811067730,NDC,facility,both,1,EA,17.72,12.55,Aetna First Health,Commercial,,15.06,85,,,7.85,15.06,percent of total billed charges,
leflunomide 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00088216030,NDC,facility,both,1,EA,174.36,123.45,Aetna First Health,Commercial,,148.21,85,,,77.28,148.21,percent of total billed charges,
leflunomide 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268047715,NDC,facility,both,1,EA,8.66,6.13,Aetna First Health,Commercial,,7.36,85,,,3.84,7.36,percent of total billed charges,
leflunomide 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505250301,NDC,facility,both,1,EA,9.68,6.85,Aetna First Health,Commercial,,8.23,85,,,4.29,8.23,percent of total billed charges,
levETIRAcetam 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904605161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084085901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739079510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68180011216,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,31722053612,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68001040207,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,50474059440,NDC,facility,both,1,EA,19.84,14.05,Aetna First Health,Commercial,,16.86,85,,,8.79,16.86,percent of total billed charges,
levETIRAcetam 250 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268046715,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268047215,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 250 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180011209,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084087001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 750 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084033811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levOCARNitine 330 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,64980013097,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levOCARNitine 330 MG Tablet 90 Each Box,63700001,CDM,,,250,RC,64980013009,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levOCARNitine 330 MG Tablet 90 Each Box,63700001,CDM,,,250,RC,50383017290,NDC,facility,both,1,EA,3.07,2.17,Aetna First Health,Commercial,,2.61,85,,,1.36,2.61,percent of total billed charges,
levOCARNitine 330 MG Tablet 90 Each Box,63700001,CDM,,,250,RC,70954049210,NDC,facility,both,1,EA,3.07,2.17,Aetna First Health,Commercial,,2.61,85,,,1.36,2.61,percent of total billed charges,
levOCARNitine 330 MG Tablet 90 Each Box,63700001,CDM,,,250,RC,54482014407,NDC,facility,both,1,EA,4.28,3.03,Aetna First Health,Commercial,,3.64,85,,,1.9,3.64,percent of total billed charges,
levoFLOXacin 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084048111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084048101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904635161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458092010,NDC,facility,both,1,EA,83.46,59.09,Aetna First Health,Commercial,,70.94,85,,,36.99,70.94,percent of total billed charges,
levoFLOXacin 250 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,65862053650,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,68180024008,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,55111027950,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,33342002108,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,31722072150,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 250 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,50458092050,NDC,facility,both,1,EA,83.46,59.09,Aetna First Health,Commercial,,70.94,85,,,36.99,70.94,percent of total billed charges,
levoFLOXacin 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084048211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levoFLOXacin 750 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084048311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,00536114263,NDC,facility,both,1,EA,11.31,8.01,Aetna First Health,Commercial,,9.61,85,,,5.01,9.61,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,68180085211,NDC,facility,both,1,EA,20.25,14.34,Aetna First Health,Commercial,,17.21,85,,,8.97,17.21,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,62756071860,NDC,facility,both,1,EA,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,62756072060,NDC,facility,both,1,EA,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,16714080901,NDC,facility,both,1,EA,40.41,28.61,Aetna First Health,Commercial,,34.35,85,,,17.91,34.35,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,52544006554,NDC,facility,both,1,EA,43.88,31.07,Aetna First Health,Commercial,,37.3,85,,,19.45,37.3,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,69536016288,NDC,facility,both,1,EA,43.88,31.07,Aetna First Health,Commercial,,37.3,85,,,19.45,37.3,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,68180085313,NDC,facility,both,1,EA,43.88,31.07,Aetna First Health,Commercial,,37.3,85,,,19.45,37.3,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Package,63700001,CDM,,,250,RC,51285016288,NDC,facility,both,1,EA,48.75,34.52,Aetna First Health,Commercial,,41.44,85,,,21.61,41.44,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Package,63700001,CDM,,,250,RC,51285014619,NDC,facility,both,1,EA,48.75,34.52,Aetna First Health,Commercial,,41.44,85,,,21.61,41.44,percent of total billed charges,
levonorgestrel 1.5 MG Tablet 1 Each Package,63700001,CDM,,,250,RC,51285094288,NDC,facility,both,1,EA,113.75,80.54,Aetna First Health,Commercial,,96.69,85,,,50.41,96.69,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378180901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180096901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079044220,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687049701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904695361,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00074662411,NDC,facility,both,1,EA,5.52,3.91,Aetna First Health,Commercial,,4.69,85,,,2.45,4.69,percent of total billed charges,
levothyroxine 100 MCG Tablet 30 Each Box,63700001,CDM,,,250,RC,72305010030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518492,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378180977,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 100 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074662490,NDC,facility,both,1,EA,5.52,3.91,Aetna First Health,Commercial,,4.69,85,,,2.45,4.69,percent of total billed charges,
levothyroxine 125 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00074706811,NDC,facility,both,1,EA,3.76,2.66,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
levothyroxine 150 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079044501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 150 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00074706911,NDC,facility,both,1,EA,5.52,3.91,Aetna First Health,Commercial,,4.69,85,,,2.45,4.69,percent of total billed charges,
levothyroxine 175 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074707090,NDC,facility,both,1,EA,5.51,3.9,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
lidocaine 5 % Patch 1 Each Box,63700001,CDM,,,250,RC,00591352511,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
lidocaine 5 % Patch 1 Each Box,63700001,CDM,,,250,RC,00603188010,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
lidocaine 5 % Patch 1 Each Package,63700001,CDM,,,250,RC,65162079104,NDC,facility,both,1,EA,8.79,6.22,Aetna First Health,Commercial,,7.47,85,,,3.9,7.47,percent of total billed charges,
lidocaine 5 % Patch 1 Each Package,63700001,CDM,,,250,RC,00591267911,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
lidocaine 5 % Patch 1 Each Package,63700001,CDM,,,250,RC,00378905516,NDC,facility,both,1,EA,32.88,23.28,Aetna First Health,Commercial,,27.95,85,,,14.57,27.95,percent of total billed charges,
lidocaine 5 % Patch 1 Each Package,63700001,CDM,,,250,RC,61959000101,NDC,facility,both,1,EA,92.77,65.68,Aetna First Health,Commercial,,78.85,85,,,41.12,78.85,percent of total billed charges,
lidocaine 5 % Patch 1 Each Package,63700001,CDM,,,250,RC,63481068701,NDC,facility,both,1,EA,92.79,65.7,Aetna First Health,Commercial,,78.87,85,,,41.12,78.87,percent of total billed charges,
lidocaine 5 % Patch 30 Each Box,63700001,CDM,,,250,RC,42858011830,NDC,facility,both,1,EA,7.58,5.37,Aetna First Health,Commercial,,6.44,85,,,3.36,6.44,percent of total billed charges,
lidocaine 5 % Patch 30 Each Box,63700001,CDM,,,250,RC,00591352530,NDC,facility,both,1,EA,10.48,7.42,Aetna First Health,Commercial,,8.91,85,,,4.64,8.91,percent of total billed charges,
lidocaine 5 % Patch 30 Each Box,63700001,CDM,,,250,RC,00603188016,NDC,facility,both,1,EA,10.48,7.42,Aetna First Health,Commercial,,8.91,85,,,4.64,8.91,percent of total billed charges,
lidocaine 5 % Patch 30 Each Box,63700001,CDM,,,250,RC,00378905593,NDC,facility,both,1,EA,28.77,20.37,Aetna First Health,Commercial,,24.45,85,,,12.75,24.45,percent of total billed charges,
lidocaine 5 % Patch 30 Each Box,63700001,CDM,,,250,RC,63481068706,NDC,facility,both,1,EA,92.79,65.7,Aetna First Health,Commercial,,78.87,85,,,41.12,78.87,percent of total billed charges,
lifitegrast 5 % Solution 5 Each Plas Cont,63700001,CDM,,,250,RC,54092060601,NDC,facility,both,1,EA,36.9,26.13,Aetna First Health,Commercial,,31.36,85,,,16.35,31.36,percent of total billed charges,
linaclotide 72 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00456120330,NDC,facility,both,1,EA,63.11,44.68,Aetna First Health,Commercial,,53.64,85,,,27.97,53.64,percent of total billed charges,
linagliptin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00597014030,NDC,facility,both,1,EA,61.26,43.37,Aetna First Health,Commercial,,52.07,85,,,27.15,52.07,percent of total billed charges,
linezolid 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,67877041933,NDC,facility,both,1,EA,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
linezolid 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68462029111,NDC,facility,both,1,EA,20.56,14.56,Aetna First Health,Commercial,,17.48,85,,,9.11,17.48,percent of total billed charges,
linezolid 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687030911,NDC,facility,both,1,EA,21.58,15.28,Aetna First Health,Commercial,,18.34,85,,,9.56,18.34,percent of total billed charges,
linezolid 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687018911,NDC,facility,both,1,EA,21.58,15.28,Aetna First Health,Commercial,,18.34,85,,,9.56,18.34,percent of total billed charges,
linezolid 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292000801,NDC,facility,both,1,EA,21.6,15.29,Aetna First Health,Commercial,,18.36,85,,,9.57,18.36,percent of total billed charges,
linezolid 600 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093824419,NDC,facility,both,1,EA,514.28,364.11,Aetna First Health,Commercial,,437.14,85,,,227.93,437.14,percent of total billed charges,
linezolid 600 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,67877041920,NDC,facility,both,1,EA,9.63,6.82,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
linezolid 600 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,31722074920,NDC,facility,both,1,EA,20.56,14.56,Aetna First Health,Commercial,,17.48,85,,,9.11,17.48,percent of total billed charges,
linezolid 600 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,60505436202,NDC,facility,both,1,EA,28.44,20.14,Aetna First Health,Commercial,,24.17,85,,,12.6,24.17,percent of total billed charges,
linezolid 600 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00093824434,NDC,facility,both,1,EA,488.88,346.13,Aetna First Health,Commercial,,415.55,85,,,216.67,415.55,percent of total billed charges,
linezolid 600 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00093824434,NDC,facility,both,1,EA,514.28,364.11,Aetna First Health,Commercial,,437.14,85,,,227.93,437.14,percent of total billed charges,
linezolid 600 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00009513502,NDC,facility,both,1,EA,595.23,421.42,Aetna First Health,Commercial,,505.95,85,,,263.81,505.95,percent of total billed charges,
linezolid 600 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,59762130702,NDC,facility,both,1,EA,25.28,17.9,Aetna First Health,Commercial,,21.49,85,,,11.2,21.49,percent of total billed charges,
linezolid 600 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,67877041984,NDC,facility,both,1,EA,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
linezolid 600 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60505436203,NDC,facility,both,1,EA,20.56,14.56,Aetna First Health,Commercial,,17.48,85,,,9.11,17.48,percent of total billed charges,
linezolid 600 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687030921,NDC,facility,both,1,EA,21.58,15.28,Aetna First Health,Commercial,,18.34,85,,,9.56,18.34,percent of total billed charges,
linezolid 600 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,42292000803,NDC,facility,both,1,EA,21.58,15.28,Aetna First Health,Commercial,,18.34,85,,,9.56,18.34,percent of total billed charges,
linezolid 600 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904655304,NDC,facility,both,1,EA,21.67,15.34,Aetna First Health,Commercial,,18.42,85,,,9.6,18.42,percent of total billed charges,
linezolid 600 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00009513503,NDC,facility,both,1,EA,531.46,376.27,Aetna First Health,Commercial,,451.74,85,,,235.54,451.74,percent of total billed charges,
liothyronine 5 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574022001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 5 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60793011501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 5 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762120601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 5 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378361101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
liothyronine 5 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51862032001,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
liothyronine 5 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42794001812,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lipase-protease-amylase 10000-32000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00023611001,NDC,facility,both,1,EA,13.17,9.32,Aetna First Health,Commercial,,11.19,85,,,5.84,11.19,percent of total billed charges,
lipase-protease-amylase 10000-32000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,73562011001,NDC,facility,both,1,EA,14.29,10.12,Aetna First Health,Commercial,,12.15,85,,,6.33,12.15,percent of total billed charges,
lipase-protease-amylase 5000-24000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,42865030002,NDC,facility,both,1,EA,3.84,2.72,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
lipase-protease-amylase 5000-24000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00023611501,NDC,facility,both,1,EA,6.66,4.72,Aetna First Health,Commercial,,5.66,85,,,2.95,5.66,percent of total billed charges,
lipase-protease-amylase 5000-24000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,73562011501,NDC,facility,both,1,EA,7.23,5.12,Aetna First Health,Commercial,,6.15,85,,,3.2,6.15,percent of total billed charges,
lisdexamfetamine 30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59417010310,NDC,facility,both,1,EA,45.24,32.03,Aetna First Health,Commercial,,38.45,85,,,20.05,38.45,percent of total billed charges,
lisinopril 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079098201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084019711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739034910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904580861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084076595,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687065611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084076511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185002501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378207201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591040501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729019401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180051201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547035110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729037501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001033200,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185060201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084076521,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084076525,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687065621,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 2.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68180051202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084019911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084019901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 40 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079098420,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084019611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril-hydroCHLOROthiazide 10-12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180051801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril-hydroCHLOROthiazide 20-12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180051901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lisinopril-hydroCHLOROthiazide 20-12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591086101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054252625,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00143318801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68462022001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,31722054401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00054852625,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium 300 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054852825,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084064011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,51079018001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00054002125,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68462022301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,64980020501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,51079018020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084064001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 300 MG Tablet Extended Release 500 Each Bottle,63700001,CDM,,,250,RC,00054002129,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 450 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084065511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 450 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,51079014201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 450 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00054002025,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 450 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68462022401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 450 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084065501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lithium CR 450 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,51079014220,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 2 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079069001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 2 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687022911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093031101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378210001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 2 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42799060501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 2 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079069020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loperamide 2 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687022901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lopinavir-ritonavir 200-50 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,31722055612,NDC,facility,both,1,EA,25.81,18.27,Aetna First Health,Commercial,,21.94,85,,,11.44,21.94,percent of total billed charges,
lopinavir-ritonavir 200-50 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00074679922,NDC,facility,both,1,EA,29.87,21.15,Aetna First Health,Commercial,,25.39,85,,,13.24,25.39,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 10 Each Box,63700001,CDM,,,250,RC,51660072411,NDC,facility,both,1,EA,0.72,0.51,Aetna First Health,Commercial,,0.61,85,,,0.32,0.61,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 10 Each Box,63700001,CDM,,,250,RC,00904583315,NDC,facility,both,1,EA,1.13,0.8,Aetna First Health,Commercial,,0.96,85,,,0.5,0.96,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 10 Each Box,63700001,CDM,,,250,RC,46122016752,NDC,facility,both,1,EA,1.16,0.82,Aetna First Health,Commercial,,0.99,85,,,0.51,0.99,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 15 Each Box,63700001,CDM,,,250,RC,51660072415,NDC,facility,both,1,EA,0.72,0.51,Aetna First Health,Commercial,,0.61,85,,,0.32,0.61,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 15 Each Box,63700001,CDM,,,250,RC,00904583348,NDC,facility,both,1,EA,1.04,0.74,Aetna First Health,Commercial,,0.88,85,,,0.46,0.88,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 15 Each Box,63700001,CDM,,,250,RC,11523716103,NDC,facility,both,1,EA,1.47,1.04,Aetna First Health,Commercial,,1.25,85,,,0.65,1.25,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 15 Each Box,63700001,CDM,,,250,RC,41100080289,NDC,facility,both,1,EA,1.47,1.04,Aetna First Health,Commercial,,1.25,85,,,0.65,1.25,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 15 Each Box,63700001,CDM,,,250,RC,11523433203,NDC,facility,both,1,EA,2.03,1.44,Aetna First Health,Commercial,,1.73,85,,,0.9,1.73,percent of total billed charges,
loratadine-pseudoephedrine 10-240 MG Tablet Extended Release 24 Hour 15 Each Box,63700001,CDM,,,250,RC,41100081088,NDC,facility,both,1,EA,2.03,1.44,Aetna First Health,Commercial,,1.73,85,,,0.9,1.73,percent of total billed charges,
loratadine-pseudoephedrine 5-120 MG Tablet Extended Release 12 Hour 10 Each Box,63700001,CDM,,,250,RC,41100080208,NDC,facility,both,1,EA,1.81,1.28,Aetna First Health,Commercial,,1.54,85,,,0.8,1.54,percent of total billed charges,
loratadine-pseudoephedrine 5-120 MG Tablet Extended Release 12 Hour 12 Each Box,63700001,CDM,,,250,RC,00573266012,NDC,facility,both,1,EA,0.84,0.59,Aetna First Health,Commercial,,0.71,85,,,0.37,0.71,percent of total billed charges,
loratadine-pseudoephedrine 5-120 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,45802012260,NDC,facility,both,1,EA,3.28,2.32,Aetna First Health,Commercial,,2.79,85,,,1.45,2.79,percent of total billed charges,
loratadine-pseudoephedrine 5-120 MG Tablet Extended Release 12 Hour 24 Each Box,63700001,CDM,,,250,RC,00573266024,NDC,facility,both,1,EA,0.74,0.52,Aetna First Health,Commercial,,0.63,85,,,0.33,0.63,percent of total billed charges,
LORazepam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079041701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084041211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084073611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687040111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687062711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591024001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904600760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69315090401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64125090401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781540401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781537101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00187006301,NDC,facility,both,1,EA,119.88,84.88,Aetna First Health,Commercial,,101.9,85,,,53.13,101.9,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079041720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904598061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739049910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084041201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084073601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904600761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687062701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00781537105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,69315090405,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00591024005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,13107008305,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,63304077205,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 0.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00781540405,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084041311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084074211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781537701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
LORazepam 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739050010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084034611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268051611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268050411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084034601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904639161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739067310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268051615,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093736498,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505316009,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862020190,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180021009,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382013516,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722070090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,58657061090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180037609,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781570092,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00603422402,NDC,facility,both,1,EA,4.71,3.33,Aetna First Health,Commercial,,4,85,,,2.09,4,percent of total billed charges,
losartan 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00006095154,NDC,facility,both,1,EA,9.7,6.87,Aetna First Health,Commercial,,8.24,85,,,4.3,8.24,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714022501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00781520731,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714022502,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505291709,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180021709,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781520792,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,43547042409,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 100-25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00006074754,NDC,facility,both,1,EA,17.42,12.33,Aetna First Health,Commercial,,14.81,85,,,7.72,14.81,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268051311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093736756,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505291503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00781520631,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714022602,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180021509,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781520692,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
losartan-hydroCHLOROthiazide 50-12.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,43547042309,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084055811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185007001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180046701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001031400,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084055801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68001021306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093092606,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lovastatin 10 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68180046707,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591036901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527139401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
loxapine 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,10135058501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lubiprostone 24 MCG capsule 1 Each Blister,63700001,CDM,,,250,RC,69339016398,NDC,facility,both,1,EA,45.94,32.53,Aetna First Health,Commercial,,39.05,85,,,20.36,39.05,percent of total billed charges,
lubiprostone 24 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,65162084206,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
lubiprostone 24 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00254302902,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
lubiprostone 24 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00480413806,NDC,facility,both,1,EA,6.17,4.37,Aetna First Health,Commercial,,5.24,85,,,2.73,5.24,percent of total billed charges,
lubiprostone 24 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,64764024060,NDC,facility,both,1,EA,21.65,15.33,Aetna First Health,Commercial,,18.4,85,,,9.6,18.4,percent of total billed charges,
lubiprostone 8 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00254302802,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
lubiprostone 8 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,65162084106,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
lubiprostone 8 MCG capsule 60 Each Bottle,63700001,CDM,,,250,RC,64764008060,NDC,facility,both,1,EA,21.65,15.33,Aetna First Health,Commercial,,18.4,85,,,9.6,18.4,percent of total billed charges,
lumateperone tosylate 42 MG capsule 10 Each Blister,63700001,CDM,,,250,RC,72060014201,NDC,facility,both,1,EA,154,109.03,Aetna First Health,Commercial,,130.9,85,,,68.25,130.9,percent of total billed charges,
lumateperone tosylate 42 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,72060014240,NDC,facility,both,1,EA,193.87,137.26,Aetna First Health,Commercial,,164.79,85,,,85.92,164.79,percent of total billed charges,
magnesium chloride 64 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,68585000575,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium chloride 64 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,10006070013,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,64980033990,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68585000698,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739035410,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,10006070028,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,64980033901,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68585000641,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,60258017101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,64980033912,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68585000612,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,57896063412,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,10006073038,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
magnesium oxide 400 (240 Mg) MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,40985027072,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084049011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268052211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687077511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536101701,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69618002701,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536117801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meclizine 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884003401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084049001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904651661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 12.5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268052215,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meclizine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079009001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762374202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555087202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762374001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
medroxyPROGESTERone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762005501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Melatonin 1 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,74312002832,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Melatonin 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00536111411,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Melatonin 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,10006073051,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Melatonin 1 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,80681004100,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Melatonin 10 MG SL Tab 100 Each Bottle,63700001,CDM,,,250,RC,87701042634,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268052411,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333051625,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68094011059,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50035061502,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
melatonin 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,16571087290,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
melatonin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,87701040813,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,30768048678,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 200 Each Bottle,63700001,CDM,,,250,RC,07610022640,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268052415,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904518206,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,20555003600,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904518252,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00536641268,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,80681008600,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,51991001406,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,57896086406,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,80681008500,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 3 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00536641208,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333052025,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268053311,NDC,facility,both,1,EA,0.58,0.41,Aetna First Health,Commercial,,0.49,85,,,0.26,0.49,percent of total billed charges,
melatonin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,87701040814,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333052010,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,20555003901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
melatonin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50035061503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
melatonin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,10006073040,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,30768015745,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00536109811,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,80681004001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
melatonin-pyridoxine 1-10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,47469000465,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
meloxicam 7.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268052511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 7.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079045701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382005001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180050101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00597002901,NDC,facility,both,1,EA,22.15,15.68,Aetna First Health,Commercial,,18.83,85,,,9.82,18.83,percent of total billed charges,
meloxicam 7.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079045720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 7.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739070110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meloxicam 7.5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268052515,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00456321011,NDC,facility,both,1,EA,19.78,14,Aetna First Health,Commercial,,16.81,85,,,8.77,16.81,percent of total billed charges,
memantine 14 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904673661,NDC,facility,both,1,EA,11.92,8.44,Aetna First Health,Commercial,,10.13,85,,,5.28,10.13,percent of total billed charges,
memantine 14 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,65162078303,NDC,facility,both,1,EA,4.66,3.3,Aetna First Health,Commercial,,3.96,85,,,2.07,3.96,percent of total billed charges,
memantine 14 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59651040530,NDC,facility,both,1,EA,4.66,3.3,Aetna First Health,Commercial,,3.96,85,,,2.07,3.96,percent of total billed charges,
memantine 14 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,70436005504,NDC,facility,both,1,EA,4.84,3.43,Aetna First Health,Commercial,,4.11,85,,,2.15,4.11,percent of total billed charges,
memantine 14 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10370034711,NDC,facility,both,1,EA,13.37,9.47,Aetna First Health,Commercial,,11.36,85,,,5.93,11.36,percent of total billed charges,
memantine 28 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00456342833,NDC,facility,both,1,EA,54.22,38.39,Aetna First Health,Commercial,,46.09,85,,,24.03,46.09,percent of total billed charges,
memantine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00591387045,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687017311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292000501,NDC,facility,both,1,EA,3.96,2.8,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
memantine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00456320511,NDC,facility,both,1,EA,25.94,18.37,Aetna First Health,Commercial,,22.05,85,,,11.5,22.05,percent of total billed charges,
memantine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904650561,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00456320563,NDC,facility,both,1,EA,25.94,18.37,Aetna First Health,Commercial,,22.05,85,,,11.5,22.05,percent of total billed charges,
memantine 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904650506,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,42292000506,NDC,facility,both,1,EA,3.96,2.8,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
memantine 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,47335032186,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00591387060,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00832111260,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,33342029709,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,55111059660,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
memantine 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00456320560,NDC,facility,both,1,EA,19.78,14,Aetna First Health,Commercial,,16.81,85,,,8.77,16.81,percent of total billed charges,
memantine 5 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,60687017357,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meperidine 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555038102,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meperidine 50 MG Tablet 25 Each Disp Pack,63700001,CDM,,,250,RC,00054859511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
meperidine 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42806005030,NDC,facility,both,1,EA,130.51,92.4,Aetna First Health,Commercial,,110.93,85,,,57.84,110.93,percent of total billed charges,
mesalamine 1000 MG Suppository 1 Each Blister,63700001,CDM,,,250,RC,59762011801,NDC,facility,both,1,EA,19.74,13.98,Aetna First Health,Commercial,,16.78,85,,,8.75,16.78,percent of total billed charges,
mesalamine 1000 MG Suppository 30 Each Box,63700001,CDM,,,250,RC,59762011803,NDC,facility,both,1,EA,19.74,13.98,Aetna First Health,Commercial,,16.78,85,,,8.75,16.78,percent of total billed charges,
mesalamine 1000 MG Suppository 30 Each Box,63700001,CDM,,,250,RC,69918056030,NDC,facility,both,1,EA,21.69,15.36,Aetna First Health,Commercial,,18.44,85,,,9.61,18.44,percent of total billed charges,
mesalamine 1000 MG Suppository 30 Each Box,63700001,CDM,,,250,RC,58914050156,NDC,facility,both,1,EA,94.56,66.95,Aetna First Health,Commercial,,80.38,85,,,41.91,80.38,percent of total billed charges,
mesalamine 1000 MG Suppository 30 Each Box,63700001,CDM,,,250,RC,58914050156,NDC,facility,both,1,EA,154.9,109.67,Aetna First Health,Commercial,,131.66,85,,,68.65,131.66,percent of total billed charges,
mesalamine 500 MG Capsule Extended Release 120 Each Bottle,63700001,CDM,,,250,RC,54092019112,NDC,facility,both,1,EA,21.25,15.05,Aetna First Health,Commercial,,18.06,85,,,9.42,18.06,percent of total billed charges,
mesalamine EC 400 MG CAPSULE DELAYED RELEASE 1 Each Blister,63700001,CDM,,,250,RC,60687055633,NDC,facility,both,1,EA,24.29,17.2,Aetna First Health,Commercial,,20.65,85,,,10.77,20.65,percent of total billed charges,
mesalamine EC 400 MG CAPSULE DELAYED RELEASE 180 Each Bottle,63700001,CDM,,,250,RC,59762011701,NDC,facility,both,1,EA,8.15,5.77,Aetna First Health,Commercial,,6.93,85,,,3.61,6.93,percent of total billed charges,
mesalamine EC 400 MG CAPSULE DELAYED RELEASE 180 Each Bottle,63700001,CDM,,,250,RC,00430075327,NDC,facility,both,1,EA,9.62,6.81,Aetna First Health,Commercial,,8.18,85,,,4.26,8.18,percent of total billed charges,
mesalamine EC 400 MG CAPSULE DELAYED RELEASE 180 Each Bottle,63700001,CDM,,,250,RC,00093590786,NDC,facility,both,1,EA,11.73,8.3,Aetna First Health,Commercial,,9.97,85,,,5.2,9.97,percent of total billed charges,
mesalamine EC 400 MG CAPSULE DELAYED RELEASE 180 Each Bottle,63700001,CDM,,,250,RC,00023585318,NDC,facility,both,1,EA,13.58,9.61,Aetna First Health,Commercial,,11.54,85,,,6.02,11.54,percent of total billed charges,
mesalamine EC 400 MG CAPSULE DELAYED RELEASE 20 Each Box,63700001,CDM,,,250,RC,60687055632,NDC,facility,both,1,EA,24.29,17.2,Aetna First Health,Commercial,,20.65,85,,,10.77,20.65,percent of total billed charges,
metaxalone 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64720012610,NDC,facility,both,1,EA,17.93,12.69,Aetna First Health,Commercial,,15.24,85,,,7.95,15.24,percent of total billed charges,
metFORMIN 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584025911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079017201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687015511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862000801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382002801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155010201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664039751,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382075801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877056101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70010006301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093104801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584025901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079017220,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904632661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739064010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687015501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904668961,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904716261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382002805,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65862000805,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382075805,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 500 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862000890,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN 850 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584033211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084007211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268053111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687064011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268055011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,60505026001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62756014201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51224000750,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,70010049101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,67877015901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,67877041301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,53746017801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904579461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084007201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687064001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268053115,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268055015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,62756014202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,70010049105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,49483062350,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,51224000760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metFORMIN-XR 500 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,75834050005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687021411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406575523,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406575501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054457025,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054855324,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406575562,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687021401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054070920,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methazolAMIDE 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559024001,NDC,facility,both,1,EA,5.58,3.95,Aetna First Health,Commercial,,4.74,85,,,2.47,4.74,percent of total billed charges,
methazolAMIDE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781107101,NDC,facility,both,1,EA,21.46,15.19,Aetna First Health,Commercial,,18.24,85,,,9.51,18.24,percent of total billed charges,
methazolAMIDE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574079101,NDC,facility,both,1,EA,21.46,15.19,Aetna First Health,Commercial,,18.24,85,,,9.51,18.24,percent of total billed charges,
methazolAMIDE 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559024101,NDC,facility,both,1,EA,32.18,22.78,Aetna First Health,Commercial,,27.35,85,,,14.26,27.35,percent of total billed charges,
methenamine 0.5 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42799010501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methenamine 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43199002001,NDC,facility,both,1,EA,6.1,4.32,Aetna First Health,Commercial,,5.18,85,,,2.7,5.18,percent of total billed charges,
methenamine 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13925010701,NDC,facility,both,1,EA,6.91,4.89,Aetna First Health,Commercial,,5.87,85,,,3.06,5.87,percent of total billed charges,
methenamine 1 GM Tablet 60 Each Bottle,63700001,CDM,,,250,RC,62135020160,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
methIMAzole 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687066911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084027511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687035711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884064001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185020501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293082001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155007001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64380021201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60793010401,NDC,facility,both,1,EA,4.22,2.99,Aetna First Health,Commercial,,3.59,85,,,1.87,3.59,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084027501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687066901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687035701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methIMAzole 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,62135020590,NDC,facility,both,1,EA,9.63,6.82,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
methocarbamol 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084005611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687055911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143129001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603448521,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722053301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547040510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385012301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70010075401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69543013410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739016610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084005601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687055901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methocarbamol 500 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,76385012350,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methsuximide 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00071052524,NDC,facility,both,1,EA,8.8,6.23,Aetna First Health,Commercial,,7.48,85,,,3.9,7.48,percent of total billed charges,
methyldopa 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079020001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methyldopa 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093293101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methyldopa 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729003001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methyldopa 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079020020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylergonovine 0.2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687041011,NDC,facility,both,1,EA,192.5,136.29,Aetna First Health,Commercial,,163.62,85,,,85.32,163.62,percent of total billed charges,
methylergonovine 0.2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687081311,NDC,facility,both,1,EA,192.5,136.29,Aetna First Health,Commercial,,163.62,85,,,85.32,163.62,percent of total billed charges,
methylergonovine 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43386014001,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
methylergonovine 0.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078005405,NDC,facility,both,1,EA,4.99,3.53,Aetna First Health,Commercial,,4.24,85,,,2.21,4.24,percent of total billed charges,
methylergonovine 0.2 MG Tablet 12 Each Bottle,63700001,CDM,,,250,RC,69238160502,NDC,facility,both,1,EA,57.75,40.89,Aetna First Health,Commercial,,49.09,85,,,25.59,49.09,percent of total billed charges,
methylergonovine 0.2 MG Tablet 12 Each Bottle,63700001,CDM,,,250,RC,00093365522,NDC,facility,both,1,EA,69.55,49.24,Aetna First Health,Commercial,,59.12,85,,,30.82,59.12,percent of total billed charges,
methylergonovine 0.2 MG Tablet 12 Each Bottle,63700001,CDM,,,250,RC,00054063905,NDC,facility,both,1,EA,188.24,133.27,Aetna First Health,Commercial,,160,85,,,83.43,160,percent of total billed charges,
methylergonovine 0.2 MG Tablet 12 Each Bottle,63700001,CDM,,,250,RC,43386014012,NDC,facility,both,1,EA,188.24,133.27,Aetna First Health,Commercial,,160,85,,,83.43,160,percent of total billed charges,
methylergonovine 0.2 MG Tablet 12 Each Bottle,63700001,CDM,,,250,RC,27437005057,NDC,facility,both,1,EA,217.88,154.26,Aetna First Health,Commercial,,185.2,85,,,96.56,185.2,percent of total billed charges,
methylergonovine 0.2 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,60687041094,NDC,facility,both,1,EA,192.5,136.29,Aetna First Health,Commercial,,163.62,85,,,85.32,163.62,percent of total billed charges,
methylergonovine 0.2 MG Tablet 28 Each Bottle,63700001,CDM,,,250,RC,43386014028,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
methylergonovine 0.2 MG Tablet 28 Each Bottle,63700001,CDM,,,250,RC,69238160508,NDC,facility,both,1,EA,57.75,40.89,Aetna First Health,Commercial,,49.09,85,,,25.59,49.09,percent of total billed charges,
methylergonovine 0.2 MG Tablet 28 Each Bottle,63700001,CDM,,,250,RC,43386014028,NDC,facility,both,1,EA,72.12,51.06,Aetna First Health,Commercial,,61.3,85,,,31.96,61.3,percent of total billed charges,
methylergonovine 0.2 MG Tablet 28 Each Bottle,63700001,CDM,,,250,RC,00054063913,NDC,facility,both,1,EA,188.14,133.2,Aetna First Health,Commercial,,159.92,85,,,83.38,159.92,percent of total billed charges,
methylergonovine 0.2 MG Tablet 28 Each Bottle,63700001,CDM,,,250,RC,27437005056,NDC,facility,both,1,EA,217.75,154.17,Aetna First Health,Commercial,,185.09,85,,,96.51,185.09,percent of total billed charges,
methylphenidate 10 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00527457937,NDC,facility,both,1,EA,4.97,3.52,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
methylphenidate 10 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406181001,NDC,facility,both,1,EA,9.98,7.07,Aetna First Health,Commercial,,8.48,85,,,4.42,8.48,percent of total billed charges,
methylphenidate 10 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00093529501,NDC,facility,both,1,EA,15.69,11.11,Aetna First Health,Commercial,,13.34,85,,,6.95,13.34,percent of total billed charges,
methylphenidate 10 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62175015137,NDC,facility,both,1,EA,16.16,11.44,Aetna First Health,Commercial,,13.74,85,,,7.16,13.74,percent of total billed charges,
methylphenidate 10 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,70010004201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,10702007501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,47781054001,NDC,facility,both,1,EA,15.23,10.78,Aetna First Health,Commercial,,12.95,85,,,6.75,12.95,percent of total billed charges,
methylphenidate 10 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406144501,NDC,facility,both,1,EA,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
methylphenidate 10 MG Tablet Extended Release 60 Each Bottle,63700001,CDM,,,250,RC,10702007506,NDC,facility,both,1,EA,9.39,6.65,Aetna First Health,Commercial,,7.98,85,,,4.16,7.98,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,50268054511,NDC,facility,both,1,EA,16.33,11.56,Aetna First Health,Commercial,,13.88,85,,,7.24,13.88,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,60687053211,NDC,facility,both,1,EA,22.17,15.7,Aetna First Health,Commercial,,18.84,85,,,9.83,18.84,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,13811070610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00527331037,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,31722095201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,57664060688,NDC,facility,both,1,EA,5.06,3.58,Aetna First Health,Commercial,,4.3,85,,,2.24,4.3,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378815501,NDC,facility,both,1,EA,21.14,14.97,Aetna First Health,Commercial,,17.97,85,,,9.37,17.97,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00591271501,NDC,facility,both,1,EA,27.25,19.29,Aetna First Health,Commercial,,23.16,85,,,12.08,23.16,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,10147068501,NDC,facility,both,1,EA,27.25,19.29,Aetna First Health,Commercial,,23.16,85,,,12.08,23.16,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62037072501,NDC,facility,both,1,EA,27.25,19.29,Aetna First Health,Commercial,,23.16,85,,,12.08,23.16,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,50458058501,NDC,facility,both,1,EA,29.25,20.71,Aetna First Health,Commercial,,24.86,85,,,12.96,24.86,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 20 Each Box,63700001,CDM,,,250,RC,50268054512,NDC,facility,both,1,EA,16.33,11.56,Aetna First Health,Commercial,,13.88,85,,,7.24,13.88,percent of total billed charges,
methylphenidate 18 MG Tablet Extended Release 30 Each Box,63700001,CDM,,,250,RC,60687053221,NDC,facility,both,1,EA,22.17,15.7,Aetna First Health,Commercial,,18.84,85,,,9.83,18.84,percent of total billed charges,
methylphenidate 20 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,10702007601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 20 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406147301,NDC,facility,both,1,EA,21.7,15.36,Aetna First Health,Commercial,,18.44,85,,,9.62,18.44,percent of total billed charges,
methylphenidate 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084080511,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406114201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664022888,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115180001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591588201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078043905,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722017301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714082101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781574801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084080521,NDC,facility,both,1,EA,7.18,5.08,Aetna First Health,Commercial,,6.1,85,,,3.18,6.1,percent of total billed charges,
methylphenidate ER 18 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175031037,NDC,facility,both,1,EA,18.15,12.85,Aetna First Health,Commercial,,15.43,85,,,8.04,15.43,percent of total billed charges,
methylphenidate LA 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,70010001201,NDC,facility,both,1,EA,11.73,8.3,Aetna First Health,Commercial,,9.97,85,,,5.2,9.97,percent of total billed charges,
methylphenidate LA 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00078042405,NDC,facility,both,1,EA,24.28,17.19,Aetna First Health,Commercial,,20.64,85,,,10.76,20.64,percent of total billed charges,
methylphenidate LA 10 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00781236101,NDC,facility,both,1,EA,28.76,20.36,Aetna First Health,Commercial,,24.45,85,,,12.75,24.45,percent of total billed charges,
metoclopramide 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084000911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079088801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079088601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687062011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093220401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739010310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739048110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079088620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687062001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093220405,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metOLazone 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079002301,NDC,facility,both,1,EA,9.59,6.79,Aetna First Health,Commercial,,8.15,85,,,4.25,8.15,percent of total billed charges,
metOLazone 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687053611,NDC,facility,both,1,EA,9.63,6.82,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
metOLazone 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687062411,NDC,facility,both,1,EA,9.63,6.82,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385013601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185505001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65580064371,NDC,facility,both,1,EA,3.87,2.74,Aetna First Health,Commercial,,3.29,85,,,1.72,3.29,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527221537,NDC,facility,both,1,EA,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378617201,NDC,facility,both,1,EA,6.31,4.47,Aetna First Health,Commercial,,5.36,85,,,2.8,5.36,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079002320,NDC,facility,both,1,EA,9.58,6.78,Aetna First Health,Commercial,,8.14,85,,,4.25,8.14,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687053601,NDC,facility,both,1,EA,9.63,6.82,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687062401,NDC,facility,both,1,EA,9.63,6.82,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
metOLazone 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904713861,NDC,facility,both,1,EA,10.94,7.75,Aetna First Health,Commercial,,9.3,85,,,4.85,9.3,percent of total billed charges,
metoprolol succinate 100 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084067311,NDC,facility,both,1,EA,4.89,3.46,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268054011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079016901,NDC,facility,both,1,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084030311,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084065911,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687039011,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,55111046601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001012100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,64679073402,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62037083001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,49884082501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742061501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68001035600,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,72516003001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00186108805,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904632261,NDC,facility,both,1,EA,3.06,2.17,Aetna First Health,Commercial,,2.6,85,,,1.36,2.6,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084030301,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084065901,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 100 Each Disp Pack,63700001,CDM,,,250,RC,00186108839,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268054015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,64679073403,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,55111046605,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 25 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,68001035603,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol succinate 50 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084066611,NDC,facility,both,1,EA,3.4,2.41,Aetna First Health,Commercial,,2.89,85,,,1.51,2.89,percent of total billed charges,
metoprolol tartrate 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584026711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584026511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664050652,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079025520,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079080101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoprolol tartrate 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079080120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084021611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687052611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079021601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111033301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29300022601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001036400,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571066501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904145361,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084021601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079021620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687052601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904715661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metroNIDAZOLE 250 MG Tablet 250 Each Bottle,63700001,CDM,,,250,RC,50111033306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mexiletine 150 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687077811,NDC,facility,both,1,EA,7.49,5.3,Aetna First Health,Commercial,,6.37,85,,,3.32,6.37,percent of total billed charges,
mexiletine 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527410737,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mexiletine 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,50742023901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mexiletine 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62559082001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mexiletine 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093873901,NDC,facility,both,1,EA,4.53,3.21,Aetna First Health,Commercial,,3.85,85,,,2.01,3.85,percent of total billed charges,
mexiletine 150 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687077821,NDC,facility,both,1,EA,7.49,5.3,Aetna First Health,Commercial,,6.37,85,,,3.32,6.37,percent of total billed charges,
mexiletine 200 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093874001,NDC,facility,both,1,EA,5.51,3.9,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
miconazole 100 MG Suppository 7 Each Box,63700001,CDM,,,250,RC,00472173607,NDC,facility,both,1,EA,1.75,1.24,Aetna First Health,Commercial,,1.49,85,,,0.78,1.49,percent of total billed charges,
miconazole 200 MG Suppository 3 Each Box,63700001,CDM,,,250,RC,00472173803,NDC,facility,both,1,EA,63.67,45.08,Aetna First Health,Commercial,,54.12,85,,,28.22,54.12,percent of total billed charges,
midodrine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268056411,NDC,facility,both,1,EA,3.01,2.13,Aetna First Health,Commercial,,2.56,85,,,1.33,2.56,percent of total billed charges,
midodrine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687038711,NDC,facility,both,1,EA,3.42,2.42,Aetna First Health,Commercial,,2.91,85,,,1.52,2.91,percent of total billed charges,
midodrine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084024011,NDC,facility,both,1,EA,3.43,2.43,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
midodrine 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378190101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00245021111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505132001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382073701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115421101,NDC,facility,both,1,EA,3.25,2.3,Aetna First Health,Commercial,,2.76,85,,,1.44,2.76,percent of total billed charges,
midodrine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687038701,NDC,facility,both,1,EA,3.42,2.42,Aetna First Health,Commercial,,2.91,85,,,1.52,2.91,percent of total billed charges,
midodrine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084024001,NDC,facility,both,1,EA,3.42,2.42,Aetna First Health,Commercial,,2.91,85,,,1.52,2.91,percent of total billed charges,
midodrine 2.5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904681706,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
midodrine 2.5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268056415,NDC,facility,both,1,EA,3.05,2.16,Aetna First Health,Commercial,,2.59,85,,,1.35,2.59,percent of total billed charges,
midodrine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084024111,NDC,facility,both,1,EA,4.12,2.92,Aetna First Health,Commercial,,3.5,85,,,1.83,3.5,percent of total billed charges,
midodrine 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268056515,NDC,facility,both,1,EA,3.25,2.3,Aetna First Health,Commercial,,2.76,85,,,1.44,2.76,percent of total billed charges,
miglitol 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00009501201,NDC,facility,both,1,EA,5.67,4.01,Aetna First Health,Commercial,,4.82,85,,,2.51,4.82,percent of total billed charges,
minocycline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591569401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63304069401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862020901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,13668048201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093316501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minocycline 50 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00591569460,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884025601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489038601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591564201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
minoxidil 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084020401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirabegron ER 25 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00469260171,NDC,facility,both,1,EA,44.84,31.75,Aetna First Health,Commercial,,38.11,85,,,19.87,38.11,percent of total billed charges,
mirabegron ER 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68180015106,NDC,facility,both,1,EA,46.4,32.85,Aetna First Health,Commercial,,39.44,85,,,20.56,39.44,percent of total billed charges,
mirabegron ER 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00469260130,NDC,facility,both,1,EA,53.7,38.02,Aetna First Health,Commercial,,45.64,85,,,23.8,45.64,percent of total billed charges,
mirabegron ER 25 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00469260190,NDC,facility,both,1,EA,53.7,38.02,Aetna First Health,Commercial,,45.64,85,,,23.8,45.64,percent of total billed charges,
mirabegron ER 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,70710116003,NDC,facility,both,1,EA,46.4,32.85,Aetna First Health,Commercial,,39.44,85,,,20.56,39.44,percent of total billed charges,
mirabegron ER 50 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00469260230,NDC,facility,both,1,EA,53.7,38.02,Aetna First Health,Commercial,,45.64,85,,,23.8,45.64,percent of total billed charges,
mirtazapine 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084011911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739035510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,66993070951,NDC,facility,both,1,EA,6.36,4.5,Aetna First Health,Commercial,,5.41,85,,,2.82,5.41,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00115165351,NDC,facility,both,1,EA,6.82,4.83,Aetna First Health,Commercial,,5.8,85,,,3.02,5.8,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00052010606,NDC,facility,both,1,EA,14.88,10.54,Aetna First Health,Commercial,,12.65,85,,,6.59,12.65,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,65862002106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,57237001106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,66993070930,NDC,facility,both,1,EA,6.36,4.5,Aetna First Health,Commercial,,5.41,85,,,2.82,5.41,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,00115165308,NDC,facility,both,1,EA,6.82,4.83,Aetna First Health,Commercial,,5.8,85,,,3.02,5.8,percent of total billed charges,
mirtazapine 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,00052010630,NDC,facility,both,1,EA,14.88,10.54,Aetna First Health,Commercial,,12.65,85,,,6.59,12.65,percent of total billed charges,
mirtazapine 7.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687058411,NDC,facility,both,1,EA,9.97,7.06,Aetna First Health,Commercial,,8.47,85,,,4.42,8.47,percent of total billed charges,
mirtazapine 7.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107000130,NDC,facility,both,1,EA,3.79,2.68,Aetna First Health,Commercial,,3.22,85,,,1.68,3.22,percent of total billed charges,
mirtazapine 7.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714070601,NDC,facility,both,1,EA,7.35,5.2,Aetna First Health,Commercial,,6.25,85,,,3.26,6.25,percent of total billed charges,
mirtazapine 7.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,57237000730,NDC,facility,both,1,EA,7.38,5.23,Aetna First Health,Commercial,,6.27,85,,,3.27,6.27,percent of total billed charges,
mirtazapine 7.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687058421,NDC,facility,both,1,EA,9.97,7.06,Aetna First Health,Commercial,,8.47,85,,,4.42,8.47,percent of total billed charges,
mirtazapine 7.5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,13107000105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 100 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084004011,NDC,facility,both,1,EA,7.25,5.13,Aetna First Health,Commercial,,6.16,85,,,3.21,6.16,percent of total billed charges,
miSOPROStol 100 MCG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,43386016012,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
miSOPROStol 200 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084004111,NDC,facility,both,1,EA,7.95,5.63,Aetna First Health,Commercial,,6.76,85,,,3.52,6.76,percent of total billed charges,
miSOPROStol 200 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762500802,NDC,facility,both,1,EA,3.38,2.39,Aetna First Health,Commercial,,2.87,85,,,1.5,2.87,percent of total billed charges,
modafinil 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084062111,NDC,facility,both,1,EA,38.5,27.26,Aetna First Health,Commercial,,32.72,85,,,17.06,32.72,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69452034213,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862060130,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,57237015430,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505252603,NDC,facility,both,1,EA,3.38,2.39,Aetna First Health,Commercial,,2.87,85,,,1.5,2.87,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378557393,NDC,facility,both,1,EA,8.52,6.03,Aetna First Health,Commercial,,7.24,85,,,3.78,7.24,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00591349930,NDC,facility,both,1,EA,8.52,6.03,Aetna First Health,Commercial,,7.24,85,,,3.78,7.24,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55253080130,NDC,facility,both,1,EA,16.09,11.39,Aetna First Health,Commercial,,13.68,85,,,7.13,13.68,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,50742015230,NDC,facility,both,1,EA,37.01,26.2,Aetna First Health,Commercial,,31.46,85,,,16.4,31.46,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63459010130,NDC,facility,both,1,EA,90.07,63.77,Aetna First Health,Commercial,,76.56,85,,,39.92,76.56,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904679104,NDC,facility,both,1,EA,32.63,23.1,Aetna First Health,Commercial,,27.74,85,,,14.46,27.74,percent of total billed charges,
modafinil 100 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084062121,NDC,facility,both,1,EA,73.89,52.31,Aetna First Health,Commercial,,62.81,85,,,32.75,62.81,percent of total billed charges,
modafinil 100 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,57237015490,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084062011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268057511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084087511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268055611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079022301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00006011701,NDC,facility,both,1,EA,20.55,14.55,Aetna First Health,Commercial,,17.47,85,,,9.11,17.47,percent of total billed charges,
montelukast 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084062001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084087501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904652961,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904680861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079022320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00006011728,NDC,facility,both,1,EA,20.56,14.56,Aetna First Health,Commercial,,17.48,85,,,9.11,17.48,percent of total billed charges,
montelukast 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093742656,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68001024804,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722072630,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69452010513,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342010207,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00006911731,NDC,facility,both,1,EA,23.71,16.79,Aetna First Health,Commercial,,20.15,85,,,10.51,20.15,percent of total billed charges,
montelukast 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268057515,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093742698,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68001024805,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68001036105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862057490,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16729011915,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,31722072690,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68462039290,NDC,facility,both,1,EA,3.97,2.81,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
montelukast 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00603465502,NDC,facility,both,1,EA,8.49,6.01,Aetna First Health,Commercial,,7.22,85,,,3.76,7.22,percent of total billed charges,
montelukast 4 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,50268057311,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
montelukast 4 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,00093742456,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 4 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,31722072730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 4 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,57237021230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 4 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,00006071131,NDC,facility,both,1,EA,18.33,12.98,Aetna First Health,Commercial,,15.58,85,,,8.12,15.58,percent of total billed charges,
montelukast 4 MG Tablet Chewable 30 Each Bottle,63700001,CDM,,,250,RC,78206017001,NDC,facility,both,1,EA,30.62,21.68,Aetna First Health,Commercial,,26.03,85,,,13.57,26.03,percent of total billed charges,
montelukast 4 MG Tablet Chewable 50 Each Box,63700001,CDM,,,250,RC,50268057315,NDC,facility,both,1,EA,3.66,2.59,Aetna First Health,Commercial,,3.11,85,,,1.62,3.11,percent of total billed charges,
montelukast 4 MG Tablet Chewable 90 Each Bottle,63700001,CDM,,,250,RC,00093742498,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
montelukast 4 MG Tablet Chewable 90 Each Bottle,63700001,CDM,,,250,RC,31722072790,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00574711212,NDC,facility,both,1,EA,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
morphine 30 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00832022700,NDC,facility,both,1,EA,15.93,11.28,Aetna First Health,Commercial,,13.54,85,,,7.06,13.54,percent of total billed charges,
morphine 30 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228309011,NDC,facility,both,1,EA,16.04,11.36,Aetna First Health,Commercial,,13.63,85,,,7.11,13.63,percent of total billed charges,
morphine 30 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00574711612,NDC,facility,both,1,EA,33.75,23.9,Aetna First Health,Commercial,,28.69,85,,,14.96,28.69,percent of total billed charges,
morphine ER 100 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00406839062,NDC,facility,both,1,EA,16.1,11.4,Aetna First Health,Commercial,,13.68,85,,,7.14,13.68,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084040311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00406831523,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084015711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406831501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,42858080101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378265801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,63304045001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00228427011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00406831562,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084040301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084015701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,63739089910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 15 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00904655761,NDC,facility,both,1,EA,4,2.83,Aetna First Health,Commercial,,3.4,85,,,1.77,3.4,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084040411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084015811,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00406833023,NDC,facility,both,1,EA,5.57,3.94,Aetna First Health,Commercial,,4.73,85,,,2.47,4.73,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,42858080201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00406833001,NDC,facility,both,1,EA,4.46,3.16,Aetna First Health,Commercial,,3.79,85,,,1.98,3.79,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00228427111,NDC,facility,both,1,EA,4.46,3.16,Aetna First Health,Commercial,,3.79,85,,,1.98,3.79,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378265901,NDC,facility,both,1,EA,4.46,3.16,Aetna First Health,Commercial,,3.79,85,,,1.98,3.79,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084040401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,63739072610,NDC,facility,both,1,EA,4.06,2.87,Aetna First Health,Commercial,,3.45,85,,,1.8,3.45,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00904655861,NDC,facility,both,1,EA,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084015801,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
morphine ER 30 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00406833062,NDC,facility,both,1,EA,5.57,3.94,Aetna First Health,Commercial,,4.73,85,,,2.47,4.73,percent of total billed charges,
morphine ER 60 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,42858080301,NDC,facility,both,1,EA,8.7,6.16,Aetna First Health,Commercial,,7.4,85,,,3.86,7.4,percent of total billed charges,
morphine immediate release 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687061711,NDC,facility,both,1,EA,3.61,2.56,Aetna First Health,Commercial,,3.07,85,,,1.6,3.07,percent of total billed charges,
morphine immediate release 15 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054023525,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine immediate release 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054023524,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine immediate release 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687061701,NDC,facility,both,1,EA,3.61,2.56,Aetna First Health,Commercial,,3.07,85,,,1.6,3.07,percent of total billed charges,
moxifloxacin 400 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084072211,NDC,facility,both,1,EA,40.25,28.5,Aetna First Health,Commercial,,34.21,85,,,17.84,34.21,percent of total billed charges,
moxifloxacin 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111011230,NDC,facility,both,1,EA,10.29,7.29,Aetna First Health,Commercial,,8.75,85,,,4.56,8.75,percent of total billed charges,
moxifloxacin 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862060330,NDC,facility,both,1,EA,10.29,7.29,Aetna First Health,Commercial,,8.75,85,,,4.56,8.75,percent of total billed charges,
moxifloxacin 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13668020130,NDC,facility,both,1,EA,31.5,22.3,Aetna First Health,Commercial,,26.78,85,,,13.96,26.78,percent of total billed charges,
moxifloxacin 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,47781026830,NDC,facility,both,1,EA,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
moxifloxacin 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093738756,NDC,facility,both,1,EA,76.23,53.97,Aetna First Health,Commercial,,64.8,85,,,33.79,64.8,percent of total billed charges,
moxifloxacin 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00085173301,NDC,facility,both,1,EA,96.96,68.65,Aetna First Health,Commercial,,82.42,85,,,42.97,82.42,percent of total billed charges,
multivitamin childrens with C and folic acid Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,80681004900,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin childrens with C and folic acid Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,80681004800,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
multivitamin childrens with C and folic acid Tablet Chewable 250 Each Bottle,63700001,CDM,,,250,RC,80681011600,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with iron 18 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00904053660,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with iron 18 MG Tablet Chewable 250 Each Bottle,63700001,CDM,,,250,RC,00904053670,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with iron 18 MG Tablet Chewable 60 Each Bottle,63700001,CDM,,,250,RC,00536344308,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333086125,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904504260,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 100 Each Bottle,63700001,CDM,,,250,RC,54629007501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 100 Each Box,63700001,CDM,,,250,RC,00904549261,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 130 Each Bottle,63700001,CDM,,,250,RC,40985022368,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 130 Each Bottle,63700001,CDM,,,250,RC,80681016000,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 130 Each Bottle,63700001,CDM,,,250,RC,00904549213,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 300 Each Bottle,63700001,CDM,,,250,RC,00904264172,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00536344508,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 60 Each Bottle,63700001,CDM,,,250,RC,80681011200,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multivitamin with minerals Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904548652,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084005111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687037411,NDC,facility,both,1,EA,4.14,2.93,Aetna First Health,Commercial,,3.52,85,,,1.83,3.52,percent of total billed charges,
nabumetone 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687063011,NDC,facility,both,1,EA,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591367001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097096507,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185014501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462035801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282025701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50228046501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115165701,NDC,facility,both,1,EA,3.41,2.41,Aetna First Health,Commercial,,2.9,85,,,1.51,2.9,percent of total billed charges,
nabumetone 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084005101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nabumetone 500 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687063021,NDC,facility,both,1,EA,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
nadolol 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079081201,NDC,facility,both,1,EA,9.52,6.74,Aetna First Health,Commercial,,8.09,85,,,4.22,8.09,percent of total billed charges,
nadolol 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084075511,NDC,facility,both,1,EA,10.21,7.23,Aetna First Health,Commercial,,8.68,85,,,4.53,8.68,percent of total billed charges,
nadolol 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687030295,NDC,facility,both,1,EA,10.21,7.23,Aetna First Health,Commercial,,8.68,85,,,4.53,8.68,percent of total billed charges,
nadolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097086707,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nadolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50742017801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nadolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378002801,NDC,facility,both,1,EA,5.4,3.82,Aetna First Health,Commercial,,4.59,85,,,2.39,4.59,percent of total billed charges,
nadolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001031700,NDC,facility,both,1,EA,6.46,4.57,Aetna First Health,Commercial,,5.49,85,,,2.86,5.49,percent of total billed charges,
nadolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093423501,NDC,facility,both,1,EA,9.6,6.8,Aetna First Health,Commercial,,8.16,85,,,4.25,8.16,percent of total billed charges,
nadolol 20 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001022100,NDC,facility,both,1,EA,9.6,6.8,Aetna First Health,Commercial,,8.16,85,,,4.25,8.16,percent of total billed charges,
nadolol 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079081220,NDC,facility,both,1,EA,9.51,6.73,Aetna First Health,Commercial,,8.08,85,,,4.21,8.08,percent of total billed charges,
nadolol 20 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687030225,NDC,facility,both,1,EA,10.21,7.23,Aetna First Health,Commercial,,8.68,85,,,4.53,8.68,percent of total billed charges,
nadolol 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69238112309,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nadolol 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781118192,NDC,facility,both,1,EA,9.6,6.8,Aetna First Health,Commercial,,8.16,85,,,4.25,8.16,percent of total billed charges,
nadolol 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079081301,NDC,facility,both,1,EA,11.13,7.88,Aetna First Health,Commercial,,9.46,85,,,4.93,9.46,percent of total billed charges,
naltrexone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084029111,NDC,facility,both,1,EA,8.79,6.22,Aetna First Health,Commercial,,7.47,85,,,3.9,7.47,percent of total billed charges,
naltrexone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406117001,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,51224020630,NDC,facility,both,1,EA,3.03,2.15,Aetna First Health,Commercial,,2.58,85,,,1.34,2.58,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00406117003,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,47335032683,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729008110,NDC,facility,both,1,EA,5.77,4.09,Aetna First Health,Commercial,,4.9,85,,,2.56,4.9,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00555090201,NDC,facility,both,1,EA,9.95,7.04,Aetna First Health,Commercial,,8.46,85,,,4.41,8.46,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62135024230,NDC,facility,both,1,EA,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68094085362,NDC,facility,both,1,EA,7.98,5.65,Aetna First Health,Commercial,,6.78,85,,,3.54,6.78,percent of total billed charges,
naltrexone 50 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084029121,NDC,facility,both,1,EA,8.78,6.22,Aetna First Health,Commercial,,7.46,85,,,3.89,7.46,percent of total billed charges,
naproxen 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00093014719,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268059411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462018801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162018810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097085307,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746018801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 250 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268059415,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084012711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
naproxen sodum 220 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536102201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
naproxen sodum 220 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536109401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
naproxen sodum 220 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904523051,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
naratriptan 1 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,00173056100,NDC,facility,both,1,EA,143.62,101.68,Aetna First Health,Commercial,,122.08,85,,,63.65,122.08,percent of total billed charges,
naratriptan 2.5 MG Tablet 9 Each Bottle,63700001,CDM,,,250,RC,00054027903,NDC,facility,both,1,EA,38.33,27.14,Aetna First Health,Commercial,,32.58,85,,,16.99,32.58,percent of total billed charges,
naratriptan 2.5 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,23155005519,NDC,facility,both,1,EA,38.33,27.14,Aetna First Health,Commercial,,32.58,85,,,16.99,32.58,percent of total billed charges,
naratriptan 2.5 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,00173056200,NDC,facility,both,1,EA,143.62,101.68,Aetna First Health,Commercial,,122.08,85,,,63.65,122.08,percent of total billed charges,
nateglinide 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084045811,NDC,facility,both,1,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
nateglinide 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067311,NDC,facility,both,1,EA,7.69,5.44,Aetna First Health,Commercial,,6.54,85,,,3.41,6.54,percent of total billed charges,
nateglinide 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42291063601,NDC,facility,both,1,EA,4.03,2.85,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
nateglinide 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078035105,NDC,facility,both,1,EA,9.11,6.45,Aetna First Health,Commercial,,7.74,85,,,4.04,7.74,percent of total billed charges,
nateglinide 60 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084045821,NDC,facility,both,1,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
nateglinide 60 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687067321,NDC,facility,both,1,EA,7.69,5.44,Aetna First Health,Commercial,,6.54,85,,,3.41,6.54,percent of total billed charges,
nateglinide 60 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382072116,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nebivolol 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547052403,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nebivolol 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62559027530,NDC,facility,both,1,EA,9.86,6.98,Aetna First Health,Commercial,,8.38,85,,,4.37,8.38,percent of total billed charges,
nebivolol 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456140230,NDC,facility,both,1,EA,21.33,15.1,Aetna First Health,Commercial,,18.13,85,,,9.45,18.13,percent of total billed charges,
Nebivolol HCl 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456141030,NDC,facility,both,1,EA,21.33,15.1,Aetna First Health,Commercial,,18.13,85,,,9.45,18.13,percent of total billed charges,
Nebivolol HCl 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00456141090,NDC,facility,both,1,EA,10.81,7.65,Aetna First Health,Commercial,,9.19,85,,,4.79,9.19,percent of total billed charges,
Nebivolol HCl 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456142030,NDC,facility,both,1,EA,20.31,14.38,Aetna First Health,Commercial,,17.26,85,,,9,17.26,percent of total billed charges,
nelfinavir 250 MG Tablet 300 Each Bottle,63700001,CDM,,,250,RC,63010001030,NDC,facility,both,1,EA,11.37,8.05,Aetna First Health,Commercial,,9.66,85,,,5.04,9.66,percent of total billed charges,
nevirapine 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722050560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nevirapine 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,51991033106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nevirapine 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65862002760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nevirapine 200 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00597004660,NDC,facility,both,1,EA,41.86,29.64,Aetna First Health,Commercial,,35.58,85,,,18.55,35.58,percent of total billed charges,
niacin CR (antihyperlipidemic) 500 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084075695,NDC,facility,both,1,EA,16.06,11.37,Aetna First Health,Commercial,,13.65,85,,,7.12,13.65,percent of total billed charges,
niacin CR (antihyperlipidemic) 500 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68180022101,NDC,facility,both,1,EA,11.86,8.4,Aetna First Health,Commercial,,10.08,85,,,5.26,10.08,percent of total billed charges,
niacin CR (antihyperlipidemic) 500 MG Tablet Extended Release 60 Each Box,63700001,CDM,,,250,RC,68084075635,NDC,facility,both,1,EA,16.06,11.37,Aetna First Health,Commercial,,13.65,85,,,7.12,13.65,percent of total billed charges,
niacin CR (antihyperlipidemic) 500 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,47335053981,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
niacin CR (antihyperlipidemic) 500 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,65162032109,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
niacin CR (antihyperlipidemic) 500 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,00093739298,NDC,facility,both,1,EA,11.86,8.4,Aetna First Health,Commercial,,10.08,85,,,5.26,10.08,percent of total billed charges,
niacin CR (antihyperlipidemic) 500 MG Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,00074307490,NDC,facility,both,1,EA,15.83,11.21,Aetna First Health,Commercial,,13.46,85,,,7.02,13.46,percent of total billed charges,
niacin CR 250 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00904062960,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin CR 250 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,10006070020,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin CR 250 MG Capsule Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,74312005800,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin ER 250 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245006211,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin ER 250 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,71279025010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
niacin ER 250 MG Tablet Extended Release 110 Each Bottle,63700001,CDM,,,250,RC,40985022849,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin ER 500 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,50268058311,NDC,facility,both,1,EA,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
niacin ER 500 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245006311,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacin ER 500 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00904434260,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacinamide 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,80681001900,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niacinamide 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904420260,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
niCARdipine 20 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00378102077,NDC,facility,both,1,EA,6.24,4.42,Aetna First Health,Commercial,,5.3,85,,,2.77,5.3,percent of total billed charges,
niCARdipine 20 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,42806050109,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
niCARdipine 20 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,68462012090,NDC,facility,both,1,EA,28.41,20.11,Aetna First Health,Commercial,,24.15,85,,,12.59,24.15,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,43598044771,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00067512509,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,00536589533,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,60505706200,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,70677003101,NDC,facility,both,1,EA,1.94,1.37,Aetna First Health,Commercial,,1.65,85,,,0.86,1.65,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00536589588,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00536110788,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,46122035274,NDC,facility,both,1,EA,2.65,1.88,Aetna First Health,Commercial,,2.25,85,,,1.17,2.25,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,43598044774,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00067512514,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00135019502,NDC,facility,both,1,EA,5.05,3.58,Aetna First Health,Commercial,,4.29,85,,,2.24,4.29,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,68001043390,NDC,facility,both,1,EA,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,00536589553,NDC,facility,both,1,EA,2.99,2.12,Aetna First Health,Commercial,,2.54,85,,,1.33,2.54,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,00067512507,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,43598044770,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
nicotine 14 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,68001043388,NDC,facility,both,1,EA,6.98,4.94,Aetna First Health,Commercial,,5.93,85,,,3.09,5.93,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00536589633,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00067512609,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,60505706300,NDC,facility,both,1,EA,2.78,1.97,Aetna First Health,Commercial,,2.36,85,,,1.23,2.36,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,00135019408,NDC,facility,both,1,EA,5,3.54,Aetna First Health,Commercial,,4.25,85,,,2.22,4.25,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,43598044871,NDC,facility,both,1,EA,6.22,4.4,Aetna First Health,Commercial,,5.29,85,,,2.76,5.29,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00135019405,NDC,facility,both,1,EA,2.14,1.52,Aetna First Health,Commercial,,1.82,85,,,0.95,1.82,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00536589688,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00536110888,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,68001043490,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00067512614,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,43598044874,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,49348014446,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,49781014214,NDC,facility,both,1,EA,4.28,3.03,Aetna First Health,Commercial,,3.64,85,,,1.9,3.64,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00135014502,NDC,facility,both,1,EA,4.51,3.19,Aetna First Health,Commercial,,3.83,85,,,2,3.83,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00135019402,NDC,facility,both,1,EA,5.05,3.58,Aetna First Health,Commercial,,4.29,85,,,2.24,4.29,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 28 Each Box,63700001,CDM,,,250,RC,43598044828,NDC,facility,both,1,EA,2.4,1.7,Aetna First Health,Commercial,,2.04,85,,,1.06,2.04,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 28 Each Box,63700001,CDM,,,250,RC,00067512628,NDC,facility,both,1,EA,2.4,1.7,Aetna First Health,Commercial,,2.04,85,,,1.06,2.04,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,00536589653,NDC,facility,both,1,EA,2.99,2.12,Aetna First Health,Commercial,,2.54,85,,,1.33,2.54,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,00067512607,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,43598044870,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
nicotine 21 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,00135019401,NDC,facility,both,1,EA,5.23,3.7,Aetna First Health,Commercial,,4.45,85,,,2.32,4.45,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00067512409,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,00536589433,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,60505706100,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00536589488,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00536110688,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,68001043290,NDC,facility,both,1,EA,2.57,1.82,Aetna First Health,Commercial,,2.18,85,,,1.14,2.18,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,00067512414,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 14 Each Box,63700001,CDM,,,250,RC,43598044674,NDC,facility,both,1,EA,2.67,1.89,Aetna First Health,Commercial,,2.27,85,,,1.18,2.27,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,00536589453,NDC,facility,both,1,EA,2.99,2.12,Aetna First Health,Commercial,,2.54,85,,,1.33,2.54,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,00067512407,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,43598044670,NDC,facility,both,1,EA,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
nicotine 7 MG/24HR Patch 24 Hour 7 Each Box,63700001,CDM,,,250,RC,68001043288,NDC,facility,both,1,EA,6.98,4.94,Aetna First Health,Commercial,,5.93,85,,,3.09,5.93,percent of total billed charges,
nicotine polacrilex 2 MG Gum 100 Each Box,63700001,CDM,,,250,RC,00536311201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 100 Each Box,63700001,CDM,,,250,RC,00536340401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 100 Each Box,63700001,CDM,,,250,RC,49348078710,NDC,facility,both,1,EA,0.6,0.42,Aetna First Health,Commercial,,0.51,85,,,0.27,0.51,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,00536136223,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,00904573411,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,00904573611,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,45802020625,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,46122072425,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,49348069136,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,00135015707,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 2 MG Gum 110 Each Box,63700001,CDM,,,250,RC,46122017125,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 2 MG Gum 20 Each Box,63700001,CDM,,,250,RC,00135047408,NDC,facility,both,1,EA,0.56,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
nicotine polacrilex 2 MG Gum 20 Each Box,63700001,CDM,,,250,RC,00135024108,NDC,facility,both,1,EA,0.56,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
nicotine polacrilex 2 MG Gum 20 Each Box,63700001,CDM,,,250,RC,00536302934,NDC,facility,both,1,EA,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
nicotine polacrilex 2 MG Gum 50 Each Box,63700001,CDM,,,250,RC,00536136206,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 50 Each Box,63700001,CDM,,,250,RC,00904573451,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 50 Each Box,63700001,CDM,,,250,RC,00904573651,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 50 Each Box,63700001,CDM,,,250,RC,24385059471,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Gum 50 Each Box,63700001,CDM,,,250,RC,87701040016,NDC,facility,both,1,EA,0.6,0.42,Aetna First Health,Commercial,,0.51,85,,,0.27,0.51,percent of total billed charges,
nicotine polacrilex 2 MG Gum 50 Each Box,63700001,CDM,,,250,RC,17856136201,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 20 Each Box,63700001,CDM,,,250,RC,46122071560,NDC,facility,both,1,EA,0.7,0.5,Aetna First Health,Commercial,,0.6,85,,,0.31,0.6,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 20 Each Box,63700001,CDM,,,250,RC,46122025460,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 20 Each Box,63700001,CDM,,,250,RC,00135050804,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,46122073408,NDC,facility,both,1,EA,0.54,0.38,Aetna First Health,Commercial,,0.46,85,,,0.24,0.46,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,46122073462,NDC,facility,both,1,EA,0.54,0.38,Aetna First Health,Commercial,,0.46,85,,,0.24,0.46,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,43598048624,NDC,facility,both,1,EA,0.58,0.41,Aetna First Health,Commercial,,0.49,85,,,0.26,0.49,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,45802034405,NDC,facility,both,1,EA,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,45802034403,NDC,facility,both,1,EA,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,46122017608,NDC,facility,both,1,EA,0.64,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,00113034403,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,43598048672,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 24 Each Box,63700001,CDM,,,250,RC,00135051006,NDC,facility,both,1,EA,0.57,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 27 Each Bottle,63700001,CDM,,,250,RC,46122025415,NDC,facility,both,1,EA,0.66,0.47,Aetna First Health,Commercial,,0.56,85,,,0.29,0.56,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 27 Each Bottle,63700001,CDM,,,250,RC,45802008902,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 27 Each Box,63700001,CDM,,,250,RC,00135280002,NDC,facility,both,1,EA,0.75,0.53,Aetna First Health,Commercial,,0.64,85,,,0.33,0.64,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 48 Each Box,63700001,CDM,,,250,RC,24385097567,NDC,facility,both,1,EA,0.63,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 50 Each Box,63700001,CDM,,,250,RC,17856123901,NDC,facility,both,1,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 72 Each Box,63700001,CDM,,,250,RC,49348085216,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 72 Each Box,63700001,CDM,,,250,RC,00135051001,NDC,facility,both,1,EA,0.7,0.5,Aetna First Health,Commercial,,0.6,85,,,0.31,0.6,percent of total billed charges,
nicotine polacrilex 2 MG Lozenge 81 Each Box,63700001,CDM,,,250,RC,00135050802,NDC,facility,both,1,EA,0.75,0.53,Aetna First Health,Commercial,,0.64,85,,,0.33,0.64,percent of total billed charges,
nicotine polacrilex 4 MG Gum 110 Each Box,63700001,CDM,,,250,RC,49348069236,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Gum 110 Each Box,63700001,CDM,,,250,RC,45802000125,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Gum 110 Each Box,63700001,CDM,,,250,RC,46122072025,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 4 MG Gum 110 Each Box,63700001,CDM,,,250,RC,45802065125,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 4 MG Gum 20 Each Box,63700001,CDM,,,250,RC,46122017460,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
nicotine polacrilex 4 MG Gum 20 Each Box,63700001,CDM,,,250,RC,00135024208,NDC,facility,both,1,EA,0.56,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
nicotine polacrilex 4 MG Gum 20 Each Box,63700001,CDM,,,250,RC,46122028660,NDC,facility,both,1,EA,0.57,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
nicotine polacrilex 4 MG Gum 20 Each Box,63700001,CDM,,,250,RC,46122071860,NDC,facility,both,1,EA,0.62,0.44,Aetna First Health,Commercial,,0.53,85,,,0.27,0.53,percent of total billed charges,
nicotine polacrilex 4 MG Gum 20 Each Box,63700001,CDM,,,250,RC,00135047508,NDC,facility,both,1,EA,0.65,0.46,Aetna First Health,Commercial,,0.55,85,,,0.29,0.55,percent of total billed charges,
nicotine polacrilex 4 MG Gum 20 Each Box,63700001,CDM,,,250,RC,00536137234,NDC,facility,both,1,EA,0.75,0.53,Aetna First Health,Commercial,,0.64,85,,,0.33,0.64,percent of total billed charges,
nicotine polacrilex 4 MG Gum 40 Each Box,63700001,CDM,,,250,RC,00536311337,NDC,facility,both,1,EA,0.69,0.49,Aetna First Health,Commercial,,0.59,85,,,0.31,0.59,percent of total billed charges,
nicotine polacrilex 4 MG Gum 50 Each Box,63700001,CDM,,,250,RC,00536137206,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,45802087305,NDC,facility,both,1,EA,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,45802087303,NDC,facility,both,1,EA,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 24 Each Bottle,63700001,CDM,,,250,RC,00113087303,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 24 Each Box,63700001,CDM,,,250,RC,00135051106,NDC,facility,both,1,EA,0.57,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 50 Each Box,63700001,CDM,,,250,RC,17856124101,NDC,facility,both,1,EA,3.85,2.73,Aetna First Health,Commercial,,3.27,85,,,1.71,3.27,percent of total billed charges,
nicotine polacrilex 4 MG Lozenge 72 Each Box,63700001,CDM,,,250,RC,49348085316,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
NIFEdipine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084002211,NDC,facility,both,1,EA,4.03,2.85,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
NIFEdipine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687042511,NDC,facility,both,1,EA,4.03,2.85,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
NIFEdipine 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268060011,NDC,facility,both,1,EA,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
NIFEdipine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228249710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,43386044024,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69315021101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59762100401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904722961,NDC,facility,both,1,EA,3.77,2.67,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
NIFEdipine 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084002201,NDC,facility,both,1,EA,4.03,2.85,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
NIFEdipine 10 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268060015,NDC,facility,both,1,EA,5.23,3.7,Aetna First Health,Commercial,,4.45,85,,,2.32,4.45,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268059711,NDC,facility,both,1,EA,4.03,2.85,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079040001,NDC,facility,both,1,EA,4.13,2.92,Aetna First Health,Commercial,,3.51,85,,,1.83,3.51,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084059711,NDC,facility,both,1,EA,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,24979001101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742026001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,59762669003,NDC,facility,both,1,EA,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175026037,NDC,facility,both,1,EA,3.75,2.66,Aetna First Health,Commercial,,3.19,85,,,1.66,3.19,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378048001,NDC,facility,both,1,EA,3.75,2.66,Aetna First Health,Commercial,,3.19,85,,,1.66,3.19,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084059701,NDC,facility,both,1,EA,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 300 Each Bottle,63700001,CDM,,,250,RC,59762669005,NDC,facility,both,1,EA,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268059715,NDC,facility,both,1,EA,4.02,2.85,Aetna First Health,Commercial,,3.42,85,,,1.78,3.42,percent of total billed charges,
NIFEdipine CR osmotic 30 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,68084059765,NDC,facility,both,1,EA,4.02,2.85,Aetna First Health,Commercial,,3.42,85,,,1.78,3.42,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268059811,NDC,facility,both,1,EA,6.86,4.86,Aetna First Health,Commercial,,5.83,85,,,3.04,5.83,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079096801,NDC,facility,both,1,EA,7.04,4.98,Aetna First Health,Commercial,,5.98,85,,,3.12,5.98,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079089601,NDC,facility,both,1,EA,7.04,4.98,Aetna First Health,Commercial,,5.98,85,,,3.12,5.98,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084059811,NDC,facility,both,1,EA,8.65,6.12,Aetna First Health,Commercial,,7.35,85,,,3.83,7.35,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,50742026101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175026137,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00093517301,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378048101,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084059801,NDC,facility,both,1,EA,6.1,4.32,Aetna First Health,Commercial,,5.18,85,,,2.7,5.18,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,51079089620,NDC,facility,both,1,EA,7.04,4.98,Aetna First Health,Commercial,,5.98,85,,,3.12,5.98,percent of total billed charges,
NIFEdipine CR osmotic 60 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268059815,NDC,facility,both,1,EA,6.25,4.42,Aetna First Health,Commercial,,5.31,85,,,2.77,5.31,percent of total billed charges,
NIFEdipine SR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378035301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
NIFEdipine SR 30 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,49884067701,NDC,facility,both,1,EA,3.03,2.15,Aetna First Health,Commercial,,2.58,85,,,1.34,2.58,percent of total billed charges,
niMODipine 30 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,23155051211,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
niMODipine 30 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084091233,NDC,facility,both,1,EA,9.21,6.52,Aetna First Health,Commercial,,7.83,85,,,4.08,7.83,percent of total billed charges,
niMODipine 30 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,69452020907,NDC,facility,both,1,EA,10.06,7.12,Aetna First Health,Commercial,,8.55,85,,,4.46,8.55,percent of total billed charges,
niMODipine 30 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,57664013560,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
niMODipine 30 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,23155010811,NDC,facility,both,1,EA,45.47,32.19,Aetna First Health,Commercial,,38.65,85,,,20.15,38.65,percent of total billed charges,
niMODipine 30 MG capsule 100 Each Box,63700001,CDM,,,250,RC,23155051200,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
niMODipine 30 MG capsule 100 Each Box,63700001,CDM,,,250,RC,57664013565,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
niMODipine 30 MG capsule 100 Each Box,63700001,CDM,,,250,RC,23155010800,NDC,facility,both,1,EA,27.13,19.21,Aetna First Health,Commercial,,23.06,85,,,12.02,23.06,percent of total billed charges,
niMODipine 30 MG capsule 20 Each Box,63700001,CDM,,,250,RC,68084091232,NDC,facility,both,1,EA,9.19,6.51,Aetna First Health,Commercial,,7.81,85,,,4.07,7.81,percent of total billed charges,
niMODipine 30 MG capsule 30 Each Box,63700001,CDM,,,250,RC,63739079733,NDC,facility,both,1,EA,10.06,7.12,Aetna First Health,Commercial,,8.55,85,,,4.46,8.55,percent of total billed charges,
niMODipine 30 MG capsule 30 Each Box,63700001,CDM,,,250,RC,69452020913,NDC,facility,both,1,EA,10.06,7.12,Aetna First Health,Commercial,,8.55,85,,,4.46,8.55,percent of total billed charges,
niMODipine 30 MG capsule 30 Each Box,63700001,CDM,,,250,RC,57664013564,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
niMODipine 30 MG capsule 30 Each Box,63700001,CDM,,,250,RC,23155010830,NDC,facility,both,1,EA,45.47,32.19,Aetna First Health,Commercial,,38.65,85,,,20.15,38.65,percent of total billed charges,
nitazoxanide 500 MG Tablet 12 Each Bottle,63700001,CDM,,,250,RC,64980052621,NDC,facility,both,1,EA,204.9,145.07,Aetna First Health,Commercial,,174.16,85,,,90.81,174.16,percent of total billed charges,
nitazoxanide 500 MG Tablet 12 Each Bottle,63700001,CDM,,,250,RC,67546011114,NDC,facility,both,1,EA,507.21,359.1,Aetna First Health,Commercial,,431.13,85,,,224.8,431.13,percent of total billed charges,
nitazoxanide 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67546011112,NDC,facility,both,1,EA,107.57,76.16,Aetna First Health,Commercial,,91.43,85,,,47.68,91.43,percent of total billed charges,
nitazoxanide 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64980052603,NDC,facility,both,1,EA,190.35,134.77,Aetna First Health,Commercial,,161.8,85,,,84.36,161.8,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079034801,NDC,facility,both,1,EA,8.96,6.34,Aetna First Health,Commercial,,7.62,85,,,3.97,7.62,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268062511,NDC,facility,both,1,EA,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084044611,NDC,facility,both,1,EA,10.29,7.29,Aetna First Health,Commercial,,8.75,85,,,4.56,8.75,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687063311,NDC,facility,both,1,EA,10.29,7.29,Aetna First Health,Commercial,,8.75,85,,,4.56,8.75,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00185012201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162047810,NDC,facility,both,1,EA,4.93,3.49,Aetna First Health,Commercial,,4.19,85,,,2.18,4.19,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001042300,NDC,facility,both,1,EA,5.47,3.87,Aetna First Health,Commercial,,4.65,85,,,2.42,4.65,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001060600,NDC,facility,both,1,EA,5.47,3.87,Aetna First Health,Commercial,,4.65,85,,,2.42,4.65,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714043901,NDC,facility,both,1,EA,5.5,3.89,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378342201,NDC,facility,both,1,EA,8.97,6.35,Aetna First Health,Commercial,,7.62,85,,,3.98,7.62,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001000100,NDC,facility,both,1,EA,8.98,6.36,Aetna First Health,Commercial,,7.63,85,,,3.98,7.63,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,52427028501,NDC,facility,both,1,EA,49.92,35.34,Aetna First Health,Commercial,,42.43,85,,,22.12,42.43,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079034820,NDC,facility,both,1,EA,8.97,6.35,Aetna First Health,Commercial,,7.62,85,,,3.98,7.62,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084044601,NDC,facility,both,1,EA,10.29,7.29,Aetna First Health,Commercial,,8.75,85,,,4.56,8.75,percent of total billed charges,
nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268062515,NDC,facility,both,1,EA,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
nitrofurantoin 50 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079058401,NDC,facility,both,1,EA,8.05,5.7,Aetna First Health,Commercial,,6.84,85,,,3.57,6.84,percent of total billed charges,
nitroglycerin 0.1 MG/HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00378910216,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.1 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00378910293,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.1 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,47781029603,NDC,facility,both,1,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
nitroglycerin 0.2 MG/HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00378910416,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.2 MG/HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,68382030901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.2 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00904549546,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.2 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00378910493,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.2 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,68382030930,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.2 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,43598089530,NDC,facility,both,1,EA,6.54,4.63,Aetna First Health,Commercial,,5.56,85,,,2.9,5.56,percent of total billed charges,
nitroglycerin 0.2 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,47781029703,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.3 MG/HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00085331503,NDC,facility,both,1,EA,19.81,14.03,Aetna First Health,Commercial,,16.84,85,,,8.78,16.84,percent of total billed charges,
nitroglycerin 0.3 MG/HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,50742051501,NDC,facility,both,1,EA,211.96,150.07,Aetna First Health,Commercial,,180.17,85,,,93.94,180.17,percent of total billed charges,
nitroglycerin 0.3 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00085331530,NDC,facility,both,1,EA,19.81,14.03,Aetna First Health,Commercial,,16.84,85,,,8.78,16.84,percent of total billed charges,
nitroglycerin 0.3 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00085331535,NDC,facility,both,1,EA,19.81,14.03,Aetna First Health,Commercial,,16.84,85,,,8.78,16.84,percent of total billed charges,
nitroglycerin 0.3 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,50742051530,NDC,facility,both,1,EA,211.96,150.07,Aetna First Health,Commercial,,180.17,85,,,93.94,180.17,percent of total billed charges,
nitroglycerin 0.4 MG/HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00378911216,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.4 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00378911293,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin 0.4 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,49730011230,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.4 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,47781029803,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.4 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00904549646,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.6 MG/HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00378911616,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
nitroglycerin 0.6 MG/HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,43598089311,NDC,facility,both,1,EA,7.95,5.63,Aetna First Health,Commercial,,6.76,85,,,3.52,6.76,percent of total billed charges,
nitroglycerin 0.6 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00378911693,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
nitroglycerin 0.6 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,43598089330,NDC,facility,both,1,EA,7.95,5.63,Aetna First Health,Commercial,,6.76,85,,,3.52,6.76,percent of total billed charges,
nitroglycerin 0.6 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00904549746,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.6 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,47781029903,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nitroglycerin 0.8 MG/HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,00085081903,NDC,facility,both,1,EA,21.48,15.21,Aetna First Health,Commercial,,18.26,85,,,9.52,18.26,percent of total billed charges,
nitroglycerin 0.8 MG/HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,50742051801,NDC,facility,both,1,EA,201.15,142.41,Aetna First Health,Commercial,,170.98,85,,,89.15,170.98,percent of total billed charges,
nitroglycerin 0.8 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00085081930,NDC,facility,both,1,EA,21.48,15.21,Aetna First Health,Commercial,,18.26,85,,,9.52,18.26,percent of total billed charges,
nitroglycerin 0.8 MG/HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,50742051830,NDC,facility,both,1,EA,201.15,142.41,Aetna First Health,Commercial,,170.98,85,,,89.15,170.98,percent of total billed charges,
nitroglycerin CR 2.5 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00904064360,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nitroglycerin CR 2.5 MG Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,49483022110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norelgestromin-ethinyl estradiol 150-35 MCG/24HR PATCH WEEKLY 1 Each Packet,63700001,CDM,,,250,RC,00378334016,NDC,facility,both,1,EA,123.57,87.49,Aetna First Health,Commercial,,105.03,85,,,54.77,105.03,percent of total billed charges,
norethindrone 5 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,68462030450,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
norethindrone 5 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,00555021110,NDC,facility,both,1,EA,6.49,4.59,Aetna First Health,Commercial,,5.52,85,,,2.88,5.52,percent of total billed charges,
norethindrone-ethinyl estradiol 1.5-30 MG-MCG Tablet 21 Each Disp Pack,63700001,CDM,,,250,RC,52544029017,NDC,facility,both,1,EA,75.19,53.23,Aetna First Health,Commercial,,63.91,85,,,33.32,63.91,percent of total billed charges,
norethindrone-ethinyl estradiol 1-35 MG-MCG Tablet 28 Each Disp Pack,63700001,CDM,,,250,RC,00555901058,NDC,facility,both,1,EA,69.58,49.26,Aetna First Health,Commercial,,59.14,85,,,30.84,59.14,percent of total billed charges,
nortriptyline 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084003111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268060311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687028111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591578601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51672400101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093081001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084003101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687028101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268060315,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 10 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,51672400105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nortriptyline 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084003211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 500000 units Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093098301,NDC,facility,both,1,EA,3.51,2.49,Aetna First Health,Commercial,,2.98,85,,,1.56,2.98,percent of total billed charges,
nystatin 500000 units Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155005101,NDC,facility,both,1,EA,3.51,2.49,Aetna First Health,Commercial,,2.98,85,,,1.56,2.98,percent of total billed charges,
nystatin 500000 units Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489040001,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
OLANZapine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084052511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292001201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268060911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904628361,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505311000,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084052501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00002411233,NDC,facility,both,1,EA,36.29,25.69,Aetna First Health,Commercial,,30.85,85,,,16.08,30.85,percent of total billed charges,
OLANZapine 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111016330,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505311003,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342006707,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268060915,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 2.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69543038090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,64380017201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884032052,NDC,facility,both,1,EA,3.01,2.13,Aetna First Health,Commercial,,2.56,85,,,1.33,2.56,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,59746030612,NDC,facility,both,1,EA,3.01,2.13,Aetna First Health,Commercial,,2.56,85,,,1.33,2.56,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,55111026279,NDC,facility,both,1,EA,6.06,4.29,Aetna First Health,Commercial,,5.15,85,,,2.69,5.15,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00093524519,NDC,facility,both,1,EA,6.27,4.44,Aetna First Health,Commercial,,5.33,85,,,2.78,5.33,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,50268061511,NDC,facility,both,1,EA,6.51,4.61,Aetna First Health,Commercial,,5.53,85,,,2.89,5.53,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 1 Each Box,63700001,CDM,,,250,RC,66993005381,NDC,facility,both,1,EA,41.59,29.45,Aetna First Health,Commercial,,35.35,85,,,18.43,35.35,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 100 Each Box,63700001,CDM,,,250,RC,60505327500,NDC,facility,both,1,EA,6.25,4.42,Aetna First Health,Commercial,,5.31,85,,,2.77,5.31,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Bottle,63700001,CDM,,,250,RC,60505327503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Bottle,63700001,CDM,,,250,RC,33342008307,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Bottle,63700001,CDM,,,250,RC,13668008630,NDC,facility,both,1,EA,8.58,6.07,Aetna First Health,Commercial,,7.29,85,,,3.8,7.29,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,59746030632,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,64380017202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,55111026281,NDC,facility,both,1,EA,6.05,4.28,Aetna First Health,Commercial,,5.14,85,,,2.68,5.14,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,00093524565,NDC,facility,both,1,EA,6.25,4.42,Aetna First Health,Commercial,,5.31,85,,,2.77,5.31,percent of total billed charges,
OLANZapine 5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,50268061513,NDC,facility,both,1,EA,6.51,4.61,Aetna First Health,Commercial,,5.53,85,,,2.89,5.53,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00002445501,NDC,facility,both,1,EA,100.24,70.97,Aetna First Health,Commercial,,85.2,85,,,44.43,85.2,percent of total billed charges,
OLANZapine orally disintegrating 15 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,00002445585,NDC,facility,both,1,EA,100.24,70.97,Aetna First Health,Commercial,,85.2,85,,,44.43,85.2,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 100 Each Bottle,63700001,CDM,,,250,RC,68462039501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 100 Each Bottle,63700001,CDM,,,250,RC,59651000101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,68462023030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,68462039530,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,16714074601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,60505014500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,16714071401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 10 MG CAPSULE DELAYED RELEASE 30 Each Bottle,63700001,CDM,,,250,RC,62175011432,NDC,facility,both,1,EA,3.93,2.78,Aetna First Health,Commercial,,3.34,85,,,1.74,3.34,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Box,63700001,CDM,,,250,RC,00904568461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 20 MG CAPSULE DELAYED RELEASE 100 Each Box,63700001,CDM,,,250,RC,60505006507,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
omeprazole 40 MG CAPSULE DELAYED RELEASE 100 Each Bottle,63700001,CDM,,,250,RC,62175013637,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oral relief for dry mouth Lozenge 27 Each Box,63700001,CDM,,,250,RC,48582015942,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
orphenadrine SR 100 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084082095,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
orphenadrine SR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43386048024,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
orphenadrine SR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00185002201,NDC,facility,both,1,EA,3.28,2.32,Aetna First Health,Commercial,,2.79,85,,,1.45,2.79,percent of total billed charges,
orphenadrine SR 100 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115201101,NDC,facility,both,1,EA,3.45,2.44,Aetna First Health,Commercial,,2.93,85,,,1.53,2.93,percent of total billed charges,
orphenadrine SR 100 MG Tablet Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,68084082025,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Blister,63700001,CDM,,,250,RC,72205004211,NDC,facility,both,1,EA,5.78,4.09,Aetna First Health,Commercial,,4.91,85,,,2.56,4.91,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Bottle,63700001,CDM,,,250,RC,00004080206,NDC,facility,both,1,EA,35.53,25.16,Aetna First Health,Commercial,,30.2,85,,,15.75,30.2,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,64380079701,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,68180067511,NDC,facility,both,1,EA,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,31722063031,NDC,facility,both,1,EA,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,69238126401,NDC,facility,both,1,EA,27.84,19.71,Aetna First Health,Commercial,,23.66,85,,,12.34,23.66,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,16714081701,NDC,facility,both,1,EA,31.49,22.29,Aetna First Health,Commercial,,26.77,85,,,13.96,26.77,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,47781046813,NDC,facility,both,1,EA,32.76,23.19,Aetna First Health,Commercial,,27.85,85,,,14.52,27.85,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,63739003807,NDC,facility,both,1,EA,36.13,25.58,Aetna First Health,Commercial,,30.71,85,,,16.01,30.71,percent of total billed charges,
oseltamivir 30 MG capsule 10 Each Box,63700001,CDM,,,250,RC,00004080285,NDC,facility,both,1,EA,48.77,34.53,Aetna First Health,Commercial,,41.45,85,,,21.61,41.45,percent of total billed charges,
oseltamivir 45 MG capsule 10 Each Bottle,63700001,CDM,,,250,RC,00004080106,NDC,facility,both,1,EA,35.53,25.16,Aetna First Health,Commercial,,30.2,85,,,15.75,30.2,percent of total billed charges,
oseltamivir 45 MG capsule 10 Each Box,63700001,CDM,,,250,RC,68180067611,NDC,facility,both,1,EA,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
oseltamivir 45 MG capsule 10 Each Box,63700001,CDM,,,250,RC,69238126501,NDC,facility,both,1,EA,27.84,19.71,Aetna First Health,Commercial,,23.66,85,,,12.34,23.66,percent of total billed charges,
oseltamivir 45 MG capsule 10 Each Box,63700001,CDM,,,250,RC,16714081801,NDC,facility,both,1,EA,30.49,21.59,Aetna First Health,Commercial,,25.92,85,,,13.51,25.92,percent of total billed charges,
oseltamivir 45 MG capsule 10 Each Box,63700001,CDM,,,250,RC,00004080185,NDC,facility,both,1,EA,48.77,34.53,Aetna First Health,Commercial,,41.45,85,,,21.61,41.45,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Blister,63700001,CDM,,,250,RC,62332041510,NDC,facility,both,1,EA,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,64380079901,NDC,facility,both,1,EA,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,33342025866,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,68180067711,NDC,facility,both,1,EA,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,31722063231,NDC,facility,both,1,EA,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,70710101002,NDC,facility,both,1,EA,11.2,7.93,Aetna First Health,Commercial,,9.52,85,,,4.96,9.52,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,69238126601,NDC,facility,both,1,EA,30.35,21.49,Aetna First Health,Commercial,,25.8,85,,,13.45,25.8,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,60219126601,NDC,facility,both,1,EA,30.35,21.49,Aetna First Health,Commercial,,25.8,85,,,13.45,25.8,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,16714081901,NDC,facility,both,1,EA,33.47,23.7,Aetna First Health,Commercial,,28.45,85,,,14.83,28.45,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,47781047013,NDC,facility,both,1,EA,35.7,25.28,Aetna First Health,Commercial,,30.35,85,,,15.82,30.35,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Box,63700001,CDM,,,250,RC,63739005007,NDC,facility,both,1,EA,39.84,28.21,Aetna First Health,Commercial,,33.86,85,,,17.66,33.86,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Disp Pack,63700001,CDM,,,250,RC,00004080006,NDC,facility,both,1,EA,38.72,27.41,Aetna First Health,Commercial,,32.91,85,,,17.16,32.91,percent of total billed charges,
oseltamivir 75 MG capsule 10 Each Disp Pack,63700001,CDM,,,250,RC,00004080085,NDC,facility,both,1,EA,53.16,37.64,Aetna First Health,Commercial,,45.19,85,,,23.56,45.19,percent of total billed charges,
oxandrolone 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084042411,NDC,facility,both,1,EA,13.22,9.36,Aetna First Health,Commercial,,11.24,85,,,5.86,11.24,percent of total billed charges,
oxandrolone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00245027111,NDC,facility,both,1,EA,9.72,6.88,Aetna First Health,Commercial,,8.26,85,,,4.31,8.26,percent of total billed charges,
oxandrolone 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884030101,NDC,facility,both,1,EA,15.14,10.72,Aetna First Health,Commercial,,12.87,85,,,6.71,12.87,percent of total billed charges,
oxandrolone 2.5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084042421,NDC,facility,both,1,EA,13.22,9.36,Aetna First Health,Commercial,,11.24,85,,,5.86,11.24,percent of total billed charges,
oxazepam 10 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,62584081211,NDC,facility,both,1,EA,8.37,5.93,Aetna First Health,Commercial,,7.11,85,,,3.71,7.11,percent of total billed charges,
oxazepam 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781280901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxazepam 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228206710,NDC,facility,both,1,EA,3.36,2.38,Aetna First Health,Commercial,,2.86,85,,,1.49,2.86,percent of total billed charges,
oxazepam 10 MG capsule 100 Each Box,63700001,CDM,,,250,RC,62584081201,NDC,facility,both,1,EA,8.35,5.91,Aetna First Health,Commercial,,7.1,85,,,3.7,7.1,percent of total billed charges,
oxazepam 15 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,62584081311,NDC,facility,both,1,EA,9.17,6.49,Aetna First Health,Commercial,,7.79,85,,,4.06,7.79,percent of total billed charges,
OXcarbazepine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084084511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687071111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584014211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462013701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62756018388,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51991029201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00054009720,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084084501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904726261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584014201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
OXcarbazepine 300 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00078033705,NDC,facility,both,1,EA,36.31,25.71,Aetna First Health,Commercial,,30.86,85,,,16.09,30.86,percent of total billed charges,
OXcarbazepine ER 300 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,17772012201,NDC,facility,both,1,EA,43.9,31.08,Aetna First Health,Commercial,,37.32,85,,,19.46,37.32,percent of total billed charges,
oxyBUTYnin 3.9 MG/24HR Patch Twice Weekly 1 Each Box,63700001,CDM,,,250,RC,52544092054,NDC,facility,both,1,EA,249.08,176.35,Aetna First Health,Commercial,,211.72,85,,,110.39,211.72,percent of total billed charges,
oxyBUTYnin 3.9 MG/24HR Patch Twice Weekly 1 Each Packet,63700001,CDM,,,250,RC,00023615301,NDC,facility,both,1,EA,339.92,240.66,Aetna First Health,Commercial,,288.93,85,,,150.65,288.93,percent of total billed charges,
oxyBUTYnin 3.9 MG/24HR Patch Twice Weekly 8 Each Box,63700001,CDM,,,250,RC,52544092008,NDC,facility,both,1,EA,283.54,200.75,Aetna First Health,Commercial,,241.01,85,,,125.66,241.01,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084040011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084040001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084048011,NDC,facility,both,1,EA,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268062711,NDC,facility,both,1,EA,9.21,6.52,Aetna First Health,Commercial,,7.83,85,,,4.08,7.83,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079072201,NDC,facility,both,1,EA,9.55,6.76,Aetna First Health,Commercial,,8.12,85,,,4.23,8.12,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175027037,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,72888003001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,65162037110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,64980020901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,16729031701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,68382025501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,27241015504,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378660501,NDC,facility,both,1,EA,8.17,5.78,Aetna First Health,Commercial,,6.94,85,,,3.62,6.94,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00093520601,NDC,facility,both,1,EA,8.63,6.11,Aetna First Health,Commercial,,7.34,85,,,3.82,7.34,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904657061,NDC,facility,both,1,EA,8.02,5.68,Aetna First Health,Commercial,,6.82,85,,,3.55,6.82,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084048001,NDC,facility,both,1,EA,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,51079072220,NDC,facility,both,1,EA,9.55,6.76,Aetna First Health,Commercial,,8.12,85,,,4.23,8.12,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,63739054833,NDC,facility,both,1,EA,10.14,7.18,Aetna First Health,Commercial,,8.62,85,,,4.49,8.62,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,50268062715,NDC,facility,both,1,EA,9.21,6.52,Aetna First Health,Commercial,,7.83,85,,,4.08,7.83,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,68084048065,NDC,facility,both,1,EA,9.22,6.53,Aetna First Health,Commercial,,7.84,85,,,4.09,7.84,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 50 Each Box,63700001,CDM,,,250,RC,00904657006,NDC,facility,both,1,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,65162037150,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,62175027041,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyBUTYnin ER 5 MG Tablet Extended Release 24 Hour 500 Each Bottle,63700001,CDM,,,250,RC,00378660505,NDC,facility,both,1,EA,9.2,6.51,Aetna First Health,Commercial,,7.82,85,,,4.08,7.82,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406055201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664022388,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10702001801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378611201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603499021,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107005501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162004710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858000101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406055262,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084035401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68308050547,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,42858000110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904644461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739036510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904696661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00603499028,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE 5 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,10702001850,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE CR 10 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,00781570301,NDC,facility,both,1,EA,8.76,6.2,Aetna First Health,Commercial,,7.45,85,,,3.88,7.45,percent of total billed charges,
oxyCODONE CR 10 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,69238229401,NDC,facility,both,1,EA,14.07,9.96,Aetna First Health,Commercial,,11.96,85,,,6.24,11.96,percent of total billed charges,
oxyCODONE CR 10 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,59011041010,NDC,facility,both,1,EA,18.66,13.21,Aetna First Health,Commercial,,15.86,85,,,8.27,15.86,percent of total billed charges,
oxyCODONE CR 10 MG Tablet ER 12 hour Abuse-Deterrent 20 Each Box,63700001,CDM,,,250,RC,59011010020,NDC,facility,both,1,EA,6.43,4.55,Aetna First Health,Commercial,,5.47,85,,,2.85,5.47,percent of total billed charges,
oxyCODONE CR 10 MG Tablet ER 12 hour Abuse-Deterrent 20 Each Box,63700001,CDM,,,250,RC,59011041020,NDC,facility,both,1,EA,19.16,13.57,Aetna First Health,Commercial,,16.29,85,,,8.49,16.29,percent of total billed charges,
oxyCODONE CR 20 MG Tablet ER 12 hour Abuse-Deterrent 20 Each Box,63700001,CDM,,,250,RC,59011042020,NDC,facility,both,1,EA,35.7,25.28,Aetna First Health,Commercial,,30.35,85,,,15.82,30.35,percent of total billed charges,
oxyCODONE CR 30 MG Tablet ER 12 hour Abuse-Deterrent 100 Each Bottle,63700001,CDM,,,250,RC,59011043010,NDC,facility,both,1,EA,24.44,17.3,Aetna First Health,Commercial,,20.77,85,,,10.83,20.77,percent of total billed charges,
oxyCODONE CR 40 MG Tablet ER 12 hour Abuse-Deterrent 20 Each Box,63700001,CDM,,,250,RC,59011044020,NDC,facility,both,1,EA,61.11,43.27,Aetna First Health,Commercial,,51.94,85,,,27.08,51.94,percent of total billed charges,
oxyCODONE CR 80 MG Tablet ER 12 hour Abuse-Deterrent 20 Each Box,63700001,CDM,,,250,RC,59011048020,NDC,facility,both,1,EA,106.68,75.53,Aetna First Health,Commercial,,90.68,85,,,47.28,90.68,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268064611,NDC,facility,both,1,EA,4.4,3.12,Aetna First Health,Commercial,,3.74,85,,,1.95,3.74,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084071011,NDC,facility,both,1,EA,6.01,4.26,Aetna First Health,Commercial,,5.11,85,,,2.66,5.11,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406052323,NDC,facility,both,1,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858010401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43386049301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107004601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406052301,NDC,facility,both,1,EA,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746020401,NDC,facility,both,1,EA,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739073910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 10-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68308048047,NDC,facility,both,1,EA,6.3,4.46,Aetna First Health,Commercial,,5.36,85,,,2.79,5.36,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084035511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406051223,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687064211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406051201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858010201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746020301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603499821,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378710401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107004401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054055125,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,47781019601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406051262,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084035501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68308040547,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904643761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687064201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084069911,NDC,facility,both,1,EA,4.98,3.53,Aetna First Health,Commercial,,4.23,85,,,2.21,4.23,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00406052223,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42858010301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107004501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722019301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00406052201,NDC,facility,both,1,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739063610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904643861,NDC,facility,both,1,EA,4.09,2.9,Aetna First Health,Commercial,,3.48,85,,,1.81,3.48,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084069901,NDC,facility,both,1,EA,4.98,3.53,Aetna First Health,Commercial,,4.23,85,,,2.21,4.23,percent of total billed charges,
oxyCODONE-acetaminophen 7.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00406052262,NDC,facility,both,1,EA,5.61,3.97,Aetna First Health,Commercial,,4.77,85,,,2.49,4.77,percent of total billed charges,
oxyMORphone SR 10 MG Tablet Extended Release 12 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00115123201,NDC,facility,both,1,EA,9.75,6.9,Aetna First Health,Commercial,,8.29,85,,,4.32,8.29,percent of total billed charges,
oyster shell calcium 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904188361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
paliperidone 1.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,27808022201,NDC,facility,both,1,EA,7.58,5.37,Aetna First Health,Commercial,,6.44,85,,,3.36,6.44,percent of total billed charges,
paliperidone 1.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,47335074483,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
paliperidone 1.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378397893,NDC,facility,both,1,EA,85.58,60.59,Aetna First Health,Commercial,,72.74,85,,,37.93,72.74,percent of total billed charges,
paliperidone 1.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00591369230,NDC,facility,both,1,EA,85.67,60.65,Aetna First Health,Commercial,,72.82,85,,,37.97,72.82,percent of total billed charges,
paliperidone 1.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,50458055401,NDC,facility,both,1,EA,99.16,70.21,Aetna First Health,Commercial,,84.29,85,,,43.95,84.29,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687045911,NDC,facility,both,1,EA,50.61,35.83,Aetna First Health,Commercial,,43.02,85,,,22.43,43.02,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904693561,NDC,facility,both,1,EA,47.78,33.83,Aetna First Health,Commercial,,40.61,85,,,21.18,40.61,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687045901,NDC,facility,both,1,EA,50.6,35.82,Aetna First Health,Commercial,,43.01,85,,,22.43,43.01,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,10147095201,NDC,facility,both,1,EA,89.04,63.04,Aetna First Health,Commercial,,75.68,85,,,39.46,75.68,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,27808022301,NDC,facility,both,1,EA,7.58,5.37,Aetna First Health,Commercial,,6.44,85,,,3.36,6.44,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,47335076583,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10147095203,NDC,facility,both,1,EA,38.54,27.29,Aetna First Health,Commercial,,32.76,85,,,17.08,32.76,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,50458055001,NDC,facility,both,1,EA,42.92,30.39,Aetna First Health,Commercial,,36.48,85,,,19.02,36.48,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378397993,NDC,facility,both,1,EA,85.58,60.59,Aetna First Health,Commercial,,72.74,85,,,37.93,72.74,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00591369330,NDC,facility,both,1,EA,85.67,60.65,Aetna First Health,Commercial,,72.82,85,,,37.97,72.82,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,16714086701,NDC,facility,both,1,EA,88.02,62.32,Aetna First Health,Commercial,,74.82,85,,,39.01,74.82,percent of total billed charges,
paliperidone 3 MG Tablet Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00591369319,NDC,facility,both,1,EA,85.67,60.65,Aetna First Health,Commercial,,72.82,85,,,37.97,72.82,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687047011,NDC,facility,both,1,EA,50.61,35.83,Aetna First Health,Commercial,,43.02,85,,,22.43,43.02,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687047001,NDC,facility,both,1,EA,50.6,35.82,Aetna First Health,Commercial,,43.01,85,,,22.43,43.01,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,10147095301,NDC,facility,both,1,EA,89.04,63.04,Aetna First Health,Commercial,,75.68,85,,,39.46,75.68,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,27808022401,NDC,facility,both,1,EA,7.58,5.37,Aetna First Health,Commercial,,6.44,85,,,3.36,6.44,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,47335076683,NDC,facility,both,1,EA,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,10147095303,NDC,facility,both,1,EA,38.54,27.29,Aetna First Health,Commercial,,32.76,85,,,17.08,32.76,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378398093,NDC,facility,both,1,EA,85.58,60.59,Aetna First Health,Commercial,,72.74,85,,,37.93,72.74,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00591369430,NDC,facility,both,1,EA,85.67,60.65,Aetna First Health,Commercial,,72.82,85,,,37.97,72.82,percent of total billed charges,
paliperidone 6 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,50458055101,NDC,facility,both,1,EA,99.16,70.21,Aetna First Health,Commercial,,84.29,85,,,43.95,84.29,percent of total billed charges,
paliperidone 9 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378398193,NDC,facility,both,1,EA,128.36,90.88,Aetna First Health,Commercial,,109.11,85,,,56.89,109.11,percent of total billed charges,
pancrelipase (lip-prot-amyl) 12000 UNIT Capsule Delayed Release Particles 250 Each Bottle,63700001,CDM,,,250,RC,00032121207,NDC,facility,both,1,EA,14.54,10.29,Aetna First Health,Commercial,,12.36,85,,,6.44,12.36,percent of total billed charges,
pancrelipase (lip-prot-amyl) 24000-76000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00032122401,NDC,facility,both,1,EA,28.82,20.4,Aetna First Health,Commercial,,24.5,85,,,12.77,24.5,percent of total billed charges,
pancrelipase (lip-prot-amyl) 24000-76000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00032263601,NDC,facility,both,1,EA,28.82,20.4,Aetna First Health,Commercial,,24.5,85,,,12.77,24.5,percent of total billed charges,
pancrelipase (lip-prot-amyl) 36000-114000 units Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00032301613,NDC,facility,both,1,EA,43.75,30.98,Aetna First Health,Commercial,,37.19,85,,,19.39,37.19,percent of total billed charges,
pancrelipase (Lip-Prot-Amyl) 6000 UNIT Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00032120601,NDC,facility,both,1,EA,7.27,5.15,Aetna First Health,Commercial,,6.18,85,,,3.22,6.18,percent of total billed charges,
pancrelipase (Lip-Prot-Amyl) 6000 UNIT Capsule Delayed Release Particles 100 Each Bottle,63700001,CDM,,,250,RC,00032004670,NDC,facility,both,1,EA,7.27,5.15,Aetna First Health,Commercial,,6.18,85,,,3.22,6.18,percent of total billed charges,
pancrelipase (Lip-Prot-Amyl) 6000 UNIT Capsule Delayed Release Particles 250 Each Bottle,63700001,CDM,,,250,RC,00032120607,NDC,facility,both,1,EA,6.93,4.91,Aetna First Health,Commercial,,5.89,85,,,3.07,5.89,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,50268063611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687058511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,50268058511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687072511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084064311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,60687058501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,68084064301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,60687072501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 50 Each Box,63700001,CDM,,,250,RC,50268063615,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 50 Each Box,63700001,CDM,,,250,RC,50268058515,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,00093001198,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,00008060601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,00378668877,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,65862055990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,31722071290,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,55111033290,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,13668009690,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 20 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,00008084381,NDC,facility,both,1,EA,29.23,20.69,Aetna First Health,Commercial,,24.85,85,,,12.95,24.85,percent of total billed charges,
pantoprazole 40 MG Packet 1 Each Packet,63700001,CDM,,,250,RC,27241025611,NDC,facility,both,1,EA,49.55,35.08,Aetna First Health,Commercial,,42.12,85,,,21.96,42.12,percent of total billed charges,
pantoprazole 40 MG Packet 1 Each Packet,63700001,CDM,,,250,RC,62756007160,NDC,facility,both,1,EA,49.55,35.08,Aetna First Health,Commercial,,42.12,85,,,21.96,42.12,percent of total billed charges,
pantoprazole 40 MG Packet 1 Each Packet,63700001,CDM,,,250,RC,60687076799,NDC,facility,both,1,EA,49.55,35.08,Aetna First Health,Commercial,,42.12,85,,,21.96,42.12,percent of total billed charges,
pantoprazole 40 MG Packet 1 Each Packet,63700001,CDM,,,250,RC,00008084401,NDC,facility,both,1,EA,50.44,35.71,Aetna First Health,Commercial,,42.87,85,,,22.36,42.87,percent of total billed charges,
pantoprazole 40 MG Packet 30 Each Box,63700001,CDM,,,250,RC,00008084402,NDC,facility,both,1,EA,29.22,20.69,Aetna First Health,Commercial,,24.84,85,,,12.95,24.84,percent of total billed charges,
pantoprazole 40 MG Packet 30 Each Box,63700001,CDM,,,250,RC,62756007164,NDC,facility,both,1,EA,49.55,35.08,Aetna First Health,Commercial,,42.12,85,,,21.96,42.12,percent of total billed charges,
pantoprazole 40 MG Packet 30 Each Box,63700001,CDM,,,250,RC,60687076727,NDC,facility,both,1,EA,49.55,35.08,Aetna First Health,Commercial,,42.12,85,,,21.96,42.12,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,51079005101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084065711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,68084081311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,66993006851,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,50268063911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,35573042851,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687073611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,66993006880,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00008060704,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,51079005120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,63739056410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,35573042880,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00904647461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 100 Each Box,63700001,CDM,,,250,RC,00008084199,NDC,facility,both,1,EA,29.23,20.69,Aetna First Health,Commercial,,24.85,85,,,12.95,24.85,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 50 Each Box,63700001,CDM,,,250,RC,50268063915,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 50 Each Box,63700001,CDM,,,250,RC,60687073665,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 80 Each Box,63700001,CDM,,,250,RC,68084081309,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 80 Each Box,63700001,CDM,,,250,RC,00904687045,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,00008060701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,66993006885,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,00093001298,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,00378668977,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,65862056090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pantoprazole 40 MG Tablet Delayed Release 90 Each Bottle,63700001,CDM,,,250,RC,31722071390,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
paricalcitol 1 MCG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00074431730,NDC,facility,both,1,EA,45.54,32.24,Aetna First Health,Commercial,,38.71,85,,,20.18,38.71,percent of total billed charges,
PARoxetine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084004411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268064011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904567661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084004401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739088810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382009706,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13107015430,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547034703,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378700193,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268064015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382009716,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904567861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PARoxetine CR 12.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,62175047032,NDC,facility,both,1,EA,3.9,2.76,Aetna First Health,Commercial,,3.32,85,,,1.73,3.32,percent of total billed charges,
PARoxetine CR 12.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,60505131603,NDC,facility,both,1,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
PARoxetine CR 12.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378200393,NDC,facility,both,1,EA,7.02,4.97,Aetna First Health,Commercial,,5.97,85,,,3.11,5.97,percent of total billed charges,
PARoxetine CR 12.5 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,60505367303,NDC,facility,both,1,EA,10.14,7.18,Aetna First Health,Commercial,,8.62,85,,,4.49,8.62,percent of total billed charges,
penicillAMINE 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,25010070515,NDC,facility,both,1,EA,213.16,150.92,Aetna First Health,Commercial,,181.19,85,,,94.47,181.19,percent of total billed charges,
penicillin v potassium 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781120501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237004001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143983701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093117201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253020010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
penicillin v potassium 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862017501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pentazocine-naloxone 50-0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591039501,NDC,facility,both,1,EA,7.22,5.11,Aetna First Health,Commercial,,6.14,85,,,3.2,6.14,percent of total billed charges,
pentosan polysulfate sodium 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,50458009801,NDC,facility,both,1,EA,23.77,16.83,Aetna First Health,Commercial,,20.2,85,,,10.53,20.2,percent of total billed charges,
pentoxifylline CR 400 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,51079088901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pentoxifylline CR 400 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00093511601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pentoxifylline CR 400 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,60505003306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pentoxifylline CR 400 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68682010110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pentoxifylline CR 400 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00378035701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pentoxifylline CR 400 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00904544861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pentoxifylline CR 400 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,51079088920,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
perampanel 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62856027230,NDC,facility,both,1,EA,72.45,51.29,Aetna First Health,Commercial,,61.58,85,,,32.11,61.58,percent of total billed charges,
perampanel 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69616027230,NDC,facility,both,1,EA,72.45,51.29,Aetna First Health,Commercial,,61.58,85,,,32.11,61.58,percent of total billed charges,
perampanel 6 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62856027630,NDC,facility,both,1,EA,143.15,101.35,Aetna First Health,Commercial,,121.68,85,,,63.44,121.68,percent of total billed charges,
phenazopyridine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084029211,NDC,facility,both,1,EA,4.1,2.9,Aetna First Health,Commercial,,3.48,85,,,1.82,3.48,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42937070110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293081001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10135062001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69367016204,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162068110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293061101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42192080101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,75826011410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,35573030510,NDC,facility,both,1,EA,6.13,4.34,Aetna First Health,Commercial,,5.21,85,,,2.72,5.21,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293080101,NDC,facility,both,1,EA,6.14,4.35,Aetna First Health,Commercial,,5.22,85,,,2.72,5.22,percent of total billed charges,
phenazopyridine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084029201,NDC,facility,both,1,EA,4.1,2.9,Aetna First Health,Commercial,,3.48,85,,,1.82,3.48,percent of total billed charges,
phenelzine 15 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,43386036021,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenelzine 15 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59762011901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenelzine 15 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00071035060,NDC,facility,both,1,EA,8.93,6.32,Aetna First Health,Commercial,,7.59,85,,,3.96,7.59,percent of total billed charges,
PHENobarbital 16.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603516521,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 16.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293062501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 16.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13517011001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 16.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69367021101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 16.2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571067101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 16.2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739020010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 16.2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739019210,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phentermine 37.5 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,10702002903,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenylephrine 0.25 % Suppository 12 Each Box,63700001,CDM,,,250,RC,00536138912,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
phenylephrine-cocoa butter 0.25-88.44 % Suppository 12 Each Box,63700001,CDM,,,250,RC,00536118612,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
phenylephrine-cocoa butter 0.25-88.44 % Suppository 12 Each Box,63700001,CDM,,,250,RC,00113027953,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
phenylephrine-cocoa butter 0.25-88.44 % Suppository 24 Each Box,63700001,CDM,,,250,RC,00573288320,NDC,facility,both,1,EA,0.74,0.52,Aetna First Health,Commercial,,0.63,85,,,0.33,0.63,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,51079012901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,60687015695,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,51672414601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00378385001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,59762521001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00071000724,NDC,facility,both,1,EA,5.52,3.91,Aetna First Health,Commercial,,4.69,85,,,2.45,4.69,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,00071000740,NDC,facility,both,1,EA,7.83,5.54,Aetna First Health,Commercial,,6.66,85,,,3.47,6.66,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 30 Each Box,63700001,CDM,,,250,RC,60687015625,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
phenytoin 50 MG Tablet Chewable 50 Each Box,63700001,CDM,,,250,RC,51079012906,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079090501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084037611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin ER 30 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00071374066,NDC,facility,both,1,EA,5.08,3.6,Aetna First Health,Commercial,,4.32,85,,,2.25,4.32,percent of total billed charges,
phosphorus 155-852-130 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084076495,NDC,facility,both,1,EA,4.66,3.3,Aetna First Health,Commercial,,3.96,85,,,2.07,3.96,percent of total billed charges,
phosphorus 155-852-130 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00486112501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phosphorus 155-852-130 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980010401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phosphorus 155-852-130 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69543026810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phosphorus 155-852-130 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,39328010710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phosphorus 155-852-130 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,71351001101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phosphorus 155-852-130 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084076425,NDC,facility,both,1,EA,3.39,2.4,Aetna First Health,Commercial,,2.88,85,,,1.5,2.88,percent of total billed charges,
phytonadione 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,54629084121,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
phytonadione 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,11845007791,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pilocarpine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084092895,NDC,facility,both,1,EA,7.95,5.63,Aetna First Health,Commercial,,6.76,85,,,3.52,6.76,percent of total billed charges,
pilocarpine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115592201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pilocarpine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527131301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pilocarpine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228280111,NDC,facility,both,1,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
pilocarpine 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62856070510,NDC,facility,both,1,EA,5.88,4.16,Aetna First Health,Commercial,,5,85,,,2.61,5,percent of total billed charges,
pilocarpine 5 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084092825,NDC,facility,both,1,EA,7.96,5.64,Aetna First Health,Commercial,,6.77,85,,,3.53,6.77,percent of total billed charges,
pimavanserin 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63090010030,NDC,facility,both,1,EA,582.75,412.59,Aetna First Health,Commercial,,495.34,85,,,258.27,495.34,percent of total billed charges,
pimozide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884034701,NDC,facility,both,1,EA,4.74,3.36,Aetna First Health,Commercial,,4.03,85,,,2.1,4.03,percent of total billed charges,
pimozide 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57844015101,NDC,facility,both,1,EA,5.93,4.2,Aetna First Health,Commercial,,5.04,85,,,2.63,5.04,percent of total billed charges,
pindolol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664065588,NDC,facility,both,1,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
pindolol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385013101,NDC,facility,both,1,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
pindolol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378005201,NDC,facility,both,1,EA,3.7,2.62,Aetna First Health,Commercial,,3.14,85,,,1.64,3.14,percent of total billed charges,
pindolol 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29033002801,NDC,facility,both,1,EA,3.7,2.62,Aetna First Health,Commercial,,3.14,85,,,1.64,3.14,percent of total billed charges,
pioglitazone 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079051301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084087811,NDC,facility,both,1,EA,3.26,2.31,Aetna First Health,Commercial,,2.77,85,,,1.44,2.77,percent of total billed charges,
pioglitazone 15 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687039111,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
pioglitazone 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079051320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084087801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687039101,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
pioglitazone 15 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904709061,NDC,facility,both,1,EA,4.55,3.22,Aetna First Health,Commercial,,3.87,85,,,2.02,3.87,percent of total billed charges,
pioglitazone 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093204856,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862051230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342005407,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093727156,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729002010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764015104,NDC,facility,both,1,EA,45.33,32.09,Aetna First Health,Commercial,,38.53,85,,,20.09,38.53,percent of total billed charges,
pioglitazone 15 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093727198,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093204898,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pioglitazone 15 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342005410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,11523723401,NDC,facility,both,1,EA,2.05,1.45,Aetna First Health,Commercial,,1.74,85,,,0.91,1.74,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,51079030601,NDC,facility,both,1,EA,2.27,1.61,Aetna First Health,Commercial,,1.93,85,,,1.01,1.93,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00904642286,NDC,facility,both,1,EA,2.34,1.66,Aetna First Health,Commercial,,1.99,85,,,1.04,1.99,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,68084043099,NDC,facility,both,1,EA,2.53,1.79,Aetna First Health,Commercial,,2.15,85,,,1.12,2.15,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,45802086800,NDC,facility,both,1,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,69784018001,NDC,facility,both,1,EA,3.81,2.7,Aetna First Health,Commercial,,3.24,85,,,1.69,3.24,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,62559015717,NDC,facility,both,1,EA,4.68,3.31,Aetna First Health,Commercial,,3.98,85,,,2.07,3.98,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00904693186,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 1 Each Sachet,63700001,CDM,,,250,RC,60687043199,NDC,facility,both,1,EA,2.53,1.79,Aetna First Health,Commercial,,2.15,85,,,1.12,2.15,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 10 Each Box,63700001,CDM,,,250,RC,11523726803,NDC,facility,both,1,EA,1.86,1.32,Aetna First Health,Commercial,,1.58,85,,,0.82,1.58,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 10 Each Box,63700001,CDM,,,250,RC,41100080676,NDC,facility,both,1,EA,1.86,1.32,Aetna First Health,Commercial,,1.58,85,,,0.82,1.58,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 100 Each Box,63700001,CDM,,,250,RC,00904642281,NDC,facility,both,1,EA,2.34,1.66,Aetna First Health,Commercial,,1.99,85,,,1.04,1.99,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 100 Each Box,63700001,CDM,,,250,RC,69784018010,NDC,facility,both,1,EA,3.53,2.5,Aetna First Health,Commercial,,3,85,,,1.56,3,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 100 Each Box,63700001,CDM,,,250,RC,62559015710,NDC,facility,both,1,EA,4.68,3.31,Aetna First Health,Commercial,,3.98,85,,,2.07,3.98,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 100 Each Box,63700001,CDM,,,250,RC,60687043192,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 14 Each Box,63700001,CDM,,,250,RC,68084043098,NDC,facility,both,1,EA,2.53,1.79,Aetna First Health,Commercial,,2.15,85,,,1.12,2.15,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 14 Each Box,63700001,CDM,,,250,RC,45802086866,NDC,facility,both,1,EA,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 14 Each Box,63700001,CDM,,,250,RC,69784018014,NDC,facility,both,1,EA,3.82,2.7,Aetna First Health,Commercial,,3.25,85,,,1.69,3.25,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 14 Each Box,63700001,CDM,,,250,RC,00574041207,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 14 Each Box,63700001,CDM,,,250,RC,60687043198,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 24 Each Box,63700001,CDM,,,250,RC,11523726808,NDC,facility,both,1,EA,1.7,1.2,Aetna First Health,Commercial,,1.44,85,,,0.75,1.44,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 30 Each Box,63700001,CDM,,,250,RC,00904642213,NDC,facility,both,1,EA,2.09,1.48,Aetna First Health,Commercial,,1.78,85,,,0.93,1.78,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 30 Each Box,63700001,CDM,,,250,RC,51079030630,NDC,facility,both,1,EA,2.26,1.6,Aetna First Health,Commercial,,1.92,85,,,1,1.92,percent of total billed charges,
polyethylene glycol 3350 17 g Packet 72 Each Box,63700001,CDM,,,250,RC,17856031202,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
polysaccharide iron complex 150 MG capsule 1 Each Box,63700001,CDM,,,250,RC,51991020399,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
polysaccharide iron complex 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,63044020301,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
polysaccharide iron complex 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904539561,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
polysaccharide iron complex 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63044020361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
polysaccharide iron complex 150 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51991020311,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
potassium & sodium phosphates 280-160-250 MG Packet 1 Each Packet,63700001,CDM,,,250,RC,71351001099,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
potassium & sodium phosphates 280-160-250 MG Packet 1 Each Packet,63700001,CDM,,,250,RC,60258000615,NDC,facility,both,1,EA,0.82,0.58,Aetna First Health,Commercial,,0.7,85,,,0.36,0.7,percent of total billed charges,
potassium & sodium phosphates 280-160-250 MG Packet 100 Each Box,63700001,CDM,,,250,RC,60258000601,NDC,facility,both,1,EA,0.82,0.58,Aetna First Health,Commercial,,0.7,85,,,0.36,0.7,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084041911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 1 Each Blister,63700001,CDM,,,250,RC,60687065311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 1 Each Blister,63700001,CDM,,,250,RC,50268067111,NDC,facility,both,1,EA,3.41,2.41,Aetna First Health,Commercial,,2.9,85,,,1.51,2.9,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62037056001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68462035701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 100 Each Box,63700001,CDM,,,250,RC,00904606861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084041901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 100 Each Box,63700001,CDM,,,250,RC,00904693061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 500 Each Bottle,63700001,CDM,,,250,RC,62037056005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 10 MEQ Capsule Extended Release 500 Each Bottle,63700001,CDM,,,250,RC,68382070105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Box,63700001,CDM,,,250,RC,54288012501,NDC,facility,both,1,EA,16.21,11.48,Aetna First Health,Commercial,,13.78,85,,,7.18,13.78,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,00245036089,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,69238161701,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,60219161701,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,42806009499,NDC,facility,both,1,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,69543045101,NDC,facility,both,1,EA,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,69543037901,NDC,facility,both,1,EA,16.1,11.4,Aetna First Health,Commercial,,13.68,85,,,7.14,13.68,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,00245003589,NDC,facility,both,1,EA,16.98,12.02,Aetna First Health,Commercial,,14.43,85,,,7.53,14.43,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,43386019490,NDC,facility,both,1,EA,18.9,13.38,Aetna First Health,Commercial,,16.06,85,,,8.38,16.06,percent of total billed charges,
potassium chloride 20 MEQ Packet 1 Each Packet,63700001,CDM,,,250,RC,00603155410,NDC,facility,both,1,EA,26.57,18.81,Aetna First Health,Commercial,,22.58,85,,,11.78,22.58,percent of total billed charges,
potassium chloride 20 MEQ Packet 100 Each Box,63700001,CDM,,,250,RC,42806009401,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
potassium chloride 20 MEQ Packet 100 Each Box,63700001,CDM,,,250,RC,00245036001,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
potassium chloride 20 MEQ Packet 100 Each Box,63700001,CDM,,,250,RC,69238161708,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
potassium chloride 20 MEQ Packet 100 Each Box,63700001,CDM,,,250,RC,69543045110,NDC,facility,both,1,EA,9.84,6.97,Aetna First Health,Commercial,,8.36,85,,,4.36,8.36,percent of total billed charges,
potassium chloride 20 MEQ Packet 100 Each Box,63700001,CDM,,,250,RC,69543037910,NDC,facility,both,1,EA,16.1,11.4,Aetna First Health,Commercial,,13.68,85,,,7.14,13.68,percent of total billed charges,
potassium chloride 20 MEQ Packet 100 Each Box,63700001,CDM,,,250,RC,00603155404,NDC,facility,both,1,EA,25.24,17.87,Aetna First Health,Commercial,,21.45,85,,,11.19,21.45,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,00245036030,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,69238161703,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,60219161703,NDC,facility,both,1,EA,5.32,3.77,Aetna First Health,Commercial,,4.52,85,,,2.36,4.52,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,42806009430,NDC,facility,both,1,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,69543045130,NDC,facility,both,1,EA,9.84,6.97,Aetna First Health,Commercial,,8.36,85,,,4.36,8.36,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,76439034330,NDC,facility,both,1,EA,16.92,11.98,Aetna First Health,Commercial,,14.38,85,,,7.5,14.38,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,00245003530,NDC,facility,both,1,EA,16.98,12.02,Aetna First Health,Commercial,,14.43,85,,,7.53,14.43,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,54288012530,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,43386019430,NDC,facility,both,1,EA,19.25,13.63,Aetna First Health,Commercial,,16.36,85,,,8.53,16.36,percent of total billed charges,
potassium chloride 20 MEQ Packet 30 Each Box,63700001,CDM,,,250,RC,00603155416,NDC,facility,both,1,EA,26.57,18.81,Aetna First Health,Commercial,,22.58,85,,,11.78,22.58,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084052411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,66758016006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00574027500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00245531689,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084063211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,66758017006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00245531789,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,60687063211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,42292000401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,60687046611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245531611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62037071001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00781571001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00832532411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,70010013601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,66758016013,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00574027511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00245531601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,63739044610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084063201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00245531701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00904721661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084052401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 500 Each Bottle,63700001,CDM,,,250,RC,68001036703,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 10 MEQ Tablet Extended Release 80 Each Box,63700001,CDM,,,250,RC,42292000408,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00245005889,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,68084036011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,66758019006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00245531989,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,60687075611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245005801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00781572001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68001023500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,66758019001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245531911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00832532511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68001044500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,62037099901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,69238106901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,70010013501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68001056700,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,63739044710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,68084036001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,66758019013,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,00245531901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,63739097310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 500 Each Bottle,63700001,CDM,,,250,RC,00781572005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 500 Each Bottle,63700001,CDM,,,250,RC,68001023503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 500 Each Bottle,63700001,CDM,,,250,RC,68001044503,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 80 Each Box,63700001,CDM,,,250,RC,68084036009,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 80 Each Box,63700001,CDM,,,250,RC,60687075609,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 20 MEQ Tablet Extended Release 90 Each Bottle,63700001,CDM,,,250,RC,66758019092,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00245004089,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,00245531589,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 10 Each Box,63700001,CDM,,,250,RC,66758011006,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245004011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00781151601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00574027401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245531511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride CR 8 MEQ Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,66758011013,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium citrate 5 MEQ (540 MG) Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68382053601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium citrate 5 MEQ (540 MG) Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,31722012901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium citrate 5 MEQ (540 MG) Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00245007011,NDC,facility,both,1,EA,3.53,2.5,Aetna First Health,Commercial,,3,85,,,1.56,3,percent of total billed charges,
potassium gluconate 595 (99 K) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,74312001110,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
potassium phosphate monobasic 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00486111101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.125 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084079395,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.125 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084079325,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.125 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,13668009190,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.125 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68462033090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pramipexole 0.125 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,33342003110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00002512301,NDC,facility,both,1,EA,34.34,24.31,Aetna First Health,Commercial,,29.19,85,,,15.22,29.19,percent of total billed charges,
prasugrel 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877060530,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862083030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162000203,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505464303,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729027310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002475930,NDC,facility,both,1,EA,22.33,15.81,Aetna First Health,Commercial,,18.98,85,,,9.9,18.98,percent of total billed charges,
prasugrel 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002512330,NDC,facility,both,1,EA,53.55,37.91,Aetna First Health,Commercial,,45.52,85,,,23.73,45.52,percent of total billed charges,
prasugrel 10 MG Tablet 90 Each Box,63700001,CDM,,,250,RC,00002512377,NDC,facility,both,1,EA,34.34,24.31,Aetna First Health,Commercial,,29.19,85,,,15.22,29.19,percent of total billed charges,
prasugrel 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00002512101,NDC,facility,both,1,EA,53.55,37.91,Aetna First Health,Commercial,,45.52,85,,,23.73,45.52,percent of total billed charges,
prasugrel 5 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,00002512152,NDC,facility,both,1,EA,53.55,37.91,Aetna First Health,Commercial,,45.52,85,,,23.73,45.52,percent of total billed charges,
prasugrel 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505464203,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729027210,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prasugrel 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002512130,NDC,facility,both,1,EA,53.55,37.91,Aetna First Health,Commercial,,45.52,85,,,23.73,45.52,percent of total billed charges,
pravastatin 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687016911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904589161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687016901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 10 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68180048502,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68180048509,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,55111022990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505016809,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382007016,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084050111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pravastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079078201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 1 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084099611,NDC,facility,both,1,EA,5.21,3.69,Aetna First Health,Commercial,,4.43,85,,,2.31,4.43,percent of total billed charges,
prazosin 1 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079063001,NDC,facility,both,1,EA,5.29,3.75,Aetna First Health,Commercial,,4.5,85,,,2.34,4.5,percent of total billed charges,
prazosin 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378110101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093406701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 1 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904702061,NDC,facility,both,1,EA,4.72,3.34,Aetna First Health,Commercial,,4.01,85,,,2.09,4.01,percent of total billed charges,
prazosin 1 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084099601,NDC,facility,both,1,EA,5.21,3.69,Aetna First Health,Commercial,,4.43,85,,,2.31,4.43,percent of total billed charges,
prazosin 1 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079063020,NDC,facility,both,1,EA,5.29,3.75,Aetna First Health,Commercial,,4.5,85,,,2.34,4.5,percent of total billed charges,
prazosin 1 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,59762531001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 1 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,66993043185,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prazosin 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079063201,NDC,facility,both,1,EA,12.57,8.9,Aetna First Health,Commercial,,10.68,85,,,5.57,10.68,percent of total billed charges,
pregabalin 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687047311,NDC,facility,both,1,EA,4.71,3.33,Aetna First Health,Commercial,,4,85,,,2.09,4,percent of total billed charges,
pregabalin 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904699161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687047301,NDC,facility,both,1,EA,4.71,3.33,Aetna First Health,Commercial,,4,85,,,2.09,4,percent of total billed charges,
pregabalin 25 MG capsule 30 Each Box,63700001,CDM,,,250,RC,00904699104,NDC,facility,both,1,EA,4.62,3.27,Aetna First Health,Commercial,,3.93,85,,,2.05,3.93,percent of total billed charges,
pregabalin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,62332011990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,72205001190,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,31722061090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,43598029190,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,50228035090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,69097067705,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pregabalin 25 MG capsule 90 Each Bottle,63700001,CDM,,,250,RC,00071101268,NDC,facility,both,1,EA,35.42,25.08,Aetna First Health,Commercial,,30.11,85,,,15.7,30.11,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162066810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60258018301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42291068601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,39328010610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76439025810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,75834005001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69543025810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,63044015001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58657017001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69367026701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13811051910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal plus vitamin with folic acid 1 mg 27-1 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,69543025850,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
prenatal vitamin 27-0.8 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333071525,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
prenatal vitamin 27-0.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904531360,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
prenatal vitamin 27-0.8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904531361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
prenatal vitamin Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,60258019701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PreserVision AREDS 2 capsule 60 Each Bottle,63700001,CDM,,,250,RC,24208069760,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
primaquine 26.3 (15 Base) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385010201,NDC,facility,both,1,EA,4.68,3.31,Aetna First Health,Commercial,,3.98,85,,,2.07,3.98,percent of total billed charges,
primaquine 26.3 (15 Base) MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00024159601,NDC,facility,both,1,EA,7.16,5.07,Aetna First Health,Commercial,,6.09,85,,,3.17,6.09,percent of total billed charges,
primaquine 26.3 (15 Base) MG Tablet 14 Each Bottle,63700001,CDM,,,250,RC,43063022514,NDC,facility,both,1,EA,7.65,5.42,Aetna First Health,Commercial,,6.5,85,,,3.39,6.5,percent of total billed charges,
primidone 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020311,NDC,facility,both,1,EA,3.05,2.16,Aetna First Health,Commercial,,2.59,85,,,1.35,2.59,percent of total billed charges,
primidone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268068611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527130101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904555960,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603537121,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746054401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162054410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084020201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
primidone 50 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268068615,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
probenecid 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084094595,NDC,facility,both,1,EA,4.77,3.38,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
probenecid 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378015601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
probenecid 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591534701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
probenecid 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527136701,NDC,facility,both,1,EA,7.05,4.99,Aetna First Health,Commercial,,5.99,85,,,3.12,5.99,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,17478076610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70700016201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42291069001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65162080710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59651015201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,43598034901,NDC,facility,both,1,EA,3.82,2.7,Aetna First Health,Commercial,,3.25,85,,,1.69,3.25,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093535301,NDC,facility,both,1,EA,5.97,4.23,Aetna First Health,Commercial,,5.07,85,,,2.65,5.07,percent of total billed charges,
progesterone 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,10888713502,NDC,facility,both,1,EA,5.97,4.23,Aetna First Health,Commercial,,5.07,85,,,2.65,5.07,percent of total billed charges,
progesterone 100 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,72989037230,NDC,facility,both,1,EA,58.36,41.32,Aetna First Health,Commercial,,49.61,85,,,25.87,49.61,percent of total billed charges,
promethazine 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084015411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 12.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687066011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001016100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382004001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 12.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162074510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084015401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 12.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687066001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine 25 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00591216139,NDC,facility,both,1,EA,38.99,27.6,Aetna First Health,Commercial,,33.14,85,,,17.28,33.14,percent of total billed charges,
promethazine 25 MG Tablet 1 Each Blister,63700001,CDM,Q0169,CPT,250,RC,68084015511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079099601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687053711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687070911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084036111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591058201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559023001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489055101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603544821,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079099620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084036101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739050910,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propafenone 150 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687053701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687058711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591555401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155011001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603548221,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378018201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115165901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238207701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904655061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687058701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904041161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 10 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268070015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079027801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079027901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084050311,NDC,facility,both,1,EA,6.97,4.93,Aetna First Health,Commercial,,5.92,85,,,3.09,5.92,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687021511,NDC,facility,both,1,EA,6.98,4.94,Aetna First Health,Commercial,,5.93,85,,,3.09,5.93,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,51991081701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62559053001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00527411637,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378616001,NDC,facility,both,1,EA,3.25,2.3,Aetna First Health,Commercial,,2.76,85,,,1.44,2.76,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,43478090088,NDC,facility,both,1,EA,5.86,4.15,Aetna First Health,Commercial,,4.98,85,,,2.6,4.98,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00228277811,NDC,facility,both,1,EA,5.89,4.17,Aetna First Health,Commercial,,5.01,85,,,2.61,5.01,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00245008411,NDC,facility,both,1,EA,5.89,4.17,Aetna First Health,Commercial,,5.01,85,,,2.61,5.01,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084050301,NDC,facility,both,1,EA,6.98,4.94,Aetna First Health,Commercial,,5.93,85,,,3.09,5.93,percent of total billed charges,
propranolol LA 60 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,60687021501,NDC,facility,both,1,EA,6.98,4.94,Aetna First Health,Commercial,,5.93,85,,,3.09,5.93,percent of total billed charges,
propranolol LA 80 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084050411,NDC,facility,both,1,EA,8.02,5.68,Aetna First Health,Commercial,,6.82,85,,,3.55,6.82,percent of total billed charges,
propylthiouracil 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084096495,NDC,facility,both,1,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
propylthiouracil 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00143148001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propylthiouracil 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253065110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propylthiouracil 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228234810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
propylthiouracil 50 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084096425,NDC,facility,both,1,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
Prosight Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00904773518,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Prosight Tablet 130 Each Bottle,63700001,CDM,,,250,RC,80681016000,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Prosight Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00904773552,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 10 Each Box,63700001,CDM,,,250,RC,45802010752,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 10 Each Box,63700001,CDM,,,250,RC,00904580315,NDC,facility,both,1,EA,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 10 Each Box,63700001,CDM,,,250,RC,00904675415,NDC,facility,both,1,EA,0.59,0.42,Aetna First Health,Commercial,,0.5,85,,,0.26,0.5,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 10 Each Box,63700001,CDM,,,250,RC,50580067010,NDC,facility,both,1,EA,0.6,0.42,Aetna First Health,Commercial,,0.51,85,,,0.27,0.51,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 10 Each Box,63700001,CDM,,,250,RC,24385005452,NDC,facility,both,1,EA,0.61,0.43,Aetna First Health,Commercial,,0.52,85,,,0.27,0.52,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,46122016660,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,51660020421,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 120 MG Tablet Extended Release 12 Hour 20 Each Box,63700001,CDM,,,250,RC,00081067020,NDC,facility,both,1,EA,0.69,0.49,Aetna First Health,Commercial,,0.59,85,,,0.31,0.59,percent of total billed charges,
pseudoephedrine 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904505359,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904505360,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904633860,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904699061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pseudoephedrine 30 MG Tablet 24 Each Bottle,63700001,CDM,,,250,RC,00904505324,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,45802043262,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,46122042862,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,00904633724,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 24 Each Box,63700001,CDM,,,250,RC,00536360735,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 96 Each Box,63700001,CDM,,,250,RC,24385043280,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
pseudoephedrine 30 MG Tablet 96 Each Box,63700001,CDM,,,250,RC,87701091090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
pseudoePHEDrine-guaiFENesin SR 60-600 MG Tablet Extended Release 12 Hour 36 Each Box,63700001,CDM,,,250,RC,63824005736,NDC,facility,both,1,EA,0.9,0.64,Aetna First Health,Commercial,,0.76,85,,,0.4,0.76,percent of total billed charges,
psyllium 100 % Packet 1 Each Package,63700001,CDM,,,250,RC,00224180100,NDC,facility,both,1,EA,0.65,0.46,Aetna First Health,Commercial,,0.55,85,,,0.29,0.55,percent of total billed charges,
psyllium 100 % Packet 30 Each Package,63700001,CDM,,,250,RC,00224180184,NDC,facility,both,1,EA,0.64,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
psyllium 25 % Packet 1 Each Packet,63700001,CDM,,,250,RC,37000002310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
psyllium 25 % Packet 30 Each Box,63700001,CDM,,,250,RC,37000074087,NDC,facility,both,1,EA,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
psyllium 25 % Packet 30 Each Box,63700001,CDM,,,250,RC,37000002304,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
psyllium 28.3 % Packet 1 Each Box,63700001,CDM,,,250,RC,00224185200,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
psyllium 28.3 % Packet 30 Each Box,63700001,CDM,,,250,RC,00224185213,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
psyllium 28.3 % Packet 30 Each Box,63700001,CDM,,,250,RC,00224185281,NDC,facility,both,1,EA,0.64,0.45,Aetna First Health,Commercial,,0.54,85,,,0.28,0.54,percent of total billed charges,
psyllium 51.7 % Packet 1 Each Package,63700001,CDM,,,250,RC,37000002410,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
psyllium 51.7 % Packet 30 Each Box,63700001,CDM,,,250,RC,37000002404,NDC,facility,both,1,EA,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
pyrazinamide 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687013811,NDC,facility,both,1,EA,8.03,5.69,Aetna First Health,Commercial,,6.83,85,,,3.56,6.83,percent of total billed charges,
pyrazinamide 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67253066010,NDC,facility,both,1,EA,7.84,5.55,Aetna First Health,Commercial,,6.66,85,,,3.47,6.66,percent of total billed charges,
pyrazinamide 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,61748001201,NDC,facility,both,1,EA,17.23,12.2,Aetna First Health,Commercial,,14.65,85,,,7.64,14.65,percent of total billed charges,
pyrazinamide 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687013801,NDC,facility,both,1,EA,8.03,5.69,Aetna First Health,Commercial,,6.83,85,,,3.56,6.83,percent of total billed charges,
pyrazinamide 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,61748001211,NDC,facility,both,1,EA,8.27,5.86,Aetna First Health,Commercial,,7.03,85,,,3.67,7.03,percent of total billed charges,
pyrazinamide 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904669661,NDC,facility,both,1,EA,10.17,7.2,Aetna First Health,Commercial,,8.64,85,,,4.51,8.64,percent of total billed charges,
pyrazinamide 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,61748001206,NDC,facility,both,1,EA,8.04,5.69,Aetna First Health,Commercial,,6.83,85,,,3.56,6.83,percent of total billed charges,
pyrazinamide 500 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,70954048410,NDC,facility,both,1,EA,15.91,11.26,Aetna First Health,Commercial,,13.52,85,,,7.05,13.52,percent of total billed charges,
pyrazinamide 500 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,70954048420,NDC,facility,both,1,EA,15.82,11.2,Aetna First Health,Commercial,,13.45,85,,,7.01,13.45,percent of total billed charges,
pyrazinamide 500 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,61748001209,NDC,facility,both,1,EA,17.57,12.44,Aetna First Health,Commercial,,14.93,85,,,7.79,14.93,percent of total billed charges,
pyRIDostigmine 60 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084049401,NDC,facility,both,1,EA,4.84,3.43,Aetna First Health,Commercial,,4.11,85,,,2.15,4.11,percent of total billed charges,
pyRIDostigmine ER 180 MG Tablet Extended Release 30 Each Bottle,63700001,CDM,,,250,RC,47781033530,NDC,facility,both,1,EA,56.44,39.96,Aetna First Health,Commercial,,47.97,85,,,25.01,47.97,percent of total billed charges,
pyRIDostigmine ER 180 MG Tablet Extended Release 30 Each Bottle,63700001,CDM,,,250,RC,00187301330,NDC,facility,both,1,EA,69.99,49.55,Aetna First Health,Commercial,,59.49,85,,,31.02,59.49,percent of total billed charges,
pyRIDostigmine ER 180 MG Tablet Extended Release 30 Each Bottle,63700001,CDM,,,250,RC,68682030130,NDC,facility,both,1,EA,72.43,51.28,Aetna First Health,Commercial,,61.57,85,,,32.1,61.57,percent of total billed charges,
pyridoxine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536440601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
QUEtiapine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053211,NDC,facility,both,1,EA,3.41,2.41,Aetna First Health,Commercial,,2.9,85,,,1.51,2.9,percent of total billed charges,
QUEtiapine 200 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053311,NDC,facility,both,1,EA,6.3,4.46,Aetna First Health,Commercial,,5.36,85,,,2.79,5.36,percent of total billed charges,
QUEtiapine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268063011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687032711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180044501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67877024201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001018500,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714045201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729014501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093206301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505313001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00310027510,NDC,facility,both,1,EA,13.6,9.63,Aetna First Health,Commercial,,11.56,85,,,6.03,11.56,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904627761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904663861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687032701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00310027539,NDC,facility,both,1,EA,13.6,9.63,Aetna First Health,Commercial,,11.56,85,,,6.03,11.56,percent of total billed charges,
QUEtiapine 25 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268063015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084053411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904627861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904680361,NDC,facility,both,1,EA,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00310028239,NDC,facility,both,1,EA,52.6,37.24,Aetna First Health,Commercial,,44.71,85,,,23.31,44.71,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,16729009512,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,68001051306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,52817016260,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,50742063760,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00310828260,NDC,facility,both,1,EA,3.09,2.19,Aetna First Health,Commercial,,2.63,85,,,1.37,2.63,percent of total billed charges,
QUEtiapine XR 200 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00310028260,NDC,facility,both,1,EA,56.81,40.22,Aetna First Health,Commercial,,48.29,85,,,25.18,48.29,percent of total billed charges,
quiNINE sulfate 324 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,50742023830,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
quiNINE sulfate 324 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,53489070007,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
quiNINE sulfate 324 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,68180056006,NDC,facility,both,1,EA,19.8,14.02,Aetna First Health,Commercial,,16.83,85,,,8.78,16.83,percent of total billed charges,
quiNINE sulfate 324 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,13310015307,NDC,facility,both,1,EA,22.92,16.23,Aetna First Health,Commercial,,19.48,85,,,10.16,19.48,percent of total billed charges,
RABEprazole 20 MG Tablet Delayed Release 30 Each Bottle,63700001,CDM,,,250,RC,62856024330,NDC,facility,both,1,EA,48.97,34.67,Aetna First Health,Commercial,,41.62,85,,,21.7,41.62,percent of total billed charges,
raloxifene 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268069411,NDC,facility,both,1,EA,10.89,7.71,Aetna First Health,Commercial,,9.26,85,,,4.83,9.26,percent of total billed charges,
raloxifene 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687026611,NDC,facility,both,1,EA,19.96,14.13,Aetna First Health,Commercial,,16.97,85,,,8.85,16.97,percent of total billed charges,
raloxifene 60 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084087111,NDC,facility,both,1,EA,19.96,14.13,Aetna First Health,Commercial,,16.97,85,,,8.85,16.97,percent of total billed charges,
raloxifene 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69097082507,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
raloxifene 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862070901,NDC,facility,both,1,EA,4.04,2.86,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
raloxifene 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43598050501,NDC,facility,both,1,EA,8.09,5.73,Aetna First Health,Commercial,,6.88,85,,,3.59,6.88,percent of total billed charges,
raloxifene 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,66993041702,NDC,facility,both,1,EA,20.77,14.71,Aetna First Health,Commercial,,17.65,85,,,9.21,17.65,percent of total billed charges,
raloxifene 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00002418402,NDC,facility,both,1,EA,23.1,16.35,Aetna First Health,Commercial,,19.64,85,,,10.24,19.64,percent of total billed charges,
raloxifene 60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00002416502,NDC,facility,both,1,EA,23.1,16.35,Aetna First Health,Commercial,,19.64,85,,,10.24,19.64,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162005703,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862070930,NDC,facility,both,1,EA,4.04,2.86,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598050530,NDC,facility,both,1,EA,8.09,5.73,Aetna First Health,Commercial,,6.88,85,,,3.59,6.88,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093729056,NDC,facility,both,1,EA,13.53,9.58,Aetna First Health,Commercial,,11.5,85,,,6,11.5,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722025630,NDC,facility,both,1,EA,19.96,14.13,Aetna First Health,Commercial,,16.97,85,,,8.85,16.97,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,66993041730,NDC,facility,both,1,EA,20.77,14.71,Aetna First Health,Commercial,,17.65,85,,,9.21,17.65,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002416530,NDC,facility,both,1,EA,23.1,16.35,Aetna First Health,Commercial,,19.64,85,,,10.24,19.64,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00002418430,NDC,facility,both,1,EA,23.1,16.35,Aetna First Health,Commercial,,19.64,85,,,10.24,19.64,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687026621,NDC,facility,both,1,EA,19.96,14.13,Aetna First Health,Commercial,,16.97,85,,,8.85,16.97,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084087121,NDC,facility,both,1,EA,19.96,14.13,Aetna First Health,Commercial,,16.97,85,,,8.85,16.97,percent of total billed charges,
raloxifene 60 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904690204,NDC,facility,both,1,EA,23.36,16.54,Aetna First Health,Commercial,,19.86,85,,,10.35,19.86,percent of total billed charges,
raloxifene 60 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268069415,NDC,facility,both,1,EA,10.88,7.7,Aetna First Health,Commercial,,9.25,85,,,4.82,9.25,percent of total billed charges,
Raltegravir 400 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00006022761,NDC,facility,both,1,EA,116.48,82.47,Aetna First Health,Commercial,,99.01,85,,,51.62,99.01,percent of total billed charges,
ramelteon 8 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268070811,NDC,facility,both,1,EA,13.69,9.69,Aetna First Health,Commercial,,11.64,85,,,6.07,11.64,percent of total billed charges,
ramelteon 8 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687069211,NDC,facility,both,1,EA,13.72,9.71,Aetna First Health,Commercial,,11.66,85,,,6.08,11.66,percent of total billed charges,
ramelteon 8 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64764080510,NDC,facility,both,1,EA,45.38,32.13,Aetna First Health,Commercial,,38.57,85,,,20.11,38.57,percent of total billed charges,
ramelteon 8 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,52817023530,NDC,facility,both,1,EA,3.96,2.8,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
ramelteon 8 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,70710134403,NDC,facility,both,1,EA,6.73,4.76,Aetna First Health,Commercial,,5.72,85,,,2.98,5.72,percent of total billed charges,
ramelteon 8 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43598074130,NDC,facility,both,1,EA,34.04,24.1,Aetna First Health,Commercial,,28.93,85,,,15.09,28.93,percent of total billed charges,
ramelteon 8 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764080530,NDC,facility,both,1,EA,45.39,32.14,Aetna First Health,Commercial,,38.58,85,,,20.12,38.58,percent of total billed charges,
ramelteon 8 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,60687069265,NDC,facility,both,1,EA,13.72,9.71,Aetna First Health,Commercial,,11.66,85,,,6.08,11.66,percent of total billed charges,
ramipril 1.25 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,16252057030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ramipril 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001014100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Ranolazine ER 1000 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,50228042460,NDC,facility,both,1,EA,4.08,2.89,Aetna First Health,Commercial,,3.47,85,,,1.81,3.47,percent of total billed charges,
ranolazine ER 500 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687054911,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
ranolazine ER 500 MG Tablet Extended Release 12 Hour 1 Each Blister,63700001,CDM,,,250,RC,50268072211,NDC,facility,both,1,EA,5.52,3.91,Aetna First Health,Commercial,,4.69,85,,,2.45,4.69,percent of total billed charges,
ranolazine ER 500 MG Tablet Extended Release 12 Hour 30 Each Box,63700001,CDM,,,250,RC,60687054921,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
ranolazine ER 500 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,27241012502,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ranolazine ER 500 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,50228042360,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ranolazine ER 500 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,67877052560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ranolazine ER 500 MG Tablet Extended Release 12 Hour 60 Each Bottle,63700001,CDM,,,250,RC,61958100301,NDC,facility,both,1,EA,23.99,16.98,Aetna First Health,Commercial,,20.39,85,,,10.63,20.39,percent of total billed charges,
rasagiline 0.5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68546014256,NDC,facility,both,1,EA,61.31,43.41,Aetna First Health,Commercial,,52.11,85,,,27.17,52.11,percent of total billed charges,
repaglinide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00574024001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
repaglinide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862067001,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
repaglinide 0.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00169008181,NDC,facility,both,1,EA,18.13,12.84,Aetna First Health,Commercial,,15.41,85,,,8.04,15.41,percent of total billed charges,
repaglinide 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00169008481,NDC,facility,both,1,EA,18.13,12.84,Aetna First Health,Commercial,,15.41,85,,,8.04,15.41,percent of total billed charges,
ribavirin 200 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084017911,NDC,facility,both,1,EA,6.51,4.61,Aetna First Health,Commercial,,5.53,85,,,2.89,5.53,percent of total billed charges,
ribavirin 200 MG capsule 50 Each Box,63700001,CDM,,,250,RC,68084017965,NDC,facility,both,1,EA,6.51,4.61,Aetna First Health,Commercial,,5.53,85,,,2.89,5.53,percent of total billed charges,
ribavirin 200 MG capsule 84 Each Bottle,63700001,CDM,,,250,RC,68382026012,NDC,facility,both,1,EA,4.67,3.31,Aetna First Health,Commercial,,3.97,85,,,2.07,3.97,percent of total billed charges,
ribavirin 200 MG Tablet 168 Each Bottle,63700001,CDM,,,250,RC,65862020768,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rifabutin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70954004110,NDC,facility,both,1,EA,44.09,31.22,Aetna First Health,Commercial,,37.48,85,,,19.54,37.48,percent of total billed charges,
rifabutin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68180028501,NDC,facility,both,1,EA,48.98,34.68,Aetna First Health,Commercial,,41.63,85,,,21.71,41.63,percent of total billed charges,
rifabutin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59762135001,NDC,facility,both,1,EA,48.98,34.68,Aetna First Health,Commercial,,41.63,85,,,21.71,41.63,percent of total billed charges,
rifabutin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00013530117,NDC,facility,both,1,EA,65.52,46.39,Aetna First Health,Commercial,,55.69,85,,,29.04,55.69,percent of total billed charges,
riFAMpin 150 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084035711,NDC,facility,both,1,EA,5.57,3.94,Aetna First Health,Commercial,,4.73,85,,,2.47,4.73,percent of total billed charges,
riFAMpin 150 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687057511,NDC,facility,both,1,EA,11.17,7.91,Aetna First Health,Commercial,,9.49,85,,,4.95,9.49,percent of total billed charges,
riFAMpin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00185080101,NDC,facility,both,1,EA,9.08,6.43,Aetna First Health,Commercial,,7.72,85,,,4.02,7.72,percent of total billed charges,
riFAMpin 150 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527139301,NDC,facility,both,1,EA,9.08,6.43,Aetna First Health,Commercial,,7.72,85,,,4.02,7.72,percent of total billed charges,
riFAMpin 150 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,61748001530,NDC,facility,both,1,EA,3.45,2.44,Aetna First Health,Commercial,,2.93,85,,,1.53,2.93,percent of total billed charges,
riFAMpin 150 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00527139330,NDC,facility,both,1,EA,4.61,3.26,Aetna First Health,Commercial,,3.92,85,,,2.04,3.92,percent of total billed charges,
riFAMpin 150 MG capsule 30 Each Bottle,63700001,CDM,,,250,RC,00185080130,NDC,facility,both,1,EA,9.08,6.43,Aetna First Health,Commercial,,7.72,85,,,4.02,7.72,percent of total billed charges,
riFAMpin 150 MG capsule 30 Each Box,63700001,CDM,,,250,RC,68084035721,NDC,facility,both,1,EA,5.58,3.95,Aetna First Health,Commercial,,4.74,85,,,2.47,4.74,percent of total billed charges,
riFAMpin 150 MG capsule 30 Each Box,63700001,CDM,,,250,RC,60687057521,NDC,facility,both,1,EA,11.15,7.89,Aetna First Health,Commercial,,9.48,85,,,4.94,9.48,percent of total billed charges,
rifAMPin 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079089001,NDC,facility,both,1,EA,7.98,5.65,Aetna First Health,Commercial,,6.78,85,,,3.54,6.78,percent of total billed charges,
rifAMPin 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079089020,NDC,facility,both,1,EA,7.98,5.65,Aetna First Health,Commercial,,6.78,85,,,3.54,6.78,percent of total billed charges,
rifAXIMin 200 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65649030141,NDC,facility,both,1,EA,46.78,33.12,Aetna First Health,Commercial,,39.76,85,,,20.73,39.76,percent of total billed charges,
rifAXIMin 200 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65649030103,NDC,facility,both,1,EA,37.07,26.25,Aetna First Health,Commercial,,31.51,85,,,16.43,31.51,percent of total billed charges,
rifAXIMin 550 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,65649030302,NDC,facility,both,1,EA,190.59,134.94,Aetna First Health,Commercial,,162,85,,,84.47,162,percent of total billed charges,
rifAXIMin 550 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,65649030303,NDC,facility,both,1,EA,190.59,134.94,Aetna First Health,Commercial,,162,85,,,84.47,162,percent of total billed charges,
riluzole 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084090895,NDC,facility,both,1,EA,15.1,10.69,Aetna First Health,Commercial,,12.84,85,,,6.69,12.84,percent of total billed charges,
riluzole 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,67877028660,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
riluzole 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68462038160,NDC,facility,both,1,EA,4.62,3.27,Aetna First Health,Commercial,,3.93,85,,,2.05,3.93,percent of total billed charges,
riluzole 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00075770060,NDC,facility,both,1,EA,121.1,85.74,Aetna First Health,Commercial,,102.93,85,,,53.67,102.93,percent of total billed charges,
risperiDONE 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079046001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084027011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079046020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084027001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904635761,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458059010,NDC,facility,both,1,EA,5.89,4.17,Aetna First Health,Commercial,,5.01,85,,,2.61,5.01,percent of total billed charges,
risperiDONE 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458030101,NDC,facility,both,1,EA,24.65,17.45,Aetna First Health,Commercial,,20.95,85,,,10.92,20.95,percent of total billed charges,
risperiDONE 0.25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,27241000250,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382011214,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,27241000206,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,43547033906,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50458059060,NDC,facility,both,1,EA,3.82,2.7,Aetna First Health,Commercial,,3.25,85,,,1.69,3.25,percent of total billed charges,
risperiDONE 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084027111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079046101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084027101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904635861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079046120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458030201,NDC,facility,both,1,EA,27.06,19.16,Aetna First Health,Commercial,,23,85,,,11.99,23,percent of total billed charges,
risperiDONE 0.5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382011314,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
risperiDONE 0.5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50458059160,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,00781531006,NDC,facility,both,1,EA,11.3,8,Aetna First Health,Commercial,,9.6,85,,,5.01,9.6,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884031152,NDC,facility,both,1,EA,12.24,8.67,Aetna First Health,Commercial,,10.4,85,,,5.42,10.4,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,00781531008,NDC,facility,both,1,EA,11.3,8,Aetna First Health,Commercial,,9.6,85,,,5.01,9.6,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,49884031191,NDC,facility,both,1,EA,12.24,8.67,Aetna First Health,Commercial,,10.4,85,,,5.42,10.4,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,50458060128,NDC,facility,both,1,EA,13.73,9.72,Aetna First Health,Commercial,,11.67,85,,,6.09,11.67,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 28 Each Box,63700001,CDM,,,250,RC,50458039528,NDC,facility,both,1,EA,28.27,20.02,Aetna First Health,Commercial,,24.03,85,,,12.53,24.03,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,59746001032,NDC,facility,both,1,EA,5.81,4.11,Aetna First Health,Commercial,,4.94,85,,,2.57,4.94,percent of total billed charges,
risperiDONE 0.5 MG Tablet Disintegrating 30 Each Box,63700001,CDM,,,250,RC,49884031155,NDC,facility,both,1,EA,12.24,8.67,Aetna First Health,Commercial,,10.4,85,,,5.42,10.4,percent of total billed charges,
risperiDONE 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079046201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ritonavir 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687042095,NDC,facility,both,1,EA,32.81,23.23,Aetna First Health,Commercial,,27.89,85,,,14.54,27.89,percent of total billed charges,
ritonavir 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722059730,NDC,facility,both,1,EA,9.33,6.61,Aetna First Health,Commercial,,7.93,85,,,4.14,7.93,percent of total billed charges,
ritonavir 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00054040713,NDC,facility,both,1,EA,18.67,13.22,Aetna First Health,Commercial,,15.87,85,,,8.27,15.87,percent of total billed charges,
ritonavir 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382069606,NDC,facility,both,1,EA,25.92,18.35,Aetna First Health,Commercial,,22.03,85,,,11.49,22.03,percent of total billed charges,
ritonavir 100 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00074333330,NDC,facility,both,1,EA,30,21.24,Aetna First Health,Commercial,,25.5,85,,,13.3,25.5,percent of total billed charges,
ritonavir 100 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687042025,NDC,facility,both,1,EA,32.81,23.23,Aetna First Health,Commercial,,27.89,85,,,14.54,27.89,percent of total billed charges,
rivaroxaban 10 MG Tablet 1 Each Box,63700001,CDM,,,250,RC,50458058001,NDC,facility,both,1,EA,54.83,38.82,Aetna First Health,Commercial,,46.61,85,,,24.3,46.61,percent of total billed charges,
rivaroxaban 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458058010,NDC,facility,both,1,EA,66.45,47.05,Aetna First Health,Commercial,,56.48,85,,,29.45,56.48,percent of total billed charges,
rivaroxaban 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,50458058030,NDC,facility,both,1,EA,66.45,47.05,Aetna First Health,Commercial,,56.48,85,,,29.45,56.48,percent of total billed charges,
rivaroxaban 10 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,50458058090,NDC,facility,both,1,EA,66.45,47.05,Aetna First Health,Commercial,,56.48,85,,,29.45,56.48,percent of total billed charges,
rivaroxaban 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,50458057930,NDC,facility,both,1,EA,66.45,47.05,Aetna First Health,Commercial,,56.48,85,,,29.45,56.48,percent of total billed charges,
rivastigmine 1.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084055011,NDC,facility,both,1,EA,10.16,7.19,Aetna First Health,Commercial,,8.64,85,,,4.5,8.64,percent of total billed charges,
rivastigmine 1.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687057411,NDC,facility,both,1,EA,10.16,7.19,Aetna First Health,Commercial,,8.64,85,,,4.5,8.64,percent of total billed charges,
rivastigmine 1.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687077711,NDC,facility,both,1,EA,11.61,8.22,Aetna First Health,Commercial,,9.87,85,,,5.15,9.87,percent of total billed charges,
rivastigmine 1.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084055001,NDC,facility,both,1,EA,10.16,7.19,Aetna First Health,Commercial,,8.64,85,,,4.5,8.64,percent of total billed charges,
rivastigmine 1.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687057401,NDC,facility,both,1,EA,10.16,7.19,Aetna First Health,Commercial,,8.64,85,,,4.5,8.64,percent of total billed charges,
rivastigmine 1.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904710761,NDC,facility,both,1,EA,11.49,8.13,Aetna First Health,Commercial,,9.77,85,,,5.09,9.77,percent of total billed charges,
rivastigmine 1.5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739057610,NDC,facility,both,1,EA,11.77,8.33,Aetna First Health,Commercial,,10,85,,,5.22,10,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,55111035260,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,72241001103,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,62332006360,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,33342008909,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,65862064860,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,51991079306,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00781261460,NDC,facility,both,1,EA,11.88,8.41,Aetna First Health,Commercial,,10.1,85,,,5.27,10.1,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00591320860,NDC,facility,both,1,EA,11.88,8.41,Aetna First Health,Commercial,,10.1,85,,,5.27,10.1,percent of total billed charges,
rivastigmine 1.5 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00078032344,NDC,facility,both,1,EA,20.06,14.2,Aetna First Health,Commercial,,17.05,85,,,8.89,17.05,percent of total billed charges,
Rivastigmine 13.3 MG/24HR Patch 24 Hour 1 Each Packet,63700001,CDM,,,250,RC,00781731358,NDC,facility,both,1,EA,47.31,33.5,Aetna First Health,Commercial,,40.21,85,,,20.97,40.21,percent of total billed charges,
Rivastigmine 13.3 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00781731331,NDC,facility,both,1,EA,47.31,33.5,Aetna First Health,Commercial,,40.21,85,,,20.97,40.21,percent of total billed charges,
rivastigmine 4.6 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00781730458,NDC,facility,both,1,EA,47.31,33.5,Aetna First Health,Commercial,,40.21,85,,,20.97,40.21,percent of total billed charges,
rivastigmine 4.6 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00078050161,NDC,facility,both,1,EA,52.57,37.22,Aetna First Health,Commercial,,44.68,85,,,23.3,44.68,percent of total billed charges,
rivastigmine 4.6 MG/24HR Patch 24 Hour 1 Each Packet,63700001,CDM,,,250,RC,00378907016,NDC,facility,both,1,EA,5.85,4.14,Aetna First Health,Commercial,,4.97,85,,,2.59,4.97,percent of total billed charges,
rivastigmine 4.6 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00378907093,NDC,facility,both,1,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
rivastigmine 4.6 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,70710119607,NDC,facility,both,1,EA,14.89,10.54,Aetna First Health,Commercial,,12.66,85,,,6.6,12.66,percent of total billed charges,
rivastigmine 4.6 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00781730431,NDC,facility,both,1,EA,47.31,33.5,Aetna First Health,Commercial,,40.21,85,,,20.97,40.21,percent of total billed charges,
rivastigmine 4.6 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00078050115,NDC,facility,both,1,EA,52.57,37.22,Aetna First Health,Commercial,,44.68,85,,,23.3,44.68,percent of total billed charges,
rivastigmine 9.5 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00078050261,NDC,facility,both,1,EA,60.08,42.54,Aetna First Health,Commercial,,51.07,85,,,26.63,51.07,percent of total billed charges,
rivastigmine 9.5 MG/24HR Patch 24 Hour 1 Each Packet,63700001,CDM,,,250,RC,00378907116,NDC,facility,both,1,EA,5.85,4.14,Aetna First Health,Commercial,,4.97,85,,,2.59,4.97,percent of total billed charges,
rivastigmine 9.5 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00378907193,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
rivastigmine 9.5 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00078050215,NDC,facility,both,1,EA,60.08,42.54,Aetna First Health,Commercial,,51.07,85,,,26.63,51.07,percent of total billed charges,
rizatriptan 10 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,00006026718,NDC,facility,both,1,EA,120.86,85.57,Aetna First Health,Commercial,,102.73,85,,,53.57,102.73,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,67877026106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,69097086517,NDC,facility,both,1,EA,3.46,2.45,Aetna First Health,Commercial,,2.94,85,,,1.53,2.94,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,59746041491,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,59746041404,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,33342008752,NDC,facility,both,1,EA,4.3,3.04,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,33342008702,NDC,facility,both,1,EA,4.3,3.04,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,65862059903,NDC,facility,both,1,EA,5.24,3.71,Aetna First Health,Commercial,,4.45,85,,,2.32,4.45,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51991035499,NDC,facility,both,1,EA,19.45,13.77,Aetna First Health,Commercial,,16.53,85,,,8.62,16.53,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68462046540,NDC,facility,both,1,EA,127.3,90.13,Aetna First Health,Commercial,,108.2,85,,,56.42,108.2,percent of total billed charges,
rizatriptan 5 MG Tablet 1 Each Package,63700001,CDM,,,250,RC,00006026601,NDC,facility,both,1,EA,102.63,72.66,Aetna First Health,Commercial,,87.24,85,,,45.49,87.24,percent of total billed charges,
rizatriptan 5 MG Tablet 12 Each Box,63700001,CDM,,,250,RC,33342008745,NDC,facility,both,1,EA,4.3,3.04,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
rizatriptan 5 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,67877026118,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rizatriptan 5 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,57237008763,NDC,facility,both,1,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
rizatriptan 5 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,69097086585,NDC,facility,both,1,EA,3.46,2.45,Aetna First Health,Commercial,,2.94,85,,,1.53,2.94,percent of total billed charges,
rizatriptan 5 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,68462046599,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
rizatriptan 5 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,59746041419,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
rizatriptan 5 MG Tablet 18 Each Box,63700001,CDM,,,250,RC,51991035478,NDC,facility,both,1,EA,19.45,13.77,Aetna First Health,Commercial,,16.53,85,,,8.62,16.53,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,69452015674,NDC,facility,both,1,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,33342009302,NDC,facility,both,1,EA,3.36,2.38,Aetna First Health,Commercial,,2.86,85,,,1.49,2.86,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,51991036299,NDC,facility,both,1,EA,5.01,3.55,Aetna First Health,Commercial,,4.26,85,,,2.22,4.26,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,33342009352,NDC,facility,both,1,EA,6.24,4.42,Aetna First Health,Commercial,,5.3,85,,,2.77,5.3,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,65862062503,NDC,facility,both,1,EA,7.15,5.06,Aetna First Health,Commercial,,6.08,85,,,3.17,6.08,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,69452015673,NDC,facility,both,1,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,33342009341,NDC,facility,both,1,EA,3.35,2.37,Aetna First Health,Commercial,,2.85,85,,,1.48,2.85,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,57237008563,NDC,facility,both,1,EA,4.99,3.53,Aetna First Health,Commercial,,4.24,85,,,2.21,4.24,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,33342009372,NDC,facility,both,1,EA,9.46,6.7,Aetna First Health,Commercial,,8.04,85,,,4.19,8.04,percent of total billed charges,
rizatriptan 5 MG Tablet Disintegrating 18 Each Box,63700001,CDM,,,250,RC,51991036278,NDC,facility,both,1,EA,19.45,13.77,Aetna First Health,Commercial,,16.53,85,,,8.62,16.53,percent of total billed charges,
roflumilast 250 MCG Tablet 20 Each Box,63700001,CDM,,,250,RC,00310008839,NDC,facility,both,1,EA,51.77,36.65,Aetna First Health,Commercial,,44,85,,,22.94,44,percent of total billed charges,
roflumilast 500 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687078611,NDC,facility,both,1,EA,10.9,7.72,Aetna First Health,Commercial,,9.26,85,,,4.83,9.26,percent of total billed charges,
roflumilast 500 MCG Tablet 20 Each Box,63700001,CDM,,,250,RC,00310009539,NDC,facility,both,1,EA,40.9,28.96,Aetna First Health,Commercial,,34.76,85,,,18.13,34.76,percent of total billed charges,
roflumilast 500 MCG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68382096906,NDC,facility,both,1,EA,5.06,3.58,Aetna First Health,Commercial,,4.3,85,,,2.24,4.3,percent of total billed charges,
roflumilast 500 MCG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456009530,NDC,facility,both,1,EA,27.37,19.38,Aetna First Health,Commercial,,23.26,85,,,12.13,23.26,percent of total billed charges,
roflumilast 500 MCG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00310009530,NDC,facility,both,1,EA,51.78,36.66,Aetna First Health,Commercial,,44.01,85,,,22.95,44.01,percent of total billed charges,
roflumilast 500 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68382096916,NDC,facility,both,1,EA,5.06,3.58,Aetna First Health,Commercial,,4.3,85,,,2.24,4.3,percent of total billed charges,
roflumilast 500 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00310009590,NDC,facility,both,1,EA,51.78,36.66,Aetna First Health,Commercial,,44.01,85,,,22.95,44.01,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084030511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687057711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084019511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462025301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,43547026810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332003031,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00054011625,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378552501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084030501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904599461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904637361,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687057701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084019501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 0.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084031111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084033211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68462025801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rOPINIRole 4 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332003531,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00310075430,NDC,facility,both,1,EA,32.27,22.85,Aetna First Health,Commercial,,27.43,85,,,14.3,27.43,percent of total billed charges,
rosuvastatin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292002901,NDC,facility,both,1,EA,4.87,3.45,Aetna First Health,Commercial,,4.14,85,,,2.16,4.14,percent of total billed charges,
rosuvastatin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687023411,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
rosuvastatin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904660261,NDC,facility,both,1,EA,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
rosuvastatin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292002920,NDC,facility,both,1,EA,4.85,3.43,Aetna First Health,Commercial,,4.12,85,,,2.15,4.12,percent of total billed charges,
rosuvastatin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687023401,NDC,facility,both,1,EA,4.9,3.47,Aetna First Health,Commercial,,4.16,85,,,2.17,4.16,percent of total billed charges,
rosuvastatin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16252061530,NDC,facility,both,1,EA,25.05,17.74,Aetna First Health,Commercial,,21.29,85,,,11.1,21.29,percent of total billed charges,
rosuvastatin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,27808015501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16714098801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
rosuvastatin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00310075590,NDC,facility,both,1,EA,28.99,20.52,Aetna First Health,Commercial,,24.64,85,,,12.85,24.64,percent of total billed charges,
rotigotine 1 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,50474080103,NDC,facility,both,1,EA,70.5,49.91,Aetna First Health,Commercial,,59.92,85,,,31.25,59.92,percent of total billed charges,
rotigotine 4 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,50474080403,NDC,facility,both,1,EA,98.34,69.62,Aetna First Health,Commercial,,83.59,85,,,43.58,83.59,percent of total billed charges,
rufinamide 200 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,31722059812,NDC,facility,both,1,EA,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
rufinamide 200 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,00378233078,NDC,facility,both,1,EA,10.75,7.61,Aetna First Health,Commercial,,9.14,85,,,4.76,9.14,percent of total billed charges,
rufinamide 200 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,68462071308,NDC,facility,both,1,EA,10.75,7.61,Aetna First Health,Commercial,,9.14,85,,,4.76,9.14,percent of total billed charges,
rufinamide 200 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,62856058252,NDC,facility,both,1,EA,46.2,32.71,Aetna First Health,Commercial,,39.27,85,,,20.48,39.27,percent of total billed charges,
saccharomyces boulardii 250 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,77333080025,NDC,facility,both,1,EA,0.88,0.62,Aetna First Health,Commercial,,0.75,85,,,0.39,0.75,percent of total billed charges,
saccharomyces boulardii 250 MG capsule 10 Each Bottle,63700001,CDM,,,250,RC,04142000008,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
saccharomyces boulardii 250 MG capsule 20 Each Box,63700001,CDM,,,250,RC,04142000024,NDC,facility,both,1,EA,0.99,0.7,Aetna First Health,Commercial,,0.84,85,,,0.44,0.84,percent of total billed charges,
saccharomyces boulardii 250 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,04142000007,NDC,facility,both,1,EA,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
saccharomyces boulardii 250 MG capsule 50 Each Box,63700001,CDM,,,250,RC,77333080050,NDC,facility,both,1,EA,0.88,0.62,Aetna First Health,Commercial,,0.75,85,,,0.39,0.75,percent of total billed charges,
sacubitril-valsartan 24-26 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00078065920,NDC,facility,both,1,EA,40.13,28.41,Aetna First Health,Commercial,,34.11,85,,,17.79,34.11,percent of total billed charges,
Sacubitril-Valsartan 49-51 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00078077735,NDC,facility,both,1,EA,25.26,17.88,Aetna First Health,Commercial,,21.47,85,,,11.2,21.47,percent of total billed charges,
Sacubitril-Valsartan 49-51 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00078077720,NDC,facility,both,1,EA,40.13,28.41,Aetna First Health,Commercial,,34.11,85,,,17.79,34.11,percent of total billed charges,
Sacubitril-Valsartan 97-103 MG Tablet 180 Each Bottle,63700001,CDM,,,250,RC,00078069667,NDC,facility,both,1,EA,40.13,28.41,Aetna First Health,Commercial,,34.11,85,,,17.79,34.11,percent of total billed charges,
Sacubitril-Valsartan 97-103 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00078069620,NDC,facility,both,1,EA,40.13,28.41,Aetna First Health,Commercial,,34.11,85,,,17.79,34.11,percent of total billed charges,
salmeterol 50 MCG/ACT Aerosol Powder Breath Activated 28 Each Inhaler,63700001,CDM,,,250,RC,00173052000,NDC,facility,both,1,EA,303.38,214.79,Aetna First Health,Commercial,,257.87,85,,,134.46,257.87,percent of total billed charges,
salsalate 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162051210,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
salsalate 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293080301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
salsalate 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51293061501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
salsalate 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42192036510,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
salsalate 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42937070310,NDC,facility,both,1,EA,5.5,3.89,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
salsalate 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904125061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
selegiline 12 MG/24HR Patch 24 Hour 1 Each Packet,63700001,CDM,,,250,RC,49502090201,NDC,facility,both,1,EA,250.25,177.18,Aetna First Health,Commercial,,212.71,85,,,110.91,212.71,percent of total billed charges,
selegiline 12 MG/24HR Patch 24 Hour 30 Each Box,63700001,CDM,,,250,RC,49502090230,NDC,facility,both,1,EA,250.25,177.18,Aetna First Health,Commercial,,212.71,85,,,110.91,212.71,percent of total billed charges,
selegiline 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,60505343803,NDC,facility,both,1,EA,5.15,3.65,Aetna First Health,Commercial,,4.38,85,,,2.28,4.38,percent of total billed charges,
selegiline 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,72319000602,NDC,facility,both,1,EA,5.15,3.65,Aetna First Health,Commercial,,4.38,85,,,2.28,4.38,percent of total billed charges,
selegiline 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00378929091,NDC,facility,both,1,EA,8.3,5.88,Aetna First Health,Commercial,,7.06,85,,,3.68,7.06,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,67618030010,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896045101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904643459,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69618004801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69618006401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896045401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904672559,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904725260,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,37864000033,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49348016510,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70677005801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,46122070278,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904516561,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904652261,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,71399824503,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904725261,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna 8.6 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,67618030020,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687062211,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904564360,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896045501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00761035920,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896030301,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,46122056778,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536124801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896055501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69618006501,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,46122066978,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603014921,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,10135066901,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57896030401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536408601,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70677005901,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536124701,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739043210,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904633961,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904672461,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687062201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904672361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,37864085099,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904564361,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 120 Each Bottle,63700001,CDM,,,250,RC,33261044202,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67618011030,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67618031030,NDC,facility,both,1,EA,0.66,0.47,Aetna First Health,Commercial,,0.56,85,,,0.29,0.56,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 300 Each Box,63700001,CDM,,,250,RC,63739043202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,57896045506,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,57896045806,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,60258095106,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,49348015619,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,70677004201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,67618031060,NDC,facility,both,1,EA,0.57,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
senna-docusate 8.6-50 MG Tablet 750 Each Box,63700001,CDM,,,250,RC,63739043201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sertraline 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084018211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084018011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687023111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714061104,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084018001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687023101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59762496001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862001130,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714061101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69097083302,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68180035106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,31722021205,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,69097083312,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,76282021260,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 25 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,69097083305,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084018111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687024211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,59762490003,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sertraline 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687024201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 1 Each Packet,63700001,CDM,,,250,RC,65862093008,NDC,facility,both,1,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00115136530,NDC,facility,both,1,EA,6.79,4.81,Aetna First Health,Commercial,,5.77,85,,,3.01,5.77,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00955105201,NDC,facility,both,1,EA,33.1,23.43,Aetna First Health,Commercial,,28.14,85,,,14.67,28.14,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 1 Each Packet,63700001,CDM,,,250,RC,43598047801,NDC,facility,both,1,EA,33.1,23.43,Aetna First Health,Commercial,,28.14,85,,,14.67,28.14,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 1 Each Packet,63700001,CDM,,,250,RC,58468013201,NDC,facility,both,1,EA,49.04,34.72,Aetna First Health,Commercial,,41.68,85,,,21.73,41.68,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 1 Each Packet,63700001,CDM,,,250,RC,58468013201,NDC,facility,both,1,EA,62.48,44.24,Aetna First Health,Commercial,,53.11,85,,,27.69,53.11,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 90 Each Box,63700001,CDM,,,250,RC,65862093090,NDC,facility,both,1,EA,6.61,4.68,Aetna First Health,Commercial,,5.62,85,,,2.93,5.62,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 90 Each Box,63700001,CDM,,,250,RC,00115136529,NDC,facility,both,1,EA,6.8,4.81,Aetna First Health,Commercial,,5.78,85,,,3.01,5.78,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 90 Each Box,63700001,CDM,,,250,RC,00955105290,NDC,facility,both,1,EA,33.1,23.43,Aetna First Health,Commercial,,28.14,85,,,14.67,28.14,percent of total billed charges,
sevelamer carbonate 0.8 g Packet 90 Each Box,63700001,CDM,,,250,RC,58468013202,NDC,facility,both,1,EA,49.04,34.72,Aetna First Health,Commercial,,41.68,85,,,21.73,41.68,percent of total billed charges,
sevelamer carbonate 2.4 GM Packet 1 Each Packet,63700001,CDM,,,250,RC,65862093108,NDC,facility,both,1,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
sevelamer carbonate 2.4 GM Packet 1 Each Packet,63700001,CDM,,,250,RC,00115136630,NDC,facility,both,1,EA,6.79,4.81,Aetna First Health,Commercial,,5.77,85,,,3.01,5.77,percent of total billed charges,
sevelamer carbonate 2.4 GM Packet 1 Each Packet,63700001,CDM,,,250,RC,43598047901,NDC,facility,both,1,EA,33.1,23.43,Aetna First Health,Commercial,,28.14,85,,,14.67,28.14,percent of total billed charges,
sevelamer carbonate 2.4 GM Packet 1 Each Packet,63700001,CDM,,,250,RC,58468013101,NDC,facility,both,1,EA,62.48,44.24,Aetna First Health,Commercial,,53.11,85,,,27.69,53.11,percent of total billed charges,
sevelamer carbonate 2.4 GM Packet 90 Each Box,63700001,CDM,,,250,RC,00955105490,NDC,facility,both,1,EA,33.1,23.43,Aetna First Health,Commercial,,28.14,85,,,14.67,28.14,percent of total billed charges,
sevelamer carbonate 2.4 GM Packet 90 Each Box,63700001,CDM,,,250,RC,43598047990,NDC,facility,both,1,EA,33.1,23.43,Aetna First Health,Commercial,,28.14,85,,,14.67,28.14,percent of total billed charges,
sevelamer carbonate 2.4 GM Packet 90 Each Box,63700001,CDM,,,250,RC,58468013102,NDC,facility,both,1,EA,49.04,34.72,Aetna First Health,Commercial,,41.68,85,,,21.73,41.68,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268072011,NDC,facility,both,1,EA,4.06,2.87,Aetna First Health,Commercial,,3.45,85,,,1.8,3.45,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68094003459,NDC,facility,both,1,EA,6.65,4.71,Aetna First Health,Commercial,,5.65,85,,,2.95,5.65,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687032833,NDC,facility,both,1,EA,19.08,13.51,Aetna First Health,Commercial,,16.22,85,,,8.46,16.22,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687032811,NDC,facility,both,1,EA,23.43,16.59,Aetna First Health,Commercial,,19.92,85,,,10.38,19.92,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,55111078948,NDC,facility,both,1,EA,26.01,18.42,Aetna First Health,Commercial,,22.11,85,,,11.53,22.11,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60687032831,NDC,facility,both,1,EA,19.08,13.51,Aetna First Health,Commercial,,16.22,85,,,8.46,16.22,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904670782,NDC,facility,both,1,EA,17.32,12.26,Aetna First Health,Commercial,,14.72,85,,,7.68,14.72,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,55111078911,NDC,facility,both,1,EA,26.01,18.42,Aetna First Health,Commercial,,22.11,85,,,11.53,22.11,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 270 Each Bottle,63700001,CDM,,,250,RC,65162005827,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 270 Each Bottle,63700001,CDM,,,250,RC,65862092127,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 270 Each Bottle,63700001,CDM,,,250,RC,00955105027,NDC,facility,both,1,EA,5.96,4.22,Aetna First Health,Commercial,,5.07,85,,,2.64,5.07,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 270 Each Bottle,63700001,CDM,,,250,RC,55111078927,NDC,facility,both,1,EA,6.46,4.57,Aetna First Health,Commercial,,5.49,85,,,2.86,5.49,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 270 Each Bottle,63700001,CDM,,,250,RC,16714081401,NDC,facility,both,1,EA,7.34,5.2,Aetna First Health,Commercial,,6.24,85,,,3.25,6.24,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 270 Each Bottle,63700001,CDM,,,250,RC,58468013001,NDC,facility,both,1,EA,20.82,14.74,Aetna First Health,Commercial,,17.7,85,,,9.23,17.7,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,60687032865,NDC,facility,both,1,EA,23.43,16.59,Aetna First Health,Commercial,,19.92,85,,,10.38,19.92,percent of total billed charges,
sevelamer carbonate 800 MG Tablet 90 Each Box,63700001,CDM,,,250,RC,68094003464,NDC,facility,both,1,EA,6.65,4.71,Aetna First Health,Commercial,,5.65,85,,,2.95,5.65,percent of total billed charges,
sildenafil citrate 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268071711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687041611,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
sildenafil citrate 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084086911,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
sildenafil citrate 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687078811,NDC,facility,both,1,EA,4.07,2.88,Aetna First Health,Commercial,,3.46,85,,,1.8,3.46,percent of total billed charges,
sildenafil citrate 20 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084086921,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
sildenafil citrate 20 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687041621,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
sildenafil citrate 20 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904667104,NDC,facility,both,1,EA,4.07,2.88,Aetna First Health,Commercial,,3.46,85,,,1.8,3.46,percent of total billed charges,
sildenafil citrate 20 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,00904667106,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68001036305,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093551798,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,42291074990,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,59762003301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65162035109,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,27241012403,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,60505340409,NDC,facility,both,1,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,68001017605,NDC,facility,both,1,EA,14.16,10.03,Aetna First Health,Commercial,,12.04,85,,,6.28,12.04,percent of total billed charges,
sildenafil citrate 20 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00069419068,NDC,facility,both,1,EA,97.16,68.79,Aetna First Health,Commercial,,82.59,85,,,43.06,82.59,percent of total billed charges,
silver nitrate - pot nitrate 75-25 % Misc 100 Each Box,63700001,CDM,,,250,RC,12870000101,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
silver nitrate - pot nitrate 75-25 % Misc 100 Each Box,63700001,CDM,,,250,RC,12165010003,NDC,facility,both,1,EA,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
silver nitrate - pot nitrate 75-25 % Misc 100 Each Package,63700001,CDM,,,250,RC,12870000102,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simethicone 125 MG Tablet Chewable 60 Each Bottle,63700001,CDM,,,250,RC,69618003206,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 125 MG Tablet Chewable 60 Each Bottle,63700001,CDM,,,250,RC,00536453408,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 125 MG Tablet Chewable 60 Each Bottle,63700001,CDM,,,250,RC,00536102008,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,77333081225,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00904506860,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,24385011878,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,87701070344,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,37864086001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,69618003301,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00536101901,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,57896079101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Bottle,63700001,CDM,,,250,RC,00603021021,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,63739022510,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,77333081210,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 100 Each Box,63700001,CDM,,,250,RC,10135020313,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simethicone 80 MG Tablet Chewable 36 Each Box,63700001,CDM,,,250,RC,00067011636,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
simvastatin 20 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084051211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084051311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739057010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111019730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729015610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093715298,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,65862005090,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
simvastatin 5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,16729015615,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SITagliptin 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00006022101,NDC,facility,both,1,EA,66.85,47.33,Aetna First Health,Commercial,,56.82,85,,,29.63,56.82,percent of total billed charges,
SITagliptin 25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00006022131,NDC,facility,both,1,EA,66.85,47.33,Aetna First Health,Commercial,,56.82,85,,,29.63,56.82,percent of total billed charges,
sodium chloride 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333083525,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium chloride 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333084425,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium chloride 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,48433012801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sodium chloride 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,58526000551,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
sodium chloride 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00223176001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium chloride 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69367022001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium chloride 1 GM Tablet 100 Each Box,63700001,CDM,,,250,RC,77333083510,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sodium chloride 1 GM Tablet 30 Each Box,63700001,CDM,,,250,RC,58526000552,NDC,facility,both,1,EA,1.59,1.13,Aetna First Health,Commercial,,1.35,85,,,0.7,1.35,percent of total billed charges,
sodium zirconium cyclosilicate 10 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00310111001,NDC,facility,both,1,EA,95.73,67.78,Aetna First Health,Commercial,,81.37,85,,,42.43,81.37,percent of total billed charges,
sodium zirconium cyclosilicate 10 g Packet 11 Each Box,63700001,CDM,,,250,RC,00310111039,NDC,facility,both,1,EA,95.73,67.78,Aetna First Health,Commercial,,81.37,85,,,42.43,81.37,percent of total billed charges,
sodium zirconium cyclosilicate 10 g Packet 30 Each Box,63700001,CDM,,,250,RC,00310111030,NDC,facility,both,1,EA,95.73,67.78,Aetna First Health,Commercial,,81.37,85,,,42.43,81.37,percent of total billed charges,
sodium zirconium cyclosilicate 5 g Packet 1 Each Packet,63700001,CDM,,,250,RC,00310110501,NDC,facility,both,1,EA,95.73,67.78,Aetna First Health,Commercial,,81.37,85,,,42.43,81.37,percent of total billed charges,
sodium zirconium cyclosilicate 5 g Packet 11 Each Box,63700001,CDM,,,250,RC,00310110539,NDC,facility,both,1,EA,109.4,77.46,Aetna First Health,Commercial,,92.99,85,,,48.49,92.99,percent of total billed charges,
sodium zirconium cyclosilicate 5 g Packet 30 Each Box,63700001,CDM,,,250,RC,00310110530,NDC,facility,both,1,EA,95.73,67.78,Aetna First Health,Commercial,,81.37,85,,,42.43,81.37,percent of total billed charges,
solifenacin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505470203,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
solifenacin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877052730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
solifenacin 5 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,51248015001,NDC,facility,both,1,EA,44.98,31.85,Aetna First Health,Commercial,,38.23,85,,,19.94,38.23,percent of total billed charges,
sotalol 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268072411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084065411,NDC,facility,both,1,EA,4.45,3.15,Aetna First Health,Commercial,,3.78,85,,,1.97,3.78,percent of total billed charges,
sotalol 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00245001289,NDC,facility,both,1,EA,5.6,3.96,Aetna First Health,Commercial,,4.76,85,,,2.48,4.76,percent of total billed charges,
sotalol 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093106101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185017101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505008000,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00603576921,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385011401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol 80 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084065401,NDC,facility,both,1,EA,4.45,3.15,Aetna First Health,Commercial,,3.78,85,,,1.97,3.78,percent of total billed charges,
sotalol 80 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268072415,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol AF 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505022201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol AF 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378512301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sotalol AF 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76385012501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079098020,NDC,facility,both,1,EA,3.72,2.63,Aetna First Health,Commercial,,3.16,85,,,1.65,3.16,percent of total billed charges,
spironolactone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079010301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084020611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268072611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687046511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00228280311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162051110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16729022501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378214601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489014301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746051101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59746021601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59651042601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00025100131,NDC,facility,both,1,EA,9.48,6.71,Aetna First Health,Commercial,,8.06,85,,,4.2,8.06,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079010320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084020601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904595161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739054410,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687046501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268072615,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00228280350,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00378214605,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,59746021605,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65162051150,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 25 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,53746051105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079097901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
spironolactone-hydroCHLOROthiazide 25-25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079010401,NDC,facility,both,1,EA,4.76,3.37,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
spironolactone-hydroCHLOROthiazide 25-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489014401,NDC,facility,both,1,EA,4.27,3.02,Aetna First Health,Commercial,,3.63,85,,,1.89,3.63,percent of total billed charges,
spironolactone-hydroCHLOROthiazide 25-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378040301,NDC,facility,both,1,EA,4.3,3.04,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
spironolactone-hydroCHLOROthiazide 25-25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079010420,NDC,facility,both,1,EA,4.76,3.37,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
succimer 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,55292020111,NDC,facility,both,1,EA,45.08,31.92,Aetna First Health,Commercial,,38.32,85,,,19.98,38.32,percent of total billed charges,
sucralfate 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079087101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079075301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687069511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 1 Each Box,63700001,CDM,,,250,RC,68084059311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093221001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591078001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762040101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,29033000301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58914017110,NDC,facility,both,1,EA,17.36,12.29,Aetna First Health,Commercial,,14.76,85,,,7.69,14.76,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Box,63700001,CDM,,,250,RC,51079075320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Box,63700001,CDM,,,250,RC,63739094310,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Box,63700001,CDM,,,250,RC,60687069501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 100 Each Box,63700001,CDM,,,250,RC,68084059301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 500 Each Bottle,63700001,CDM,,,250,RC,00093221005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 500 Each Bottle,63700001,CDM,,,250,RC,59762040105,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00093221098,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sucralfate 1 GM Tablet 90 Each Bottle,63700001,CDM,,,250,RC,62135043690,NDC,facility,both,1,EA,14,9.91,Aetna First Health,Commercial,,11.9,85,,,6.2,11.9,percent of total billed charges,
sucroferric oxyhydroxide 500 MG Tablet Chewable 90 Each Bottle,63700001,CDM,,,250,RC,49230064551,NDC,facility,both,1,EA,62.53,44.27,Aetna First Health,Commercial,,53.15,85,,,27.71,53.15,percent of total billed charges,
sulfADIAZINE 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00185075701,NDC,facility,both,1,EA,12.86,9.1,Aetna First Health,Commercial,,10.93,85,,,5.7,10.93,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084074795,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268072811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687060311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687054211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746027101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237023201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489014501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862041901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084074725,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268072815,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 400-80 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,60687060365,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079012801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084023011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268072911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292002801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687053111,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687061411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746027201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68084023001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862042001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237023301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904272561,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739022810,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687061401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,50268072913,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65862042005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 80 Each Box,63700001,CDM,,,250,RC,42292002808,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 800-160 MG Tablet 80 Each Box,63700001,CDM,,,250,RC,51079012808,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268073011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591079601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762500001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,59762500005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00013010101,NDC,facility,both,1,EA,5.28,3.74,Aetna First Health,Commercial,,4.49,85,,,2.34,4.49,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00013010110,NDC,facility,both,1,EA,5.63,3.99,Aetna First Health,Commercial,,4.79,85,,,2.5,4.79,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62135096001,NDC,facility,both,1,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 300 Each Bottle,63700001,CDM,,,250,RC,59762500002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet 50 Each Bottle,63700001,CDM,,,250,RC,50268073015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,59762010401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,59762010405,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfaSALAzine 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00013010201,NDC,facility,both,1,EA,4.07,2.88,Aetna First Health,Commercial,,3.46,85,,,1.8,3.46,percent of total billed charges,
sulfaSALAzine 500 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00013010250,NDC,facility,both,1,EA,7.36,5.21,Aetna First Health,Commercial,,6.26,85,,,3.26,6.26,percent of total billed charges,
sulfaSALAzine 500 MG Tablet Delayed Release 300 Each Bottle,63700001,CDM,,,250,RC,59762010406,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 20 MG/ACT Solution 1 Each Inhaler,63700001,CDM,,,250,RC,00781652306,NDC,facility,both,1,EA,157.6,111.58,Aetna First Health,Commercial,,133.96,85,,,69.85,133.96,percent of total billed charges,
SUMAtriptan 20 MG/ACT Solution 1 Each Inhaler,63700001,CDM,,,250,RC,45802059800,NDC,facility,both,1,EA,196.81,139.34,Aetna First Health,Commercial,,167.29,85,,,87.23,167.29,percent of total billed charges,
SUMAtriptan 20 MG/ACT Solution 1 Each Inhaler,63700001,CDM,,,250,RC,45802059806,NDC,facility,both,1,EA,196.81,139.34,Aetna First Health,Commercial,,167.29,85,,,87.23,167.29,percent of total billed charges,
SUMAtriptan 20 MG/ACT Solution 1 Each Inhaler,63700001,CDM,,,250,RC,00173052300,NDC,facility,both,1,EA,374.13,264.88,Aetna First Health,Commercial,,318.01,85,,,165.81,318.01,percent of total billed charges,
SUMAtriptan 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,63304009711,NDC,facility,both,1,EA,6.63,4.69,Aetna First Health,Commercial,,5.64,85,,,2.94,5.64,percent of total billed charges,
SUMAtriptan 25 MG Tablet 36 Each Bottle,63700001,CDM,,,250,RC,55111029136,NDC,facility,both,1,EA,6.2,4.39,Aetna First Health,Commercial,,5.27,85,,,2.75,5.27,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Bottle,63700001,CDM,,,250,RC,00378563059,NDC,facility,both,1,EA,3.64,2.58,Aetna First Health,Commercial,,3.09,85,,,1.61,3.09,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,65862014636,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,62756052069,NDC,facility,both,1,EA,6.2,4.39,Aetna First Health,Commercial,,5.27,85,,,2.75,5.27,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,55111029109,NDC,facility,both,1,EA,6.2,4.39,Aetna First Health,Commercial,,5.27,85,,,2.75,5.27,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,16714053111,NDC,facility,both,1,EA,6.2,4.39,Aetna First Health,Commercial,,5.27,85,,,2.75,5.27,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,16714079601,NDC,facility,both,1,EA,6.2,4.39,Aetna First Health,Commercial,,5.27,85,,,2.75,5.27,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,63304009719,NDC,facility,both,1,EA,6.63,4.69,Aetna First Health,Commercial,,5.64,85,,,2.94,5.64,percent of total billed charges,
SUMAtriptan 25 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,00173073500,NDC,facility,both,1,EA,121.58,86.08,Aetna First Health,Commercial,,103.34,85,,,53.88,103.34,percent of total billed charges,
SUMAtriptan 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,63304009811,NDC,facility,both,1,EA,6.16,4.36,Aetna First Health,Commercial,,5.24,85,,,2.73,5.24,percent of total billed charges,
SUMAtriptan 50 MG Tablet 9 Each Box,63700001,CDM,,,250,RC,63304009819,NDC,facility,both,1,EA,6.16,4.36,Aetna First Health,Commercial,,5.24,85,,,2.73,5.24,percent of total billed charges,
talc 5 g Recon Susp 1 Each Bottle,63700001,CDM,,,250,RC,63256020005,NDC,facility,both,1,EA,191.25,135.4,Aetna First Health,Commercial,,162.56,85,,,84.76,162.56,percent of total billed charges,
tamsulosin 0.4 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079029401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084040711,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084029911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268074011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00228299611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68382013201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62756016088,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,16714071301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57237001401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862059801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093733801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00597005801,NDC,facility,both,1,EA,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00024583701,NDC,facility,both,1,EA,34.04,24.1,Aetna First Health,Commercial,,28.93,85,,,15.09,28.93,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079029420,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084040701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739056710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084029901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904640161,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268074015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,16714071302,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,65862059805,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tamsulosin 0.4 MG capsule 500 Each Bottle,63700001,CDM,,,250,RC,67877045005,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 15 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079041801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
temazepam 7.5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084054911,NDC,facility,both,1,EA,10.54,7.46,Aetna First Health,Commercial,,8.96,85,,,4.67,8.96,percent of total billed charges,
temazepam 7.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00406996001,NDC,facility,both,1,EA,9.31,6.59,Aetna First Health,Commercial,,7.91,85,,,4.13,7.91,percent of total billed charges,
temazepam 7.5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00406991501,NDC,facility,both,1,EA,45.9,32.5,Aetna First Health,Commercial,,39.02,85,,,20.34,39.02,percent of total billed charges,
temazepam 7.5 MG capsule 30 Each Box,63700001,CDM,,,250,RC,00904643604,NDC,facility,both,1,EA,12.26,8.68,Aetna First Health,Commercial,,10.42,85,,,5.43,10.42,percent of total billed charges,
temazepam 7.5 MG capsule 30 Each Box,63700001,CDM,,,250,RC,63739000333,NDC,facility,both,1,EA,16.86,11.94,Aetna First Health,Commercial,,14.33,85,,,7.47,14.33,percent of total billed charges,
temazepam 7.5 MG capsule 30 Each Box,63700001,CDM,,,250,RC,68084054921,NDC,facility,both,1,EA,18.94,13.41,Aetna First Health,Commercial,,16.1,85,,,8.39,16.1,percent of total billed charges,
tenofovir 300 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687036695,NDC,facility,both,1,EA,15.82,11.2,Aetna First Health,Commercial,,13.45,85,,,7.01,13.45,percent of total billed charges,
tenofovir 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,42291080030,NDC,facility,both,1,EA,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
tenofovir 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69097053302,NDC,facility,both,1,EA,3.36,2.38,Aetna First Health,Commercial,,2.86,85,,,1.49,2.86,percent of total billed charges,
tenofovir 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722053530,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
tenofovir 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862042130,NDC,facility,both,1,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
tenofovir 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714082001,NDC,facility,both,1,EA,7.88,5.58,Aetna First Health,Commercial,,6.7,85,,,3.49,6.7,percent of total billed charges,
tenofovir 300 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,61958040101,NDC,facility,both,1,EA,146.24,103.54,Aetna First Health,Commercial,,124.3,85,,,64.81,124.3,percent of total billed charges,
tenofovir 300 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904682104,NDC,facility,both,1,EA,16.51,11.69,Aetna First Health,Commercial,,14.03,85,,,7.32,14.03,percent of total billed charges,
terazosin 1 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079093601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 1 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268076411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59746038306,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781205101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 1 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904612661,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 1 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079093620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terazosin 1 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268076415,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51991052601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714050101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862007930,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,51991052633,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67405050003,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69097085902,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714079501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
terbinafine 250 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55111025030,NDC,facility,both,1,EA,4.07,2.88,Aetna First Health,Commercial,,3.46,85,,,1.8,3.46,percent of total billed charges,
terbutaline 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62559072101,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
terbutaline 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527131801,NDC,facility,both,1,EA,4.76,3.37,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
terbutaline 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24979013201,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
terbutaline 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00115261101,NDC,facility,both,1,EA,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
terbutaline 2.5 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,62135052490,NDC,facility,both,1,EA,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
terconazole 80 MG Suppository 3 Each Box,63700001,CDM,,,250,RC,00062535101,NDC,facility,both,1,EA,58.65,41.52,Aetna First Health,Commercial,,49.85,85,,,25.99,49.85,percent of total billed charges,
terconazole 80 MG Suppository 3 Each Box,63700001,CDM,,,250,RC,45802071708,NDC,facility,both,1,EA,108.85,77.07,Aetna First Health,Commercial,,92.52,85,,,48.24,92.52,percent of total billed charges,
testosterone 2 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,52544007654,NDC,facility,both,1,EA,26.92,19.06,Aetna First Health,Commercial,,22.88,85,,,11.93,22.88,percent of total billed charges,
testosterone 2 MG/24HR Patch 24 Hour 1 Each Box,63700001,CDM,,,250,RC,00023599002,NDC,facility,both,1,EA,35.95,25.45,Aetna First Health,Commercial,,30.56,85,,,15.93,30.56,percent of total billed charges,
testosterone 2 MG/24HR Patch 24 Hour 60 Each Box,63700001,CDM,,,250,RC,52544007660,NDC,facility,both,1,EA,26.94,19.07,Aetna First Health,Commercial,,22.9,85,,,11.94,22.9,percent of total billed charges,
testosterone 2 MG/24HR Patch 24 Hour 60 Each Box,63700001,CDM,,,250,RC,00023599060,NDC,facility,both,1,EA,35.93,25.44,Aetna First Health,Commercial,,30.54,85,,,15.92,30.54,percent of total billed charges,
testosterone 4 MG/24HR Patch 24 Hour 1 Each Package,63700001,CDM,,,250,RC,00023599204,NDC,facility,both,1,EA,71.86,50.88,Aetna First Health,Commercial,,61.08,85,,,31.85,61.08,percent of total billed charges,
tetracycline 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,51991090601,NDC,facility,both,1,EA,5.83,4.13,Aetna First Health,Commercial,,4.96,85,,,2.58,4.96,percent of total billed charges,
tetracycline 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,23155076601,NDC,facility,both,1,EA,6.65,4.71,Aetna First Health,Commercial,,5.65,85,,,2.95,5.65,percent of total billed charges,
tetracycline 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,23155001701,NDC,facility,both,1,EA,15.75,11.15,Aetna First Health,Commercial,,13.39,85,,,6.98,13.39,percent of total billed charges,
theophylline 100 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,52244010010,NDC,facility,both,1,EA,12.32,8.72,Aetna First Health,Commercial,,10.47,85,,,5.46,10.47,percent of total billed charges,
theophylline 200 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,52244020010,NDC,facility,both,1,EA,18.31,12.96,Aetna First Health,Commercial,,15.56,85,,,8.11,15.56,percent of total billed charges,
therapeutic multivitamin Tablet 100 Each Box,63700001,CDM,,,250,RC,00904053061,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
therapeutic multivitamin Tablet 100 Each Box,63700001,CDM,,,250,RC,00904053961,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
therapeutic multivitamin-minerals Tablet 100 Each Box,63700001,CDM,,,250,RC,00904549261,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268085111,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,77333093425,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,54629005701,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536468001,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904054460,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,87701040729,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,79854020010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,48433010801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,37864090599,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,77333093410,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thiamine 100 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268085115,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
thioridazine 10 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079056501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378061201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53489014801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thioridazine 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079056520,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781222601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thiothixene 1 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70954001410,NDC,facility,both,1,EA,3.33,2.36,Aetna First Health,Commercial,,2.83,85,,,1.48,2.83,percent of total billed charges,
thiothixene 5 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079058801,NDC,facility,both,1,EA,6.09,4.31,Aetna First Health,Commercial,,5.18,85,,,2.7,5.18,percent of total billed charges,
thiothixene 5 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079058820,NDC,facility,both,1,EA,6.07,4.3,Aetna First Health,Commercial,,5.16,85,,,2.69,5.16,percent of total billed charges,
thyroid 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,42192032901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
thyroid 30 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00456045801,NDC,facility,both,1,EA,3.37,2.39,Aetna First Health,Commercial,,2.86,85,,,1.49,2.86,percent of total billed charges,
thyroid 32.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64727329901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiaGABine 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00093503056,NDC,facility,both,1,EA,22.22,15.73,Aetna First Health,Commercial,,18.89,85,,,9.85,18.89,percent of total billed charges,
tiaGABine 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,72205008430,NDC,facility,both,1,EA,22.22,15.73,Aetna First Health,Commercial,,18.89,85,,,9.85,18.89,percent of total billed charges,
tiaGABine 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,63459040230,NDC,facility,both,1,EA,22.75,16.11,Aetna First Health,Commercial,,19.34,85,,,10.08,19.34,percent of total billed charges,
ticagrelor 60 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00186077660,NDC,facility,both,1,EA,26.32,18.63,Aetna First Health,Commercial,,22.37,85,,,11.67,22.37,percent of total billed charges,
ticagrelor 90 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00186077739,NDC,facility,both,1,EA,26.32,18.63,Aetna First Health,Commercial,,22.37,85,,,11.67,22.37,percent of total billed charges,
ticagrelor 90 MG Tablet 14 Each Bottle,63700001,CDM,,,250,RC,00186077728,NDC,facility,both,1,EA,14.26,10.1,Aetna First Health,Commercial,,12.12,85,,,6.32,12.12,percent of total billed charges,
ticagrelor 90 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00186077760,NDC,facility,both,1,EA,26.32,18.63,Aetna First Health,Commercial,,22.37,85,,,11.67,22.37,percent of total billed charges,
tiZANidine 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268075911,NDC,facility,both,1,EA,3.05,2.16,Aetna First Health,Commercial,,2.59,85,,,1.35,2.59,percent of total billed charges,
tiZANidine 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084077595,NDC,facility,both,1,EA,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
tiZANidine 2 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,00378072219,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 2 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,60505025103,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 2 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,55111017915,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 2 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,29300016815,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 2 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,00185003451,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 2 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,42291080815,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tiZANidine 2 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68084077525,NDC,facility,both,1,EA,3.77,2.67,Aetna First Health,Commercial,,3.2,85,,,1.67,3.2,percent of total billed charges,
tiZANidine 2 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268075915,NDC,facility,both,1,EA,3.05,2.16,Aetna First Health,Commercial,,2.59,85,,,1.35,2.59,percent of total billed charges,
tiZANidine 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079099801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tofacitinib citrate 5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00069100101,NDC,facility,both,1,EA,337.4,238.88,Aetna First Health,Commercial,,286.79,85,,,149.54,286.79,percent of total billed charges,
tolterodine 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,29300023916,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tolterodine 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722080560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tolterodine 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,59762017006,NDC,facility,both,1,EA,5.21,3.69,Aetna First Health,Commercial,,4.43,85,,,2.31,4.43,percent of total billed charges,
tolterodine 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093205606,NDC,facility,both,1,EA,9.26,6.56,Aetna First Health,Commercial,,7.87,85,,,4.1,7.87,percent of total billed charges,
tolterodine 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,60505352706,NDC,facility,both,1,EA,9.26,6.56,Aetna First Health,Commercial,,7.87,85,,,4.1,7.87,percent of total billed charges,
tolterodine 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00093001006,NDC,facility,both,1,EA,9.26,6.56,Aetna First Health,Commercial,,7.87,85,,,4.1,7.87,percent of total billed charges,
tolterodine 1 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00009454102,NDC,facility,both,1,EA,29.53,20.91,Aetna First Health,Commercial,,25.1,85,,,13.09,25.1,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,60687031911,NDC,facility,both,1,EA,35.15,24.89,Aetna First Health,Commercial,,29.88,85,,,15.58,29.88,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,51079019701,NDC,facility,both,1,EA,35.39,25.06,Aetna First Health,Commercial,,30.08,85,,,15.68,30.08,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00009519004,NDC,facility,both,1,EA,31.26,22.13,Aetna First Health,Commercial,,26.57,85,,,13.85,26.57,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,43975032203,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,70436016004,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,13668018930,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,27241019130,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59762004701,NDC,facility,both,1,EA,8.85,6.27,Aetna First Health,Commercial,,7.52,85,,,3.92,7.52,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00378340293,NDC,facility,both,1,EA,22.47,15.91,Aetna First Health,Commercial,,19.1,85,,,9.96,19.1,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00093205056,NDC,facility,both,1,EA,22.5,15.93,Aetna First Health,Commercial,,19.12,85,,,9.97,19.12,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00093716356,NDC,facility,both,1,EA,22.5,15.93,Aetna First Health,Commercial,,19.12,85,,,9.97,19.12,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00009519001,NDC,facility,both,1,EA,48.08,34.04,Aetna First Health,Commercial,,40.87,85,,,21.31,40.87,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,00904659204,NDC,facility,both,1,EA,31.73,22.46,Aetna First Health,Commercial,,26.97,85,,,14.06,26.97,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,60687031921,NDC,facility,both,1,EA,35.15,24.89,Aetna First Health,Commercial,,29.88,85,,,15.58,29.88,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 30 Each Box,63700001,CDM,,,250,RC,51079019703,NDC,facility,both,1,EA,35.39,25.06,Aetna First Health,Commercial,,30.08,85,,,15.68,30.08,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,13668018990,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,27241019190,NDC,facility,both,1,EA,3.5,2.48,Aetna First Health,Commercial,,2.98,85,,,1.55,2.98,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,59762004702,NDC,facility,both,1,EA,8.85,6.27,Aetna First Health,Commercial,,7.52,85,,,3.92,7.52,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00093716398,NDC,facility,both,1,EA,22.5,15.93,Aetna First Health,Commercial,,19.12,85,,,9.97,19.12,percent of total billed charges,
tolterodine ER 2 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00009519002,NDC,facility,both,1,EA,30.94,21.91,Aetna First Health,Commercial,,26.3,85,,,13.71,26.3,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00009519104,NDC,facility,both,1,EA,31.26,22.13,Aetna First Health,Commercial,,26.57,85,,,13.85,26.57,percent of total billed charges,
tolterodine ER 4 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00009519102,NDC,facility,both,1,EA,30.94,21.91,Aetna First Health,Commercial,,26.3,85,,,13.71,26.3,percent of total billed charges,
topiramate 15 MG CAPSULE SPRINKLE 60 Each Bottle,63700001,CDM,,,250,RC,00093733506,NDC,facility,both,1,EA,3.79,2.68,Aetna First Health,Commercial,,3.22,85,,,1.68,3.22,percent of total billed charges,
topiramate 15 MG CAPSULE SPRINKLE 60 Each Bottle,63700001,CDM,,,250,RC,68382000414,NDC,facility,both,1,EA,3.79,2.68,Aetna First Health,Commercial,,3.22,85,,,1.68,3.22,percent of total billed charges,
topiramate 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079072601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084034211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268075011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079072620,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084034201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268075015,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68462010860,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,69097012203,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68382013814,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
topiramate 25 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50458063965,NDC,facility,both,1,EA,15.28,10.82,Aetna First Health,Commercial,,12.99,85,,,6.77,12.99,percent of total billed charges,
topiramate 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079072701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 20 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084053901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268075411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65862012501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,31722052901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505023201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
torsemide 5 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268075415,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584055911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079099101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084080811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687079511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093005801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378415101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664037708,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68084080801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162062710,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714048101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079099120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584055901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739067110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904636561,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904717961,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687079501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 300 Each Punchcard,63700001,CDM,,,250,RC,51079099156,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,57664037713,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,65162062750,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol-acetaminophen 37.5-325 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084082511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol-acetaminophen 37.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57664053788,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol-acetaminophen 37.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,53746061701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol-acetaminophen 37.5-325 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505264401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traMADol-acetaminophen 37.5-325 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084082501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
tranexamic acid 650 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268077211,NDC,facility,both,1,EA,14.73,10.43,Aetna First Health,Commercial,,12.52,85,,,6.53,12.52,percent of total billed charges,
tranexamic acid 650 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687075011,NDC,facility,both,1,EA,15.03,10.64,Aetna First Health,Commercial,,12.78,85,,,6.66,12.78,percent of total billed charges,
tranexamic acid 650 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62559026530,NDC,facility,both,1,EA,9.33,6.61,Aetna First Health,Commercial,,7.93,85,,,4.14,7.93,percent of total billed charges,
tranexamic acid 650 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00591372030,NDC,facility,both,1,EA,14.62,10.35,Aetna First Health,Commercial,,12.43,85,,,6.48,12.43,percent of total billed charges,
tranexamic acid 650 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505363803,NDC,facility,both,1,EA,14.62,10.35,Aetna First Health,Commercial,,12.43,85,,,6.48,12.43,percent of total billed charges,
tranexamic acid 650 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,69918030130,NDC,facility,both,1,EA,15.21,10.77,Aetna First Health,Commercial,,12.93,85,,,6.74,12.93,percent of total billed charges,
tranexamic acid 650 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,55566211002,NDC,facility,both,1,EA,19.01,13.46,Aetna First Health,Commercial,,16.16,85,,,8.43,16.16,percent of total billed charges,
tranexamic acid 650 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,50268077213,NDC,facility,both,1,EA,14.73,10.43,Aetna First Health,Commercial,,12.52,85,,,6.53,12.52,percent of total billed charges,
tranylcypromine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884003201,NDC,facility,both,1,EA,9.36,6.63,Aetna First Health,Commercial,,7.96,85,,,4.15,7.96,percent of total billed charges,
tranylcypromine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,64980018301,NDC,facility,both,1,EA,9.45,6.69,Aetna First Health,Commercial,,8.03,85,,,4.19,8.03,percent of total billed charges,
tranylcypromine 10 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591559001,NDC,facility,both,1,EA,9.45,6.69,Aetna First Health,Commercial,,8.03,85,,,4.19,8.03,percent of total billed charges,
traZODone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00182125900,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084012411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687044311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111043301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382080501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,13107007901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505265301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,50111056001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00182125989,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904399061,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60505265300,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084012401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904655461,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904686861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687044301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,50111043302,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
traZODone 50 MG Tablet 500 Each Bottle,63700001,CDM,,,250,RC,68382080505,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65197000201,NDC,facility,both,1,EA,13.31,9.42,Aetna First Health,Commercial,,11.31,85,,,5.9,11.31,percent of total billed charges,
triamterene 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,52817036410,NDC,facility,both,1,EA,31.33,22.18,Aetna First Health,Commercial,,26.63,85,,,13.89,26.63,percent of total billed charges,
triamterene 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59212000201,NDC,facility,both,1,EA,51.49,36.45,Aetna First Health,Commercial,,43.77,85,,,22.82,43.77,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00781207401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,72578009001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084075095,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084075011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378135201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591042401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781112301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505265601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001021600,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781506801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001032700,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001038700,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084075025,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 37.5-25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084075021,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 75-50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079043301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 75-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378135501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 75-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,60505265701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 75-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382085701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 75-50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001032800,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triamterene-hydroCHLOROthiazide 75-50 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079043320,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079057201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378240101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781802801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00781103001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832049411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079057220,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trifluoperazine 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079057301,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
trifluoperazine 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079057320,NDC,facility,both,1,EA,3.71,2.63,Aetna First Health,Commercial,,3.15,85,,,1.64,3.15,percent of total billed charges,
trifluoperazine 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079057401,NDC,facility,both,1,EA,4.69,3.32,Aetna First Health,Commercial,,3.99,85,,,2.08,3.99,percent of total billed charges,
trifluoperazine 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079057420,NDC,facility,both,1,EA,4.68,3.31,Aetna First Health,Commercial,,3.98,85,,,2.07,3.98,percent of total billed charges,
trihexyphenidyl 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,62584088611,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591533501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16571016010,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69452024120,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 2 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,70954021210,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 2 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,62584088601,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trihexyphenidyl 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591533701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trimethoprim 100 MG Tablet 1 Each Blister,63700001,CDM,J3490,CPT,250,RC,50268077511,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trimethoprim 100 MG Tablet 100 Each Bottle,63700001,CDM,J3490,CPT,250,RC,00591557101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trimethoprim 100 MG Tablet 100 Each Bottle,63700001,CDM,J3490,CPT,250,RC,43386033001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trimethoprim 100 MG Tablet 100 Each Bottle,63700001,CDM,J3490,CPT,250,RC,70954054110,NDC,facility,both,1,EA,6.52,4.62,Aetna First Health,Commercial,,5.54,85,,,2.89,5.54,percent of total billed charges,
trimethoprim 100 MG Tablet 100 Each Bottle,63700001,CDM,J3490,CPT,250,RC,51862048601,NDC,facility,both,1,EA,6.52,4.62,Aetna First Health,Commercial,,5.54,85,,,2.89,5.54,percent of total billed charges,
trimethoprim 100 MG Tablet 50 Each Box,63700001,CDM,J3490,CPT,250,RC,50268077515,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
triprolidine-pseudoephedrine 2.5-60 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904025059,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
trospium 20 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,68462046160,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trospium 20 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00574014560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
trospium 60 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68001042704,NDC,facility,both,1,EA,18.86,13.35,Aetna First Health,Commercial,,16.03,85,,,8.36,16.03,percent of total billed charges,
upadacitinib 15 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00074230630,NDC,facility,both,1,EA,750.31,531.22,Aetna First Health,Commercial,,637.76,85,,,332.54,637.76,percent of total billed charges,
urea 15 g Packet 8 Each Box,63700001,CDM,,,250,RC,62530000011,NDC,facility,both,1,EA,12.69,8.98,Aetna First Health,Commercial,,10.79,85,,,5.62,10.79,percent of total billed charges,
ursodiol 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084089295,NDC,facility,both,1,EA,10.38,7.35,Aetna First Health,Commercial,,8.82,85,,,4.6,8.82,percent of total billed charges,
ursodiol 250 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687052711,NDC,facility,both,1,EA,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
ursodiol 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,49884041201,NDC,facility,both,1,EA,4.96,3.51,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
ursodiol 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591299801,NDC,facility,both,1,EA,7.51,5.32,Aetna First Health,Commercial,,6.38,85,,,3.33,6.38,percent of total billed charges,
ursodiol 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001037700,NDC,facility,both,1,EA,7.51,5.32,Aetna First Health,Commercial,,6.38,85,,,3.33,6.38,percent of total billed charges,
ursodiol 250 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58914078510,NDC,facility,both,1,EA,19.27,13.64,Aetna First Health,Commercial,,16.38,85,,,8.54,16.38,percent of total billed charges,
ursodiol 250 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084089225,NDC,facility,both,1,EA,10.38,7.35,Aetna First Health,Commercial,,8.82,85,,,4.6,8.82,percent of total billed charges,
ursodiol 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268079711,NDC,facility,both,1,EA,14.47,10.24,Aetna First Health,Commercial,,12.3,85,,,6.41,12.3,percent of total billed charges,
ursodiol 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,51079038301,NDC,facility,both,1,EA,20.83,14.75,Aetna First Health,Commercial,,17.71,85,,,9.23,17.71,percent of total billed charges,
ursodiol 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,60687010011,NDC,facility,both,1,EA,20.84,14.75,Aetna First Health,Commercial,,17.71,85,,,9.24,17.71,percent of total billed charges,
ursodiol 300 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,50268079611,NDC,facility,both,1,EA,26.83,19,Aetna First Health,Commercial,,22.81,85,,,11.89,22.81,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59651042101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591315901,NDC,facility,both,1,EA,3.58,2.53,Aetna First Health,Commercial,,3.04,85,,,1.59,3.04,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,70710148301,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00527132601,NDC,facility,both,1,EA,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,51079038320,NDC,facility,both,1,EA,4.86,3.44,Aetna First Health,Commercial,,4.13,85,,,2.15,4.13,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904622161,NDC,facility,both,1,EA,15.38,10.89,Aetna First Health,Commercial,,13.07,85,,,6.82,13.07,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,00904716861,NDC,facility,both,1,EA,15.38,10.89,Aetna First Health,Commercial,,13.07,85,,,6.82,13.07,percent of total billed charges,
ursodiol 300 MG capsule 100 Each Box,63700001,CDM,,,250,RC,60687010001,NDC,facility,both,1,EA,20.84,14.75,Aetna First Health,Commercial,,17.71,85,,,9.24,17.71,percent of total billed charges,
ursodiol 300 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268079715,NDC,facility,both,1,EA,14.47,10.24,Aetna First Health,Commercial,,12.3,85,,,6.41,12.3,percent of total billed charges,
ursodiol 300 MG capsule 50 Each Box,63700001,CDM,,,250,RC,00904716806,NDC,facility,both,1,EA,17.15,12.14,Aetna First Health,Commercial,,14.58,85,,,7.6,14.58,percent of total billed charges,
ursodiol 300 MG capsule 50 Each Box,63700001,CDM,,,250,RC,00904622106,NDC,facility,both,1,EA,26.2,18.55,Aetna First Health,Commercial,,22.27,85,,,11.61,22.27,percent of total billed charges,
ursodiol 300 MG capsule 50 Each Box,63700001,CDM,,,250,RC,50268079615,NDC,facility,both,1,EA,28.63,20.27,Aetna First Health,Commercial,,24.34,85,,,12.69,24.34,percent of total billed charges,
valACYclovir 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268078811,NDC,facility,both,1,EA,6.13,4.34,Aetna First Health,Commercial,,5.21,85,,,2.72,5.21,percent of total billed charges,
valACYclovir 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079009301,NDC,facility,both,1,EA,10.69,7.57,Aetna First Health,Commercial,,9.09,85,,,4.74,9.09,percent of total billed charges,
valACYclovir 500 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084021511,NDC,facility,both,1,EA,11.2,7.93,Aetna First Health,Commercial,,9.52,85,,,4.96,9.52,percent of total billed charges,
valACYclovir 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904656561,NDC,facility,both,1,EA,8.53,6.04,Aetna First Health,Commercial,,7.25,85,,,3.78,7.25,percent of total billed charges,
valACYclovir 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084021501,NDC,facility,both,1,EA,11.2,7.93,Aetna First Health,Commercial,,9.52,85,,,4.96,9.52,percent of total billed charges,
valACYclovir 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,63739052510,NDC,facility,both,1,EA,13.52,9.57,Aetna First Health,Commercial,,11.49,85,,,5.99,11.49,percent of total billed charges,
valACYclovir 500 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00173093356,NDC,facility,both,1,EA,29.48,20.87,Aetna First Health,Commercial,,25.06,85,,,13.07,25.06,percent of total billed charges,
valACYclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378427593,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862044830,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16714069801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,57237004230,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,31722070430,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valACYclovir 500 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68084021521,NDC,facility,both,1,EA,10.82,7.66,Aetna First Health,Commercial,,9.2,85,,,4.8,9.2,percent of total billed charges,
valACYclovir 500 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,51079009303,NDC,facility,both,1,EA,10.69,7.57,Aetna First Health,Commercial,,9.09,85,,,4.74,9.09,percent of total billed charges,
valACYclovir 500 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378427577,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valGANciclovir 450 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084096595,NDC,facility,both,1,EA,240.19,170.05,Aetna First Health,Commercial,,204.16,85,,,106.45,204.16,percent of total billed charges,
valGANciclovir 450 MG Tablet 20 Each Box,63700001,CDM,,,250,RC,50268078712,NDC,facility,both,1,EA,55.79,39.5,Aetna First Health,Commercial,,47.42,85,,,24.73,47.42,percent of total billed charges,
valGANciclovir 450 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084096525,NDC,facility,both,1,EA,240.19,170.05,Aetna First Health,Commercial,,204.16,85,,,106.45,204.16,percent of total billed charges,
valGANciclovir 450 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,27241015860,NDC,facility,both,1,EA,14.58,10.32,Aetna First Health,Commercial,,12.39,85,,,6.46,12.39,percent of total billed charges,
valGANciclovir 450 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722083260,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
valGANciclovir 450 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,55111076260,NDC,facility,both,1,EA,81.99,58.05,Aetna First Health,Commercial,,69.69,85,,,36.34,69.69,percent of total billed charges,
valGANciclovir 450 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00004003822,NDC,facility,both,1,EA,309.41,219.06,Aetna First Health,Commercial,,263,85,,,137.13,263,percent of total billed charges,
valproic acid 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00591401201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproic acid 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,50111085201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproic acid 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00832031011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproic acid 250 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,69452015020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproic acid 250 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739025110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproic acid 250 MG capsule 100 Each Box,63700001,CDM,,,250,RC,63739008610,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687061211,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268078311,NDC,facility,both,1,EA,3.54,2.51,Aetna First Health,Commercial,,3.01,85,,,1.57,3.01,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,51660014030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65862057030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,33342006207,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378580793,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,13668006730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59746036030,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,43547036703,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,67877041530,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00078042315,NDC,facility,both,1,EA,27.07,19.17,Aetna First Health,Commercial,,23.01,85,,,12,23.01,percent of total billed charges,
valsartan 40 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687061221,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 40 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,62332004490,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valsartan 80 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687012811,NDC,facility,both,1,EA,3.52,2.49,Aetna First Health,Commercial,,2.99,85,,,1.56,2.99,percent of total billed charges,
valsartan 80 MG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,51660014190,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
vancomycin 125 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68180016611,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
vancomycin 125 MG capsule 20 Each Box,63700001,CDM,,,250,RC,42494045020,NDC,facility,both,1,EA,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
vancomycin 125 MG capsule 20 Each Box,63700001,CDM,,,250,RC,00121086720,NDC,facility,both,1,EA,7,4.96,Aetna First Health,Commercial,,5.95,85,,,3.1,5.95,percent of total billed charges,
vancomycin 125 MG capsule 20 Each Box,63700001,CDM,,,250,RC,68180016613,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
vancomycin 125 MG capsule 20 Each Box,63700001,CDM,,,250,RC,62559039020,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
vancomycin 125 MG capsule 20 Each Box,63700001,CDM,,,250,RC,47781072902,NDC,facility,both,1,EA,17.5,12.39,Aetna First Health,Commercial,,14.88,85,,,7.76,14.88,percent of total billed charges,
vancomycin 125 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,00121086750,NDC,facility,both,1,EA,7.25,5.13,Aetna First Health,Commercial,,6.16,85,,,3.21,6.16,percent of total billed charges,
vancomycin 125 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,62559039050,NDC,facility,both,1,EA,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
vancomycin 125 MG capsule 50 Each Bottle,63700001,CDM,,,250,RC,47781072950,NDC,facility,both,1,EA,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
varenicline 0.5 MG Tablet 56 Each Bottle,63700001,CDM,,,250,RC,49884015576,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
varenicline 0.5 MG Tablet 56 Each Bottle,63700001,CDM,,,250,RC,60505476505,NDC,facility,both,1,EA,25.97,18.39,Aetna First Health,Commercial,,22.07,85,,,11.51,22.07,percent of total billed charges,
varenicline 0.5 MG Tablet 56 Each Bottle,63700001,CDM,,,250,RC,00069046856,NDC,facility,both,1,EA,29.33,20.77,Aetna First Health,Commercial,,24.93,85,,,13,24.93,percent of total billed charges,
varenicline 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687064811,NDC,facility,both,1,EA,45.57,32.26,Aetna First Health,Commercial,,38.73,85,,,20.2,38.73,percent of total billed charges,
varenicline 1 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687064821,NDC,facility,both,1,EA,45.57,32.26,Aetna First Health,Commercial,,38.73,85,,,20.2,38.73,percent of total billed charges,
varenicline 1 MG Tablet 56 Each Bottle,63700001,CDM,,,250,RC,49884015676,NDC,facility,both,1,EA,3.44,2.44,Aetna First Health,Commercial,,2.92,85,,,1.52,2.92,percent of total billed charges,
varenicline 1 MG Tablet 56 Each Bottle,63700001,CDM,,,250,RC,60505476606,NDC,facility,both,1,EA,25.97,18.39,Aetna First Health,Commercial,,22.07,85,,,11.51,22.07,percent of total billed charges,
varenicline 1 MG Tablet 56 Each Bottle,63700001,CDM,,,250,RC,00069046956,NDC,facility,both,1,EA,29.33,20.77,Aetna First Health,Commercial,,24.93,85,,,13,24.93,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084071311,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 150 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00008083603,NDC,facility,both,1,EA,31.23,22.11,Aetna First Health,Commercial,,26.55,85,,,13.84,26.55,percent of total billed charges,
venlafaxine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50268079811,NDC,facility,both,1,EA,3.28,2.32,Aetna First Health,Commercial,,2.79,85,,,1.45,2.79,percent of total billed charges,
venlafaxine 25 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084089695,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
venlafaxine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68382001801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68001015700,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093019901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 25 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,62332000831,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 25 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,68084089625,NDC,facility,both,1,EA,3.68,2.61,Aetna First Health,Commercial,,3.13,85,,,1.63,3.13,percent of total billed charges,
venlafaxine 25 MG Tablet 50 Each Box,63700001,CDM,,,250,RC,50268079815,NDC,facility,both,1,EA,3.28,2.32,Aetna First Health,Commercial,,2.79,85,,,1.45,2.79,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084048411,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,68084069811,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 1 Each Blister,63700001,CDM,,,250,RC,00008083702,NDC,facility,both,1,EA,25.59,18.12,Aetna First Health,Commercial,,21.75,85,,,11.34,21.75,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084048401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,68084069801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904646861,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00008083703,NDC,facility,both,1,EA,25.59,18.12,Aetna First Health,Commercial,,21.75,85,,,11.34,21.75,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00093738456,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,65862052730,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,68382003406,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00008083721,NDC,facility,both,1,EA,25.59,18.12,Aetna First Health,Commercial,,21.75,85,,,11.34,21.75,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,65862052790,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,68382003416,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,00093738498,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Capsule Extended Release 24 Hour 90 Each Bottle,63700001,CDM,,,250,RC,59762018002,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 37.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084033011,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
venlafaxine 75 MG Capsule Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00008083303,NDC,facility,both,1,EA,28.67,20.3,Aetna First Health,Commercial,,24.37,85,,,12.71,24.37,percent of total billed charges,
venlafaxine 75 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,41616075983,NDC,facility,both,1,EA,11.08,7.84,Aetna First Health,Commercial,,9.42,85,,,4.91,9.42,percent of total billed charges,
venlafaxine 75 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,65580030203,NDC,facility,both,1,EA,18.9,13.38,Aetna First Health,Commercial,,16.06,85,,,8.38,16.06,percent of total billed charges,
verapamil 120 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591034501,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591040401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 40 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,23155005901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil 80 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00591034301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,51079089401,NDC,facility,both,1,EA,3.05,2.16,Aetna First Health,Commercial,,2.59,85,,,1.35,2.59,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,60687049311,NDC,facility,both,1,EA,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,68462029201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,75834032001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00093304301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,00172428560,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 100 Each Bottle,63700001,CDM,,,250,RC,57664011688,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,60687049301,NDC,facility,both,1,EA,4.93,3.49,Aetna First Health,Commercial,,4.19,85,,,2.18,4.19,percent of total billed charges,
verapamil CR 120 MG Tablet Extended Release 100 Each Box,63700001,CDM,,,250,RC,51079089420,NDC,facility,both,1,EA,6.76,4.79,Aetna First Health,Commercial,,5.75,85,,,3,5.75,percent of total billed charges,
verapamil CR 240 MG Tablet Extended Release 1 Each Blister,63700001,CDM,,,250,RC,51079086901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
verapamil ER 100 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,62175048537,NDC,facility,both,1,EA,5.48,3.88,Aetna First Health,Commercial,,4.66,85,,,2.43,4.66,percent of total billed charges,
verapamil ER 100 MG Capsule Extended Release 24 Hour 100 Each Bottle,63700001,CDM,,,250,RC,00378620101,NDC,facility,both,1,EA,5.49,3.89,Aetna First Health,Commercial,,4.67,85,,,2.43,4.67,percent of total billed charges,
Vilazodone HCl 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505477203,NDC,facility,both,1,EA,17.87,12.65,Aetna First Health,Commercial,,15.19,85,,,7.92,15.19,percent of total billed charges,
Vilazodone HCl 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,60505437203,NDC,facility,both,1,EA,17.87,12.65,Aetna First Health,Commercial,,15.19,85,,,7.92,15.19,percent of total billed charges,
Vilazodone HCl 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,16729035210,NDC,facility,both,1,EA,28.92,20.48,Aetna First Health,Commercial,,24.58,85,,,12.82,24.58,percent of total billed charges,
Vilazodone HCl 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00480204556,NDC,facility,both,1,EA,31.77,22.49,Aetna First Health,Commercial,,27,85,,,14.08,27,percent of total billed charges,
Vilazodone HCl 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456111030,NDC,facility,both,1,EA,40.54,28.7,Aetna First Health,Commercial,,34.46,85,,,17.97,34.46,percent of total billed charges,
Vilazodone HCl 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,62332023330,NDC,facility,both,1,EA,18.39,13.02,Aetna First Health,Commercial,,15.63,85,,,8.15,15.63,percent of total billed charges,
Vilazodone HCl 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00456112030,NDC,facility,both,1,EA,40.54,28.7,Aetna First Health,Commercial,,34.46,85,,,17.97,34.46,percent of total billed charges,
vitafusion multivites gummy Tablet Chewable 70 Each Bottle,63700001,CDM,,,250,RC,02791701471,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin A 3 MG (10000 UT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,00904208560,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin A 3 MG (10000 UT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,74312001020,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin A 3 MG (10000 UT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,87701040725,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin A 3 MG (10000 UT) capsule 110 Each Bottle,63700001,CDM,,,250,RC,40985021464,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904582460,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Bottle,63700001,CDM,,,250,RC,58487002371,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536333401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Bottle,63700001,CDM,,,250,RC,87701040749,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Bottle,63700001,CDM,,,250,RC,80681016900,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Bottle,63700001,CDM,,,250,RC,79854005024,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Box,63700001,CDM,,,250,RC,00904582461,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Box,63700001,CDM,,,250,RC,48433010401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Box,63700001,CDM,,,250,RC,10006070033,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Box,63700001,CDM,,,250,RC,20555003300,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 100 Each Box,63700001,CDM,,,250,RC,17856582401,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 110 Each Bottle,63700001,CDM,,,250,RC,40985027062,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 180 Each Bottle,63700001,CDM,,,250,RC,00904582493,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin D (cholecalciferol) 25 mcg (1000 Units) Tablet 200 Each Bottle,63700001,CDM,,,250,RC,87701040750,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 180 MG (400 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,30768003268,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 180 MG (400 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,87701040754,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 180 MG (400 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,57896075201,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 180 MG (400 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,31604001160,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 180 MG (400 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,10006070034,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 180 MG (400 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,40093010202,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
vitamin E 45 MG (100 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,80681013400,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
vitamin E 45 MG (100 UNIT) capsule 100 Each Bottle,63700001,CDM,,,250,RC,57896075401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
Vortioxetine HBr 10 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764073030,NDC,facility,both,1,EA,57.13,40.45,Aetna First Health,Commercial,,48.56,85,,,25.32,48.56,percent of total billed charges,
vortioxetine HBr 20 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,64764075030,NDC,facility,both,1,EA,57.13,40.45,Aetna First Health,Commercial,,48.56,85,,,25.32,48.56,percent of total billed charges,
warfarin 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00832121189,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056016901,NDC,facility,both,1,EA,7.21,5.1,Aetna First Health,Commercial,,6.13,85,,,3.2,6.13,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00555083102,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00832121100,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093171201,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51672402701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,65162076110,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,57237011901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,76282032701,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00056016970,NDC,facility,both,1,EA,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00832121101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
warfarin 1 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056016975,NDC,facility,both,1,EA,7.22,5.11,Aetna First Health,Commercial,,6.14,85,,,3.2,6.14,percent of total billed charges,
warfarin 10 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056017475,NDC,facility,both,1,EA,9.31,6.59,Aetna First Health,Commercial,,7.91,85,,,4.13,7.91,percent of total billed charges,
warfarin 2 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056017001,NDC,facility,both,1,EA,6.27,4.44,Aetna First Health,Commercial,,5.33,85,,,2.78,5.33,percent of total billed charges,
warfarin 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056017601,NDC,facility,both,1,EA,7.53,5.33,Aetna First Health,Commercial,,6.4,85,,,3.34,6.4,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00056017670,NDC,facility,both,1,EA,7.77,5.5,Aetna First Health,Commercial,,6.6,85,,,3.44,6.6,percent of total billed charges,
warfarin 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00056017675,NDC,facility,both,1,EA,7.52,5.32,Aetna First Health,Commercial,,6.39,85,,,3.33,6.39,percent of total billed charges,
warfarin 3 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056018801,NDC,facility,both,1,EA,7.56,5.35,Aetna First Health,Commercial,,6.43,85,,,3.35,6.43,percent of total billed charges,
warfarin 3 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00056018870,NDC,facility,both,1,EA,6.49,4.59,Aetna First Health,Commercial,,5.52,85,,,2.88,5.52,percent of total billed charges,
warfarin 4 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056016801,NDC,facility,both,1,EA,7.81,5.53,Aetna First Health,Commercial,,6.64,85,,,3.46,6.64,percent of total billed charges,
warfarin 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,00056017201,NDC,facility,both,1,EA,7.84,5.55,Aetna First Health,Commercial,,6.66,85,,,3.47,6.66,percent of total billed charges,
warfarin 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00056017270,NDC,facility,both,1,EA,8.1,5.73,Aetna First Health,Commercial,,6.88,85,,,3.59,6.88,percent of total billed charges,
warfarin 7.5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00056017370,NDC,facility,both,1,EA,8.98,6.36,Aetna First Health,Commercial,,7.63,85,,,3.98,7.63,percent of total billed charges,
witch hazel 50 % Pad 100 Each Box,63700001,CDM,,,250,RC,04138800730,NDC,facility,both,1,EA,26.4,18.69,Aetna First Health,Commercial,,22.44,85,,,11.7,22.44,percent of total billed charges,
witch hazel 50 % Pad 100 Each Jar,63700001,CDM,,,250,RC,54162000401,NDC,facility,both,1,EA,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
witch hazel 50 % Pad 40 Each Box,63700001,CDM,,,250,RC,12547015040,NDC,facility,both,1,EA,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
witch hazel 50 % Pad 48 Each Package,63700001,CDM,,,250,RC,00573055620,NDC,facility,both,1,EA,7.85,5.56,Aetna First Health,Commercial,,6.67,85,,,3.48,6.67,percent of total billed charges,
witch hazel-glycerin Pad 100 Each Jar,63700001,CDM,,,250,RC,00904505960,NDC,facility,both,1,EA,3.75,2.66,Aetna First Health,Commercial,,3.19,85,,,1.66,3.19,percent of total billed charges,
xylitol 550 MG DISK 40 Each Box,63700001,CDM,,,250,RC,55933000020,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00054008425,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00093526801,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,29300013101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,57237023901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,42043021001,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zaleplon 5 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,60793014501,NDC,facility,both,1,EA,36.67,25.96,Aetna First Health,Commercial,,31.17,85,,,16.25,31.17,percent of total billed charges,
zidovudine 100 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084046111,NDC,facility,both,1,EA,8.47,6,Aetna First Health,Commercial,,7.2,85,,,3.75,7.2,percent of total billed charges,
zidovudine 100 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,65862010701,NDC,facility,both,1,EA,5.3,3.75,Aetna First Health,Commercial,,4.5,85,,,2.35,4.5,percent of total billed charges,
zidovudine 100 MG capsule 30 Each Box,63700001,CDM,,,250,RC,68084046121,NDC,facility,both,1,EA,8.49,6.01,Aetna First Health,Commercial,,7.22,85,,,3.76,7.22,percent of total billed charges,
zinc gluconate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536667101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
zinc gluconate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00904319160,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
zinc gluconate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,80681000200,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
zinc gluconate 50 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,40093010153,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zinc sulfate 220 (50 Zn) MG capsule 1 Each Blister,63700001,CDM,,,250,RC,77333098325,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
zinc sulfate 220 (50 Zn) MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68585000801,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
zinc sulfate 220 (50 Zn) MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,37864099101,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
zinc sulfate 220 (50 Zn) MG capsule 100 Each Box,63700001,CDM,,,250,RC,77333098310,NDC,facility,both,1,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
ziprasidone 20 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084010311,NDC,facility,both,1,EA,9.7,6.87,Aetna First Health,Commercial,,8.24,85,,,4.3,8.24,percent of total billed charges,
ziprasidone 20 MG capsule 40 Each Box,63700001,CDM,,,250,RC,63739098832,NDC,facility,both,1,EA,9.73,6.89,Aetna First Health,Commercial,,8.27,85,,,4.31,8.27,percent of total billed charges,
ziprasidone 20 MG capsule 40 Each Box,63700001,CDM,,,250,RC,00904626908,NDC,facility,both,1,EA,16.89,11.96,Aetna First Health,Commercial,,14.36,85,,,7.49,14.36,percent of total billed charges,
ziprasidone 20 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,65862070260,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ziprasidone 20 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001013606,NDC,facility,both,1,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
ziprasidone 20 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68001045006,NDC,facility,both,1,EA,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
ziprasidone 20 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,68180033107,NDC,facility,both,1,EA,4.67,3.31,Aetna First Health,Commercial,,3.97,85,,,2.07,3.97,percent of total billed charges,
ziprasidone 20 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,16714083501,NDC,facility,both,1,EA,4.72,3.34,Aetna First Health,Commercial,,4.01,85,,,2.09,4.01,percent of total billed charges,
ziprasidone 20 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,60505252806,NDC,facility,both,1,EA,9.41,6.66,Aetna First Health,Commercial,,8,85,,,4.17,8,percent of total billed charges,
ziprasidone 20 MG capsule 60 Each Bottle,63700001,CDM,,,250,RC,00049396060,NDC,facility,both,1,EA,44.7,31.65,Aetna First Health,Commercial,,38,85,,,19.81,38,percent of total billed charges,
ziprasidone 20 MG capsule 80 Each Box,63700001,CDM,,,250,RC,00904626945,NDC,facility,both,1,EA,9.65,6.83,Aetna First Health,Commercial,,8.2,85,,,4.28,8.2,percent of total billed charges,
ziprasidone 20 MG capsule 80 Each Box,63700001,CDM,,,250,RC,68084010309,NDC,facility,both,1,EA,9.7,6.87,Aetna First Health,Commercial,,8.24,85,,,4.3,8.24,percent of total billed charges,
ziprasidone 20 MG capsule 80 Each Box,63700001,CDM,,,250,RC,00049396041,NDC,facility,both,1,EA,44.7,31.65,Aetna First Health,Commercial,,38,85,,,19.81,38,percent of total billed charges,
ziprasidone 60 MG capsule 40 Each Box,63700001,CDM,,,250,RC,00904627108,NDC,facility,both,1,EA,20.3,14.37,Aetna First Health,Commercial,,17.26,85,,,9,17.26,percent of total billed charges,
ziprasidone 60 MG capsule 80 Each Box,63700001,CDM,,,250,RC,00049398041,NDC,facility,both,1,EA,54.24,38.4,Aetna First Health,Commercial,,46.1,85,,,24.04,46.1,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,68382071569,NDC,facility,both,1,EA,24.5,17.35,Aetna First Health,Commercial,,20.82,85,,,10.86,20.82,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet Disintegrating 6 Each Box,63700001,CDM,,,250,RC,68462049976,NDC,facility,both,1,EA,19.19,13.59,Aetna First Health,Commercial,,16.31,85,,,8.51,16.31,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet Disintegrating 6 Each Box,63700001,CDM,,,250,RC,68382071586,NDC,facility,both,1,EA,24.48,17.33,Aetna First Health,Commercial,,20.81,85,,,10.85,20.81,percent of total billed charges,
ZOLMitriptan 2.5 MG Tablet Disintegrating 6 Each Box,63700001,CDM,,,250,RC,00115069151,NDC,facility,both,1,EA,140.36,99.37,Aetna First Health,Commercial,,119.31,85,,,62.21,119.31,percent of total billed charges,
ZOLmitriptan 5 MG Solution 6 Each Box,63700001,CDM,,,250,RC,64896068151,NDC,facility,both,1,EA,208.91,147.91,Aetna First Health,Commercial,,177.57,85,,,92.59,177.57,percent of total billed charges,
zolmitriptan orally disintegrating 5 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,68382071787,NDC,facility,both,1,EA,29.12,20.62,Aetna First Health,Commercial,,24.75,85,,,12.91,24.75,percent of total billed charges,
zolmitriptan orally disintegrating 5 MG Tablet Disintegrating 3 Each Box,63700001,CDM,,,250,RC,64980025713,NDC,facility,both,1,EA,19.65,13.91,Aetna First Health,Commercial,,16.7,85,,,8.71,16.7,percent of total billed charges,
zolmitriptan orally disintegrating 5 MG Tablet Disintegrating 3 Each Box,63700001,CDM,,,250,RC,68462050033,NDC,facility,both,1,EA,22.81,16.15,Aetna First Health,Commercial,,19.39,85,,,10.11,19.39,percent of total billed charges,
zolmitriptan orally disintegrating 5 MG Tablet Disintegrating 3 Each Box,63700001,CDM,,,250,RC,00115069250,NDC,facility,both,1,EA,155.17,109.86,Aetna First Health,Commercial,,131.89,85,,,68.77,131.89,percent of total billed charges,
zolpidem 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079072401,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zolpidem 5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,68084018911,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zolpidem 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00093007301,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zolpidem 5 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,16714062101,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zolpidem 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,00904608261,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zolpidem 5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,68084018901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zolpidem tartrate 1.75 MG SL Tab 1 Each Blister,63700001,CDM,,,250,RC,43386076201,NDC,facility,both,1,EA,27.66,19.58,Aetna First Health,Commercial,,23.51,85,,,12.26,23.51,percent of total billed charges,
zonisamide 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68462012901,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 50 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,62756025902,NDC,facility,both,1,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
testosterone 25 MG/2.5GM (1%) Gel 2.5 g Package,63700001,CDM,,,250,RC,45802011665,NDC,facility,both,1,GM,48.61,34.42,Aetna First Health,Commercial,,41.32,85,,,21.54,41.32,percent of total billed charges,
testosterone 25 MG/2.5GM (1%) Gel 2.5 g Box,63700001,CDM,,,250,RC,00051842530,NDC,facility,both,1,GM,57.72,40.87,Aetna First Health,Commercial,,49.06,85,,,25.58,49.06,percent of total billed charges,
testosterone 25 MG/2.5GM (1%) Gel 2.5 g Package,63700001,CDM,,,250,RC,00051842501,NDC,facility,both,1,GM,57.72,40.87,Aetna First Health,Commercial,,49.06,85,,,25.58,49.06,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00168026815,NDC,facility,both,1,GM,159.72,113.08,Aetna First Health,Commercial,,135.76,85,,,70.79,135.76,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Ointment 50 g Tube,63700001,CDM,,,250,RC,68180094702,NDC,facility,both,1,GM,190,134.52,Aetna First Health,Commercial,,161.5,85,,,84.21,161.5,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00472038215,NDC,facility,both,1,GM,211.44,149.7,Aetna First Health,Commercial,,179.72,85,,,93.71,179.72,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Ointment 45 g Tube,63700001,CDM,,,250,RC,00472038245,NDC,facility,both,1,GM,425.7,301.4,Aetna First Health,Commercial,,361.84,85,,,188.67,361.84,percent of total billed charges,
dinoprostone 0.5 MG/3GM Gel 3 g Package,63700001,CDM,,,250,RC,00009335902,NDC,facility,both,1,GM,432.21,306,Aetna First Health,Commercial,,367.38,85,,,191.56,367.38,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Ointment 50 g Tube,63700001,CDM,,,250,RC,66993089749,NDC,facility,both,1,GM,473.6,335.31,Aetna First Health,Commercial,,402.56,85,,,209.9,402.56,percent of total billed charges,
Vitamins A & D Ointment 5 g Packet,63700001,CDM,,,250,RC,00168003545,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Vitamins A & D Ointment 5 g Packet,63700001,CDM,,,250,RC,54162000005,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
white petrolatum Ointment 5 g Packet,63700001,CDM,,,250,RC,00168005345,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lubricating jelly Gel 3 g Box,63700001,CDM,,,250,RC,00281020543,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lubricating jelly Gel 5 g Box,63700001,CDM,,,250,RC,00281020545,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
povidone-iodine 10 % Ointment 1 g Packet,63700001,CDM,,,250,RC,52380002601,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
povidone-iodine 10 % Ointment 1 g Packet,63700001,CDM,,,250,RC,52380012602,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Surgilube Gel 3 g Box,63700001,CDM,,,250,RC,00281020543,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
lubricating jelly Gel 5 g Tube,63700001,CDM,,,250,RC,08137008946,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
hydrocortisone 1 % Cream 1.5 g Packet,63700001,CDM,,,250,RC,00168015408,NDC,facility,both,1,GR,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
hydrocortisone 1 % Ointment 28.4 g Tube,63700001,CDM,,,250,RC,49348052272,NDC,facility,both,1,GR,1.79,1.27,Aetna First Health,Commercial,,1.52,85,,,0.79,1.52,percent of total billed charges,
hydrocortisone 1 % Ointment 28 g Tube,63700001,CDM,,,250,RC,00472034556,NDC,facility,both,1,GR,1.97,1.39,Aetna First Health,Commercial,,1.67,85,,,0.87,1.67,percent of total billed charges,
methyl salicylate-menthol Ointment 28 g Tube,63700001,CDM,,,250,RC,54162055501,NDC,facility,both,1,GR,2.06,1.46,Aetna First Health,Commercial,,1.75,85,,,0.91,1.75,percent of total billed charges,
Vitamins A & D Ointment 56 g Tube,63700001,CDM,,,250,RC,54162000002,NDC,facility,both,1,GR,2.27,1.61,Aetna First Health,Commercial,,1.93,85,,,1.01,1.93,percent of total billed charges,
lanolin Cream 7 g Tube,63700001,CDM,,,250,RC,92771059007,NDC,facility,both,1,GR,2.29,1.62,Aetna First Health,Commercial,,1.95,85,,,1.01,1.95,percent of total billed charges,
Aloe Vesta Protective Ointment 56 g Tube,63700001,CDM,,,250,RC,43553324913,NDC,facility,both,1,GR,2.77,1.96,Aetna First Health,Commercial,,2.35,85,,,1.23,2.35,percent of total billed charges,
zinc oxide 20 % Ointment 30 g Tube,63700001,CDM,,,250,RC,00536570028,NDC,facility,both,1,GR,3.11,2.2,Aetna First Health,Commercial,,2.64,85,,,1.38,2.64,percent of total billed charges,
hydrocortisone 1 % Ointment 28 g Tube,63700001,CDM,,,250,RC,45802027603,NDC,facility,both,1,GR,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
lanolin Cream 7 g Tube,63700001,CDM,,,250,RC,44677010202,NDC,facility,both,1,GR,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
lubricating jelly Gel 56.7 g Tube,63700001,CDM,,,250,RC,00281020502,NDC,facility,both,1,GR,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
Surgilube Gel 56.7 g Tube,63700001,CDM,,,250,RC,00281020502,NDC,facility,both,1,GR,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
white petrolatum Ointment 28.35 g Tube,63700001,CDM,,,250,RC,00168005321,NDC,facility,both,1,GR,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
benzocaine (dental) 20 % Gel 15 g Tube,63700001,CDM,,,250,RC,54162092615,NDC,facility,both,1,GR,3.38,2.39,Aetna First Health,Commercial,,2.87,85,,,1.5,2.87,percent of total billed charges,
zinc oxide 20 % Ointment 28.35 g Tube,63700001,CDM,,,250,RC,00168006231,NDC,facility,both,1,GR,3.87,2.74,Aetna First Health,Commercial,,3.29,85,,,1.72,3.29,percent of total billed charges,
Icy Hot Original Pain Relief 10-30 % Cream 35.4 g Tube,63700001,CDM,,,250,RC,41167000883,NDC,facility,both,1,GR,3.98,2.82,Aetna First Health,Commercial,,3.38,85,,,1.76,3.38,percent of total billed charges,
benzocaine-resorcinol 5-2 % Cream 28 g Tube,63700001,CDM,,,250,RC,11509000367,NDC,facility,both,1,GR,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
Vitamins A & D Ointment 56.7 g Tube,63700001,CDM,,,250,RC,00168003501,NDC,facility,both,1,GR,4,2.83,Aetna First Health,Commercial,,3.4,85,,,1.77,3.4,percent of total billed charges,
hydrocortisone 0.5 % Cream 28.35 g Tube,63700001,CDM,,,250,RC,00168001431,NDC,facility,both,1,GR,4.04,2.86,Aetna First Health,Commercial,,3.43,85,,,1.79,3.43,percent of total billed charges,
Vitamins A & D Ointment 113 g Tube,63700001,CDM,,,250,RC,45802039504,NDC,facility,both,1,GR,4.07,2.88,Aetna First Health,Commercial,,3.46,85,,,1.8,3.46,percent of total billed charges,
Aloe Vesta Protective Ointment 56 g Tube,63700001,CDM,,,250,RC,68455010849,NDC,facility,both,1,GR,4.12,2.92,Aetna First Health,Commercial,,3.5,85,,,1.83,3.5,percent of total billed charges,
talc Powder 71 g Bottle,63700001,CDM,,,250,RC,00145150405,NDC,facility,both,1,GR,4.26,3.02,Aetna First Health,Commercial,,3.62,85,,,1.89,3.62,percent of total billed charges,
pramoxine - benzyl alcohol 1-10 % Gel 35.4 g Tube,63700001,CDM,,,250,RC,00225049533,NDC,facility,both,1,GR,4.41,3.12,Aetna First Health,Commercial,,3.75,85,,,1.95,3.75,percent of total billed charges,
lubricating jelly Gel 120.49 g Box,63700001,CDM,,,250,RC,00281020536,NDC,facility,both,1,GR,4.7,3.33,Aetna First Health,Commercial,,4,85,,,2.08,4,percent of total billed charges,
Surgilube Gel 120.49 g Box,63700001,CDM,,,250,RC,00281020536,NDC,facility,both,1,GR,4.7,3.33,Aetna First Health,Commercial,,4,85,,,2.08,4,percent of total billed charges,
glucose 40 % Gel 37.5 g Package,63700001,CDM,,,250,RC,00574006930,NDC,facility,both,1,GR,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
glucose 40 % Gel 37.5 g Package,63700001,CDM,,,250,RC,00057407030,NDC,facility,both,1,GR,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
glucose 40 % Gel 37.5 g Package,63700001,CDM,,,250,RC,00574007030,NDC,facility,both,1,GR,4.73,3.35,Aetna First Health,Commercial,,4.02,85,,,2.1,4.02,percent of total billed charges,
lubricating jelly Gel 120 g Tube,63700001,CDM,,,250,RC,49614044426,NDC,facility,both,1,GR,4.86,3.44,Aetna First Health,Commercial,,4.13,85,,,2.15,4.13,percent of total billed charges,
Vitamins A & D Ointment 113 g Tube,63700001,CDM,,,250,RC,00085009602,NDC,facility,both,1,GR,4.92,3.48,Aetna First Health,Commercial,,4.18,85,,,2.18,4.18,percent of total billed charges,
menthol-methyl salicylate 10-15 % Cream 57 g Tube,63700001,CDM,,,250,RC,74300008186,NDC,facility,both,1,GR,4.96,3.51,Aetna First Health,Commercial,,4.22,85,,,2.2,4.22,percent of total billed charges,
emollient Cream 113 g Jar,63700001,CDM,,,250,RC,54162060002,NDC,facility,both,1,GR,5.59,3.96,Aetna First Health,Commercial,,4.75,85,,,2.48,4.75,percent of total billed charges,
emollient Cream 113 g Jar,63700001,CDM,,,250,RC,92771060002,NDC,facility,both,1,GR,5.59,3.96,Aetna First Health,Commercial,,4.75,85,,,2.48,4.75,percent of total billed charges,
menthol-zinc oxide 0.44-20.6 % Ointment 71 g Tube,63700001,CDM,,,250,RC,00799000102,NDC,facility,both,1,GR,5.86,4.15,Aetna First Health,Commercial,,4.98,85,,,2.6,4.98,percent of total billed charges,
hydrocortisone 1 % Cream 28.35 g Tube,63700001,CDM,,,250,RC,00168015431,NDC,facility,both,1,GR,6,4.25,Aetna First Health,Commercial,,5.1,85,,,2.66,5.1,percent of total billed charges,
emollient Cream 454 g Jar,63700001,CDM,,,250,RC,00904775127,NDC,facility,both,1,GR,6.13,4.34,Aetna First Health,Commercial,,5.21,85,,,2.72,5.21,percent of total billed charges,
benzocaine-menthol 20-0.5 % Aerosol 56 g Can,63700001,CDM,,,250,RC,63029850401,NDC,facility,both,1,GR,6.47,4.58,Aetna First Health,Commercial,,5.5,85,,,2.87,5.5,percent of total billed charges,
camphor-menthol-methyl salicylate 4-10-30 % Cream 57 g Tube,63700001,CDM,,,250,RC,74300008193,NDC,facility,both,1,GR,6.5,4.6,Aetna First Health,Commercial,,5.52,85,,,2.88,5.52,percent of total billed charges,
camphor-eucalyptus-menthol Ointment 50 g Jar,63700001,CDM,,,250,RC,23900000361,NDC,facility,both,1,GR,6.68,4.73,Aetna First Health,Commercial,,5.68,85,,,2.96,5.68,percent of total billed charges,
miconazole 2 % Cream 45 g Tube,63700001,CDM,,,250,RC,00713025237,NDC,facility,both,1,GR,6.75,4.78,Aetna First Health,Commercial,,5.74,85,,,2.99,5.74,percent of total billed charges,
benzocaine-menthol 20-0.5 % Aerosol 56 g Can,63700001,CDM,,,250,RC,16864068002,NDC,facility,both,1,GR,6.8,4.81,Aetna First Health,Commercial,,5.78,85,,,3.01,5.78,percent of total billed charges,
lanolin 30 % Ointment 200 g Tube,63700001,CDM,,,250,RC,12090000606,NDC,facility,both,1,GR,6.9,4.89,Aetna First Health,Commercial,,5.86,85,,,3.06,5.86,percent of total billed charges,
ammonium lactate 12 % Cream 140 g Tube,63700001,CDM,,,250,RC,00904598348,NDC,facility,both,1,GR,7.14,5.06,Aetna First Health,Commercial,,6.07,85,,,3.16,6.07,percent of total billed charges,
Vitamins A & D Ointment 113.4 g Tube,63700001,CDM,,,250,RC,00168003504,NDC,facility,both,1,GR,7.14,5.06,Aetna First Health,Commercial,,6.07,85,,,3.16,6.07,percent of total billed charges,
emollient Cream 57 g Tube,63700001,CDM,,,250,RC,72140003868,NDC,facility,both,1,GR,7.27,5.15,Aetna First Health,Commercial,,6.18,85,,,3.22,6.18,percent of total billed charges,
menthol-zinc oxide 0.44-20.6 % Ointment 113 g Tube,63700001,CDM,,,250,RC,00799000104,NDC,facility,both,1,GR,7.29,5.16,Aetna First Health,Commercial,,6.2,85,,,3.23,6.2,percent of total billed charges,
dibucaine 1 % Ointment 28 g Tube,63700001,CDM,,,250,RC,00536121195,NDC,facility,both,1,GR,7.35,5.2,Aetna First Health,Commercial,,6.25,85,,,3.26,6.25,percent of total billed charges,
hydrophor Ointment 50 g Tube,63700001,CDM,,,250,RC,72140045231,NDC,facility,both,1,GR,7.35,5.2,Aetna First Health,Commercial,,6.25,85,,,3.26,6.25,percent of total billed charges,
dibucaine (perianal) 1 % Ointment 28 g Tube,63700001,CDM,,,250,RC,45802005003,NDC,facility,both,1,GR,7.52,5.32,Aetna First Health,Commercial,,6.39,85,,,3.33,6.39,percent of total billed charges,
ammonium lactate 12 % Lotion 400 g Bottle,63700001,CDM,,,250,RC,71399014004,NDC,facility,both,1,GR,7.8,5.52,Aetna First Health,Commercial,,6.63,85,,,3.46,6.63,percent of total billed charges,
miconazole 2 % Ointment 56 g Tube,63700001,CDM,,,250,RC,68455010851,NDC,facility,both,1,GR,7.81,5.53,Aetna First Health,Commercial,,6.64,85,,,3.46,6.64,percent of total billed charges,
miconazole 2 % Ointment 56 g Tube,63700001,CDM,,,250,RC,43553000302,NDC,facility,both,1,GR,7.81,5.53,Aetna First Health,Commercial,,6.64,85,,,3.46,6.64,percent of total billed charges,
trolamine salicylate 10 % Cream 100 g Tube,63700001,CDM,,,250,RC,00225036011,NDC,facility,both,1,GR,8.25,5.84,Aetna First Health,Commercial,,7.01,85,,,3.66,7.01,percent of total billed charges,
povidone-iodine 10 % Ointment 30 g Tube,63700001,CDM,,,250,RC,11822039290,NDC,facility,both,1,GR,8.37,5.93,Aetna First Health,Commercial,,7.11,85,,,3.71,7.11,percent of total billed charges,
phenylephrine-mineral oil-pet 0.25-14-74.9 % Ointment 28 g Tube,63700001,CDM,,,250,RC,00573287110,NDC,facility,both,1,GR,8.4,5.95,Aetna First Health,Commercial,,7.14,85,,,3.72,7.14,percent of total billed charges,
petrolatum 42 % Ointment 100 g Jar,63700001,CDM,,,250,RC,00536114397,NDC,facility,both,1,GR,8.55,6.05,Aetna First Health,Commercial,,7.27,85,,,3.79,7.27,percent of total billed charges,
camphor-menthol-methyl salicylate 4-10-30 % Cream 113 g Tube,63700001,CDM,,,250,RC,74300000536,NDC,facility,both,1,GR,8.64,6.12,Aetna First Health,Commercial,,7.34,85,,,3.83,7.34,percent of total billed charges,
sodium bicarbonate Powder 113 g Bottle,63700001,CDM,,,250,RC,00395268594,NDC,facility,both,1,GR,8.64,6.12,Aetna First Health,Commercial,,7.34,85,,,3.83,7.34,percent of total billed charges,
miconazole 2 % Cream 45 g Tube,63700001,CDM,,,250,RC,61269073063,NDC,facility,both,1,GR,8.91,6.31,Aetna First Health,Commercial,,7.57,85,,,3.95,7.57,percent of total billed charges,
salicylic acid 17 % Gel 7 g Tube,63700001,CDM,,,250,RC,75137058507,NDC,facility,both,1,GR,8.96,6.34,Aetna First Health,Commercial,,7.62,85,,,3.97,7.62,percent of total billed charges,
hydroxypropyl methylcellulose 0.3 % Gel 10 g Tube,63700001,CDM,,,250,RC,00078042957,NDC,facility,both,1,GR,9,6.37,Aetna First Health,Commercial,,7.65,85,,,3.99,7.65,percent of total billed charges,
ammonium lactate 12 % Cream 140 g Tube,63700001,CDM,,,250,RC,92771061305,NDC,facility,both,1,GR,9.24,6.54,Aetna First Health,Commercial,,7.85,85,,,4.1,7.85,percent of total billed charges,
dibucaine 1 % Ointment 28 g Tube,63700001,CDM,,,250,RC,54162001101,NDC,facility,both,1,GR,9.28,6.57,Aetna First Health,Commercial,,7.89,85,,,4.11,7.89,percent of total billed charges,
emollient Ointment 113 g Tube,63700001,CDM,,,250,RC,54323021502,NDC,facility,both,1,GR,9.32,6.6,Aetna First Health,Commercial,,7.92,85,,,4.13,7.92,percent of total billed charges,
ammonium lactate 12 % Cream 140 g Tube,63700001,CDM,,,250,RC,63044040420,NDC,facility,both,1,GR,9.66,6.84,Aetna First Health,Commercial,,8.21,85,,,4.28,8.21,percent of total billed charges,
nitroglycerin 2 % Ointment 1 g Packet,63700001,CDM,,,250,RC,00281032608,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
white petrolatum Ointment 28.4 g Tube,63700001,CDM,,,250,RC,53329006801,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
zinc oxide 20 % Ointment 30 g Tube,63700001,CDM,,,250,RC,00536131628,NDC,facility,both,1,GR,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
hydroxypropyl methylcellulose 0.3 % Gel 10 g Tube,63700001,CDM,,,250,RC,00078042947,NDC,facility,both,1,GR,10.1,7.15,Aetna First Health,Commercial,,8.58,85,,,4.48,8.58,percent of total billed charges,
Saline 0.9 % Aerosol Solution 28 g Tube,63700001,CDM,,,250,RC,22600008559,NDC,facility,both,1,GR,10.19,7.21,Aetna First Health,Commercial,,8.66,85,,,4.52,8.66,percent of total billed charges,
emollient Cream 454 g Jar,63700001,CDM,,,250,RC,54162060001,NDC,facility,both,1,GR,10.22,7.24,Aetna First Health,Commercial,,8.69,85,,,4.53,8.69,percent of total billed charges,
hydrocortisone 2.5 % Cream 20 g Tube,63700001,CDM,,,250,RC,45802000402,NDC,facility,both,1,GR,10.4,7.36,Aetna First Health,Commercial,,8.84,85,,,4.61,8.84,percent of total billed charges,
citric acid anhydrous Granules 100 g Bottle,63700001,CDM,,,250,RC,51552004804,NDC,facility,both,1,GR,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
hydrophor Ointment 85 g Tube,63700001,CDM,,,250,RC,72140063377,NDC,facility,both,1,GR,10.71,7.58,Aetna First Health,Commercial,,9.1,85,,,4.75,9.1,percent of total billed charges,
urea 20 % Cream 85 g Tube,63700001,CDM,,,250,RC,00536110945,NDC,facility,both,1,GR,10.84,7.67,Aetna First Health,Commercial,,9.21,85,,,4.8,9.21,percent of total billed charges,
emollient Cream 113 g Jar,63700001,CDM,,,250,RC,72140000022,NDC,facility,both,1,GR,11.02,7.8,Aetna First Health,Commercial,,9.37,85,,,4.88,9.37,percent of total billed charges,
emollient Ointment 99 g Jar,63700001,CDM,,,250,RC,72140003263,NDC,facility,both,1,GR,11.14,7.89,Aetna First Health,Commercial,,9.47,85,,,4.94,9.47,percent of total billed charges,
hydrophor Ointment 99 g Jar,63700001,CDM,,,250,RC,72140003263,NDC,facility,both,1,GR,11.14,7.89,Aetna First Health,Commercial,,9.47,85,,,4.94,9.47,percent of total billed charges,
trolamine salicylate 10 % Cream 141 g Tube,63700001,CDM,,,250,RC,41167005724,NDC,facility,both,1,GR,11.21,7.94,Aetna First Health,Commercial,,9.53,85,,,4.97,9.53,percent of total billed charges,
petrolatum-zinc oxide 49-15 % Ointment 113 g Tube,63700001,CDM,,,250,RC,43553325604,NDC,facility,both,1,GR,11.36,8.04,Aetna First Health,Commercial,,9.66,85,,,5.03,9.66,percent of total billed charges,
hydrophor Ointment 454 g Jar,63700001,CDM,,,250,RC,61924018416,NDC,facility,both,1,GR,11.58,8.2,Aetna First Health,Commercial,,9.84,85,,,5.13,9.84,percent of total billed charges,
miconazole 2 % Cream 45 g Tube,63700001,CDM,,,250,RC,51672203506,NDC,facility,both,1,GR,12.08,8.55,Aetna First Health,Commercial,,10.27,85,,,5.35,10.27,percent of total billed charges,
Vitamins A & D Ointment 113 g Tube,63700001,CDM,,,250,RC,24385007026,NDC,facility,both,1,GR,12.66,8.96,Aetna First Health,Commercial,,10.76,85,,,5.61,10.76,percent of total billed charges,
sunscreen 2-2.5-6.6 % STICK 4.25 g,63700001,CDM,,,250,RC,10157982201,NDC,facility,both,1,GR,12.75,9.03,Aetna First Health,Commercial,,10.84,85,,,5.65,10.84,percent of total billed charges,
dibucaine (perianal) 1 % Ointment 28 g Tube,63700001,CDM,,,250,RC,71399282901,NDC,facility,both,1,GR,12.77,9.04,Aetna First Health,Commercial,,10.85,85,,,5.66,10.85,percent of total billed charges,
hydrocortisone 2.5 % Ointment 28.35 g Tube,63700001,CDM,,,250,RC,00168014630,NDC,facility,both,1,GR,13.15,9.31,Aetna First Health,Commercial,,11.18,85,,,5.83,11.18,percent of total billed charges,
hydrocortisone 2.5 % Cream 30 g Tube,63700001,CDM,,,250,RC,00168008031,NDC,facility,both,1,GR,13.2,9.35,Aetna First Health,Commercial,,11.22,85,,,5.85,11.22,percent of total billed charges,
tioconazole 6.5 % Ointment 4.6 g Package,63700001,CDM,,,250,RC,00067209046,NDC,facility,both,1,GR,13.48,9.54,Aetna First Health,Commercial,,11.46,85,,,5.97,11.46,percent of total billed charges,
emollient Cream 453 g Jar,63700001,CDM,,,250,RC,45334030001,NDC,facility,both,1,GR,13.59,9.62,Aetna First Health,Commercial,,11.55,85,,,6.02,11.55,percent of total billed charges,
glucose 40 % Gel 112.5 g Tube,63700001,CDM,,,250,RC,00574006945,NDC,facility,both,1,GR,14.18,10.04,Aetna First Health,Commercial,,12.05,85,,,6.28,12.05,percent of total billed charges,
hydrophor Ointment 454 g Jar,63700001,CDM,,,250,RC,54162050001,NDC,facility,both,1,GR,14.3,10.12,Aetna First Health,Commercial,,12.16,85,,,6.34,12.16,percent of total billed charges,
triamcinolone acetonide 0.025 % Cream 15 g Tube,63700001,CDM,,,250,RC,45802006335,NDC,facility,both,1,GR,14.4,10.2,Aetna First Health,Commercial,,12.24,85,,,6.38,12.24,percent of total billed charges,
tioconazole 6.5 % Ointment 4.6 g Package,63700001,CDM,,,250,RC,24385037482,NDC,facility,both,1,GR,14.5,10.27,Aetna First Health,Commercial,,12.32,85,,,6.43,12.32,percent of total billed charges,
urea 20 % Cream 85 g Tube,63700001,CDM,,,250,RC,71399843403,NDC,facility,both,1,GR,14.54,10.29,Aetna First Health,Commercial,,12.36,85,,,6.44,12.36,percent of total billed charges,
tioconazole 6.5 % Ointment 4.6 g Package,63700001,CDM,,,250,RC,49348050859,NDC,facility,both,1,GR,14.66,10.38,Aetna First Health,Commercial,,12.46,85,,,6.5,12.46,percent of total billed charges,
hydroxypropyl methylcellulose 0.3 % Gel 10 g Tube,63700001,CDM,,,250,RC,00065047401,NDC,facility,both,1,GR,14.69,10.4,Aetna First Health,Commercial,,12.49,85,,,6.51,12.49,percent of total billed charges,
urea 20 % Cream 85 g Tube,63700001,CDM,,,250,RC,58980061030,NDC,facility,both,1,GR,15.05,10.66,Aetna First Health,Commercial,,12.79,85,,,6.67,12.79,percent of total billed charges,
A+D Prevent Ointment 113 g Tube,63700001,CDM,,,250,RC,41100081124,NDC,facility,both,1,GR,15.37,10.88,Aetna First Health,Commercial,,13.06,85,,,6.81,13.06,percent of total billed charges,
Vitamins A & D Ointment 113 g Tube,63700001,CDM,,,250,RC,41100081124,NDC,facility,both,1,GR,15.37,10.88,Aetna First Health,Commercial,,13.06,85,,,6.81,13.06,percent of total billed charges,
ammonium lactate 12 % Cream 140 g Tube,63700001,CDM,,,250,RC,45802051377,NDC,facility,both,1,GR,15.75,11.15,Aetna First Health,Commercial,,13.39,85,,,6.98,13.39,percent of total billed charges,
Vitamins A & D Ointment 113 g Tube,63700001,CDM,,,250,RC,71399012204,NDC,facility,both,1,GR,15.82,11.2,Aetna First Health,Commercial,,13.45,85,,,7.01,13.45,percent of total billed charges,
sodium bicarbonate Powder 454 g Box,63700001,CDM,,,250,RC,07192335777,NDC,facility,both,1,GR,18.16,12.86,Aetna First Health,Commercial,,15.44,85,,,8.05,15.44,percent of total billed charges,
Dimethicone-Zinc Oxide 5-5 % Ointment 141 g Bottle,63700001,CDM,,,250,RC,43553000705,NDC,facility,both,1,GR,18.82,13.32,Aetna First Health,Commercial,,16,85,,,8.34,16,percent of total billed charges,
emollient Cream 454 g Jar,63700001,CDM,,,250,RC,72140000021,NDC,facility,both,1,GR,19.07,13.5,Aetna First Health,Commercial,,16.21,85,,,8.45,16.21,percent of total billed charges,
emollient Ointment 396 g Jar,63700001,CDM,,,250,RC,72140003147,NDC,facility,both,1,GR,19.6,13.88,Aetna First Health,Commercial,,16.66,85,,,8.69,16.66,percent of total billed charges,
tioconazole 6.5 % Ointment 4.6 g Package,63700001,CDM,,,250,RC,63736044101,NDC,facility,both,1,GR,20.11,14.24,Aetna First Health,Commercial,,17.09,85,,,8.91,17.09,percent of total billed charges,
zinc oxide 20 % Ointment 28.4 g Tube,63700001,CDM,,,250,RC,75834017001,NDC,facility,both,1,GR,21.02,14.88,Aetna First Health,Commercial,,17.87,85,,,9.32,17.87,percent of total billed charges,
hydrocortisone 1 % Ointment 28.4 g Tube,63700001,CDM,,,250,RC,00472132626,NDC,facility,both,1,GR,21.58,15.28,Aetna First Health,Commercial,,18.34,85,,,9.56,18.34,percent of total billed charges,
hydrophor Ointment 396 g Jar,63700001,CDM,,,250,RC,72140063608,NDC,facility,both,1,GR,21.98,15.56,Aetna First Health,Commercial,,18.68,85,,,9.74,18.68,percent of total billed charges,
ammonium lactate 12 % Lotion 400 g Bottle,63700001,CDM,,,250,RC,45802052526,NDC,facility,both,1,GR,23.4,16.57,Aetna First Health,Commercial,,19.89,85,,,10.37,19.89,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 30 g Tube,63700001,CDM,,,250,RC,51672128402,NDC,facility,both,1,GR,24,16.99,Aetna First Health,Commercial,,20.4,85,,,10.64,20.4,percent of total billed charges,
hydrocortisone 1 % Cream 28.35 g Tube,63700001,CDM,,,250,RC,00168001531,NDC,facility,both,1,GR,24.04,17.02,Aetna First Health,Commercial,,20.43,85,,,10.65,20.43,percent of total billed charges,
camphor-menthol-methyl salicylate 4-10-30 % Cream 113 g Tube,63700001,CDM,,,250,RC,74300008194,NDC,facility,both,1,GR,25.31,17.92,Aetna First Health,Commercial,,21.51,85,,,11.22,21.51,percent of total billed charges,
miconazole 2 % Ointment 57 g Tube,63700001,CDM,,,250,RC,11701006723,NDC,facility,both,1,GR,25.99,18.4,Aetna First Health,Commercial,,22.09,85,,,11.52,22.09,percent of total billed charges,
sodium bicarbonate Powder 454 g Bottle,63700001,CDM,,,250,RC,51552005906,NDC,facility,both,1,GR,27.24,19.29,Aetna First Health,Commercial,,23.15,85,,,12.07,23.15,percent of total billed charges,
phenylephrine-mineral oil-pet 0.25-14-74.9 % Ointment 28 g Tube,63700001,CDM,,,250,RC,00573287193,NDC,facility,both,1,GR,27.78,19.67,Aetna First Health,Commercial,,23.61,85,,,12.31,23.61,percent of total billed charges,
sodium bicarbonate Powder 454 g Bottle,63700001,CDM,,,250,RC,00395268501,NDC,facility,both,1,GR,27.92,19.77,Aetna First Health,Commercial,,23.73,85,,,12.37,23.73,percent of total billed charges,
Intrasite Gel Applipak Gel 15 g Applicator,63700001,CDM,,,250,RC,00050223480,NDC,facility,both,1,GR,28.14,19.92,Aetna First Health,Commercial,,23.92,85,,,12.47,23.92,percent of total billed charges,
Intrasite Gel Applipak Gel 15 g Box,63700001,CDM,,,250,RC,00223043856,NDC,facility,both,1,GR,28.14,19.92,Aetna First Health,Commercial,,23.92,85,,,12.47,23.92,percent of total billed charges,
antimicrobial hydrogel Gel 28 g Tube,63700001,CDM,,,250,RC,61470101401,NDC,facility,both,1,GR,28.22,19.98,Aetna First Health,Commercial,,23.99,85,,,12.51,23.99,percent of total billed charges,
hydroxypropyl methylcellulose 0.3 % Gel 10 g Tube,63700001,CDM,,,250,RC,00065806401,NDC,facility,both,1,GR,28.6,20.25,Aetna First Health,Commercial,,24.31,85,,,12.68,24.31,percent of total billed charges,
white petrolatum Ointment 453.6 g Jar,63700001,CDM,,,250,RC,00168005316,NDC,facility,both,1,GR,29.94,21.2,Aetna First Health,Commercial,,25.45,85,,,13.27,25.45,percent of total billed charges,
desoximetasone 0.25 % Cream 15 g Tube,63700001,CDM,,,250,RC,68180095001,NDC,facility,both,1,GR,40.02,28.33,Aetna First Health,Commercial,,34.02,85,,,17.74,34.02,percent of total billed charges,
hydrocortisone 0.2 % Cream 15 g Tube,63700001,CDM,,,250,RC,68180095401,NDC,facility,both,1,GR,40.02,28.33,Aetna First Health,Commercial,,34.02,85,,,17.74,34.02,percent of total billed charges,
capsaicin 0.075 % Cream 60 g Tube,63700001,CDM,,,250,RC,00603064988,NDC,facility,both,1,GR,40.41,28.61,Aetna First Health,Commercial,,34.35,85,,,17.91,34.35,percent of total billed charges,
bismuth subgallate Powder 100 g Bottle,63700001,CDM,,,250,RC,51552020205,NDC,facility,both,1,GR,42.15,29.84,Aetna First Health,Commercial,,35.83,85,,,18.68,35.83,percent of total billed charges,
Bismuth Subnitrate Powder 100 g Bottle,63700001,CDM,,,250,RC,51552016209,NDC,facility,both,1,GR,43.2,30.59,Aetna First Health,Commercial,,36.72,85,,,19.15,36.72,percent of total billed charges,
emollient Ointment 198 g Tube,63700001,CDM,,,250,RC,72140001945,NDC,facility,both,1,GR,44.35,31.4,Aetna First Health,Commercial,,37.7,85,,,19.66,37.7,percent of total billed charges,
hydrophor Ointment 198 g Tube,63700001,CDM,,,250,RC,72140001945,NDC,facility,both,1,GR,44.35,31.4,Aetna First Health,Commercial,,37.7,85,,,19.66,37.7,percent of total billed charges,
hydrocortisone 1 % Cream 454 g Jar,63700001,CDM,,,250,RC,45802043805,NDC,facility,both,1,GR,59.93,42.43,Aetna First Health,Commercial,,50.94,85,,,26.56,50.94,percent of total billed charges,
clobetasol 0.05 % Ointment 60 g Tube,63700001,CDM,,,250,RC,43386009662,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
fluocinonide 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,51672138601,NDC,facility,both,1,GR,60,42.48,Aetna First Health,Commercial,,51,85,,,26.59,51,percent of total billed charges,
oxyquinoline-sod lauryl sulf 0.025-0.01 % Gel 113.4 g Tube,63700001,CDM,,,250,RC,59365503000,NDC,facility,both,1,GR,60.33,42.71,Aetna First Health,Commercial,,51.28,85,,,26.74,51.28,percent of total billed charges,
betamethasone valerate 0.1 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00168003315,NDC,facility,both,1,GR,65.1,46.09,Aetna First Health,Commercial,,55.33,85,,,28.85,55.33,percent of total billed charges,
urea 40 % Cream 85 g Tube,63700001,CDM,,,250,RC,00316740003,NDC,facility,both,1,GR,67.32,47.66,Aetna First Health,Commercial,,57.22,85,,,29.84,57.22,percent of total billed charges,
clobetasol 0.05 % Cream 45 g Tube,63700001,CDM,,,250,RC,68180095603,NDC,facility,both,1,GR,68.94,48.81,Aetna First Health,Commercial,,58.6,85,,,30.55,58.6,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 454 g Jar,63700001,CDM,,,250,RC,52817081154,NDC,facility,both,1,GR,70.82,50.14,Aetna First Health,Commercial,,60.2,85,,,31.39,60.2,percent of total billed charges,
fluocinonide 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,51672126401,NDC,facility,both,1,GR,73.98,52.38,Aetna First Health,Commercial,,62.88,85,,,32.79,62.88,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 454 g Jar,63700001,CDM,,,250,RC,45802006405,NDC,facility,both,1,GR,78.09,55.29,Aetna First Health,Commercial,,66.38,85,,,34.61,66.38,percent of total billed charges,
hydrocortisone (perianal) 1 % Cream 28.4 g Tube,63700001,CDM,,,250,RC,64980030230,NDC,facility,both,1,GR,79.75,56.46,Aetna First Health,Commercial,,67.79,85,,,35.35,67.79,percent of total billed charges,
mometasone 0.1 % Ointment 45 g Tube,63700001,CDM,,,250,RC,68462022555,NDC,facility,both,1,GR,84.06,59.51,Aetna First Health,Commercial,,71.45,85,,,37.26,71.45,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 454 g Jar,63700001,CDM,,,250,RC,16714098604,NDC,facility,both,1,GR,87.17,61.72,Aetna First Health,Commercial,,74.09,85,,,38.63,74.09,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 454 g Jar,63700001,CDM,,,250,RC,67877025145,NDC,facility,both,1,GR,88.98,63,Aetna First Health,Commercial,,75.63,85,,,39.44,75.63,percent of total billed charges,
betamethasone valerate 0.1 % Cream 15 g Tube,63700001,CDM,,,250,RC,00168004015,NDC,facility,both,1,GR,89.52,63.38,Aetna First Health,Commercial,,76.09,85,,,39.68,76.09,percent of total billed charges,
desonide 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,51672128101,NDC,facility,both,1,GR,92.46,65.46,Aetna First Health,Commercial,,78.59,85,,,40.98,78.59,percent of total billed charges,
urea 40 % Cream 198.4 g Tube,63700001,CDM,,,250,RC,00316740007,NDC,facility,both,1,GR,99.2,70.23,Aetna First Health,Commercial,,84.32,85,,,43.97,84.32,percent of total billed charges,
triamcinolone acetonide 0.1 % Cream 453.6 g Jar,63700001,CDM,,,250,RC,00168000416,NDC,facility,both,1,GR,99.79,70.65,Aetna First Health,Commercial,,84.82,85,,,44.23,84.82,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 454 g Jar,63700001,CDM,,,250,RC,52565001426,NDC,facility,both,1,GR,99.88,70.72,Aetna First Health,Commercial,,84.9,85,,,44.27,84.9,percent of total billed charges,
triamcinolone acetonide 0.025 % Ointment 454 g Jar,63700001,CDM,,,250,RC,45802005405,NDC,facility,both,1,GR,101.7,72,Aetna First Health,Commercial,,86.44,85,,,45.07,86.44,percent of total billed charges,
fluocinonide 0.05 % Ointment 30 g Tube,63700001,CDM,,,250,RC,51672126402,NDC,facility,both,1,GR,103.68,73.41,Aetna First Health,Commercial,,88.13,85,,,45.95,88.13,percent of total billed charges,
balsam peru-castor oil Ointment 56.7 g Tube,63700001,CDM,,,250,RC,58980078021,NDC,facility,both,1,GR,112.49,79.64,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
fluocinolone acetonide 0.025 % Cream 15 g Tube,63700001,CDM,,,250,RC,00168006015,NDC,facility,both,1,GR,112.56,79.69,Aetna First Health,Commercial,,95.68,85,,,49.89,95.68,percent of total billed charges,
PLO base Gel 454 g Jar,63700001,CDM,,,250,RC,00395013501,NDC,facility,both,1,GR,115.09,81.48,Aetna First Health,Commercial,,97.83,85,,,51.01,97.83,percent of total billed charges,
mometasone 0.1 % Ointment 45 g Tube,63700001,CDM,,,250,RC,45802011942,NDC,facility,both,1,GR,116.46,82.45,Aetna First Health,Commercial,,98.99,85,,,51.62,98.99,percent of total billed charges,
fluocinolone acetonide 0.025 % Cream 15 g Tube,63700001,CDM,,,250,RC,52565002015,NDC,facility,both,1,GR,117,82.84,Aetna First Health,Commercial,,99.45,85,,,51.85,99.45,percent of total billed charges,
fluocinolone acetonide 0.025 % Cream 15 g Tube,63700001,CDM,,,250,RC,00713070915,NDC,facility,both,1,GR,117,82.84,Aetna First Health,Commercial,,99.45,85,,,51.85,99.45,percent of total billed charges,
balsam peru-castor oil Ointment 60 g Tube,63700001,CDM,,,250,RC,75834013960,NDC,facility,both,1,GR,119.04,84.28,Aetna First Health,Commercial,,101.18,85,,,52.76,101.18,percent of total billed charges,
lidocaine 5 % Ointment 30 g Tube,63700001,CDM,,,250,RC,51672302002,NDC,facility,both,1,GR,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
desoximetasone 0.25 % Cream 15 g Tube,63700001,CDM,,,250,RC,51672127001,NDC,facility,both,1,GR,125.16,88.61,Aetna First Health,Commercial,,106.39,85,,,55.47,106.39,percent of total billed charges,
ammonium lactate 12 % Lotion 400 g Bottle,63700001,CDM,,,250,RC,45802041926,NDC,facility,both,1,GR,129.6,91.76,Aetna First Health,Commercial,,110.16,85,,,57.44,110.16,percent of total billed charges,
betamethasone dipropionate 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,00472038015,NDC,facility,both,1,GR,129.6,91.76,Aetna First Health,Commercial,,110.16,85,,,57.44,110.16,percent of total billed charges,
terconazole 0.4 % Cream 45 g Tube,63700001,CDM,,,250,RC,00591319689,NDC,facility,both,1,GR,131.04,92.78,Aetna First Health,Commercial,,111.38,85,,,58.08,111.38,percent of total billed charges,
terconazole 0.4 % Cream 45 g Tube,63700001,CDM,,,250,RC,51672130406,NDC,facility,both,1,GR,131.04,92.78,Aetna First Health,Commercial,,111.38,85,,,58.08,111.38,percent of total billed charges,
triamcinolone acetonide 0.1 % Ointment 454 g Jar,63700001,CDM,,,250,RC,45802005505,NDC,facility,both,1,GR,134.38,95.14,Aetna First Health,Commercial,,114.22,85,,,59.56,114.22,percent of total billed charges,
terconazole 0.4 % Cream 45 g Tube,63700001,CDM,,,250,RC,00168034646,NDC,facility,both,1,GR,143.28,101.44,Aetna First Health,Commercial,,121.79,85,,,63.5,121.79,percent of total billed charges,
betamethasone dipropionate 0.05 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00168005615,NDC,facility,both,1,GR,144.06,101.99,Aetna First Health,Commercial,,122.45,85,,,63.85,122.45,percent of total billed charges,
fluocinonide 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,51672125301,NDC,facility,both,1,GR,145.74,103.18,Aetna First Health,Commercial,,123.88,85,,,64.59,123.88,percent of total billed charges,
fluocinonide 0.05 % Cream 15 g Tube,63700001,CDM,,,250,RC,00093026215,NDC,facility,both,1,GR,145.74,103.18,Aetna First Health,Commercial,,123.88,85,,,64.59,123.88,percent of total billed charges,
hydrocortisone micronized Powder 10 g Bottle,63700001,CDM,,,250,RC,00574042010,NDC,facility,both,1,GR,148,104.78,Aetna First Health,Commercial,,125.8,85,,,65.59,125.8,percent of total billed charges,
hydrocortisone 1 % Cream 454 g Jar,63700001,CDM,,,250,RC,68001047650,NDC,facility,both,1,GR,159.81,113.15,Aetna First Health,Commercial,,135.84,85,,,70.83,135.84,percent of total billed charges,
clobetasol 0.05 % Cream 60 g Tube,63700001,CDM,,,250,RC,51672125803,NDC,facility,both,1,GR,160.08,113.34,Aetna First Health,Commercial,,136.07,85,,,70.95,136.07,percent of total billed charges,
beclomethasone 40 MCG/ACT Aerosol Solution 8.7 g Inhaler,63700001,CDM,,,250,RC,59310020240,NDC,facility,both,1,GR,162.98,115.39,Aetna First Health,Commercial,,138.53,85,,,72.23,138.53,percent of total billed charges,
beclomethasone 80 MCG/ACT Aerosol Solution 8.7 g Inhaler,63700001,CDM,,,250,RC,59310020480,NDC,facility,both,1,GR,218.22,154.5,Aetna First Health,Commercial,,185.49,85,,,96.72,185.49,percent of total billed charges,
hydrocortisone 1 % Ointment 453.6 g Jar,63700001,CDM,,,250,RC,00168002016,NDC,facility,both,1,GR,239.5,169.57,Aetna First Health,Commercial,,203.58,85,,,106.15,203.58,percent of total billed charges,
triamcinolone acetonide 0.1 % Paste 5 g Tube,63700001,CDM,,,250,RC,51672126705,NDC,facility,both,1,GR,257.88,182.58,Aetna First Health,Commercial,,219.2,85,,,114.29,219.2,percent of total billed charges,
triamcinolone acetonide 0.1 % Paste 5 g Tube,63700001,CDM,,,250,RC,64980032005,NDC,facility,both,1,GR,257.88,182.58,Aetna First Health,Commercial,,219.2,85,,,114.29,219.2,percent of total billed charges,
triamcinolone acetonide 0.1 % Paste 5 g Tube,63700001,CDM,,,250,RC,00713065540,NDC,facility,both,1,GR,257.88,182.58,Aetna First Health,Commercial,,219.2,85,,,114.29,219.2,percent of total billed charges,
betamethasone dipropionate 0.05 % Cream 45 g Tube,63700001,CDM,,,250,RC,00472038045,NDC,facility,both,1,GR,259.2,183.51,Aetna First Health,Commercial,,220.32,85,,,114.88,220.32,percent of total billed charges,
hydrocortisone (perianal) 2.5 % Cream 28.35 g Tube,63700001,CDM,,,250,RC,10631040701,NDC,facility,both,1,GR,279.98,198.23,Aetna First Health,Commercial,,237.98,85,,,124.09,237.98,percent of total billed charges,
hydrocortisone 0.2 % Cream 15 g Tube,63700001,CDM,,,250,RC,45802045535,NDC,facility,both,1,GR,286.5,202.84,Aetna First Health,Commercial,,243.52,85,,,126.98,243.52,percent of total billed charges,
hydrocortisone 0.2 % Cream 15 g Tube,63700001,CDM,,,250,RC,51672129001,NDC,facility,both,1,GR,286.5,202.84,Aetna First Health,Commercial,,243.52,85,,,126.98,243.52,percent of total billed charges,
hydrocortisone valerate 0.2 % Ointment 15 g Tube,63700001,CDM,,,250,RC,51672129201,NDC,facility,both,1,GR,314.88,222.94,Aetna First Health,Commercial,,267.65,85,,,139.55,267.65,percent of total billed charges,
hydrocortisone valerate 0.2 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00713066915,NDC,facility,both,1,GR,314.88,222.94,Aetna First Health,Commercial,,267.65,85,,,139.55,267.65,percent of total billed charges,
hydrocortisone valerate 0.2 % Ointment 15 g Tube,63700001,CDM,,,250,RC,68462083617,NDC,facility,both,1,GR,314.88,222.94,Aetna First Health,Commercial,,267.65,85,,,139.55,267.65,percent of total billed charges,
hydrocortisone valerate 0.2 % Ointment 15 g Tube,63700001,CDM,,,250,RC,00713056015,NDC,facility,both,1,GR,314.88,222.94,Aetna First Health,Commercial,,267.65,85,,,139.55,267.65,percent of total billed charges,
lidocaine 5 % Ointment 50 g Jar,63700001,CDM,,,250,RC,51672300803,NDC,facility,both,1,GR,316.4,224.01,Aetna First Health,Commercial,,268.94,85,,,140.23,268.94,percent of total billed charges,
clobetasol 0.05 % Ointment 60 g Tube,63700001,CDM,,,250,RC,00713065660,NDC,facility,both,1,GR,323.28,228.88,Aetna First Health,Commercial,,274.79,85,,,143.28,274.79,percent of total billed charges,
betamethasone dipropionate 0.05 % Cream 45 g Tube,63700001,CDM,,,250,RC,00168005546,NDC,facility,both,1,GR,338.04,239.33,Aetna First Health,Commercial,,287.33,85,,,149.82,287.33,percent of total billed charges,
clindamycin 2 % Cream 40 g Tube,63700001,CDM,,,250,RC,59762500901,NDC,facility,both,1,GR,347.52,246.04,Aetna First Health,Commercial,,295.39,85,,,154.02,295.39,percent of total billed charges,
urea 40 % Cream 85 g Bottle,63700001,CDM,,,250,RC,54295030824,NDC,facility,both,1,GR,354.28,250.83,Aetna First Health,Commercial,,301.14,85,,,157.02,301.14,percent of total billed charges,
urea 40 % Cream 85 g Bottle,63700001,CDM,,,250,RC,44523061703,NDC,facility,both,1,GR,354.28,250.83,Aetna First Health,Commercial,,301.14,85,,,157.02,301.14,percent of total billed charges,
beclomethasone  HFA 80 MCG/ACT Aerosol Breath Activated 10.6 g Inhaler,63700001,CDM,,,250,RC,59310030480,NDC,facility,both,1,GR,357.64,253.21,Aetna First Health,Commercial,,303.99,85,,,158.51,303.99,percent of total billed charges,
clindamycin 2 % Cream 40 g Tube,63700001,CDM,,,250,RC,00168027740,NDC,facility,both,1,GR,417.12,295.32,Aetna First Health,Commercial,,354.55,85,,,184.87,354.55,percent of total billed charges,
sodium bicarbonate Powder 500 g Bottle,63700001,CDM,,,250,RC,38779064008,NDC,facility,both,1,GR,436,308.69,Aetna First Health,Commercial,,370.6,85,,,193.24,370.6,percent of total billed charges,
glycopyrrolate-formoterol 9-4.8 MCG/ACT Aerosol 10.7 g Inhaler,63700001,CDM,,,250,RC,00310460012,NDC,facility,both,1,GR,456.68,323.33,Aetna First Health,Commercial,,388.18,85,,,202.4,388.18,percent of total billed charges,
fluticasone-salmeterol 115-21 MCG/ACT Aerosol 12 g Inhaler,63700001,CDM,,,250,RC,00173071620,NDC,facility,both,1,GR,507.2,359.1,Aetna First Health,Commercial,,431.12,85,,,224.79,431.12,percent of total billed charges,
clobetasol 0.05 % Ointment 60 g Tube,63700001,CDM,,,250,RC,00168016260,NDC,facility,both,1,GR,521.28,369.07,Aetna First Health,Commercial,,443.09,85,,,231.03,443.09,percent of total billed charges,
azelaic acid 15 % Gel 50 g Tube,63700001,CDM,,,250,RC,68462062652,NDC,facility,both,1,GR,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
azelaic acid 15 % Gel 50 g Tube,63700001,CDM,,,250,RC,51672138903,NDC,facility,both,1,GR,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
hydrocortisone valerate 0.2 % Ointment 45 g Tube,63700001,CDM,,,250,RC,51672129206,NDC,facility,both,1,GR,634.86,449.48,Aetna First Health,Commercial,,539.63,85,,,281.37,539.63,percent of total billed charges,
fluticasone-salmeterol 230-21 MCG/ACT Aerosol 12 g Inhaler,63700001,CDM,,,250,RC,00173071720,NDC,facility,both,1,GR,667.05,472.27,Aetna First Health,Commercial,,566.99,85,,,295.64,566.99,percent of total billed charges,
nitroglycerin 0.4 MG/SPRAY Solution 4.9 g Bottle,63700001,CDM,,,250,RC,52536030065,NDC,facility,both,1,GR,748.25,529.76,Aetna First Health,Commercial,,636.01,85,,,331.62,636.01,percent of total billed charges,
nitroglycerin 0.4 MG/SPRAY Solution 4.9 g Spray Bottle,63700001,CDM,,,250,RC,45802021001,NDC,facility,both,1,GR,748.25,529.76,Aetna First Health,Commercial,,636.01,85,,,331.62,636.01,percent of total billed charges,
nitroglycerin 0.4 MG/SPRAY Solution 4.9 g Spray Bottle,63700001,CDM,,,250,RC,70003030065,NDC,facility,both,1,GR,748.25,529.76,Aetna First Health,Commercial,,636.01,85,,,331.62,636.01,percent of total billed charges,
nitroglycerin 0.4 MG/SPRAY Solution 4.9 g Spray Bottle,63700001,CDM,,,250,RC,28595012049,NDC,facility,both,1,GR,748.25,529.76,Aetna First Health,Commercial,,636.01,85,,,331.62,636.01,percent of total billed charges,
clobetasol 0.05 % Ointment 60 g Tube,63700001,CDM,,,250,RC,16714078204,NDC,facility,both,1,GR,833.28,589.96,Aetna First Health,Commercial,,708.29,85,,,369.31,708.29,percent of total billed charges,
clobetasol 0.05 % Cream 60 g Tube,63700001,CDM,,,250,RC,51672129703,NDC,facility,both,1,GR,872.16,617.49,Aetna First Health,Commercial,,741.34,85,,,386.54,741.34,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,50383006307,NDC,facility,both,1,ML,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,50383006306,NDC,facility,both,1,ML,0.71,0.5,Aetna First Health,Commercial,,0.6,85,,,0.31,0.6,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,50383008705,NDC,facility,both,1,ML,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,50383008707,NDC,facility,both,1,ML,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121177500,NDC,facility,both,1,ML,0.85,0.6,Aetna First Health,Commercial,,0.72,85,,,0.38,0.72,percent of total billed charges,
hydrogen peroxide 3 % Solution 118 mL Bottle,63700001,CDM,,,250,RC,49348003134,NDC,facility,both,1,ML,0.89,0.63,Aetna First Health,Commercial,,0.76,85,,,0.39,0.76,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 10 mL Cup,63700001,CDM,,,250,RC,00121063810,NDC,facility,both,1,ML,0.92,0.65,Aetna First Health,Commercial,,0.78,85,,,0.41,0.78,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 10 mL Cup,63700001,CDM,,,250,RC,00121155000,NDC,facility,both,1,ML,0.98,0.69,Aetna First Health,Commercial,,0.83,85,,,0.43,0.83,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 10 mL Cup,63700001,CDM,,,250,RC,50383008710,NDC,facility,both,1,ML,0.98,0.69,Aetna First Health,Commercial,,0.83,85,,,0.43,0.83,percent of total billed charges,
acetaminophen 325 MG/10.15ML Suspension 10.15 mL Cup,63700001,CDM,,,250,RC,68094058862,NDC,facility,both,1,ML,1.37,0.97,Aetna First Health,Commercial,,1.16,85,,,0.61,1.16,percent of total billed charges,
acetaminophen 325 MG/10.15ML Suspension 10.15 mL Cup,63700001,CDM,,,250,RC,68094033059,NDC,facility,both,1,ML,1.48,1.05,Aetna First Health,Commercial,,1.26,85,,,0.66,1.26,percent of total billed charges,
acetaminophen 325 MG/10.15ML Suspension 10.15 mL Cup,63700001,CDM,,,250,RC,68094033062,NDC,facility,both,1,ML,1.48,1.05,Aetna First Health,Commercial,,1.26,85,,,0.66,1.26,percent of total billed charges,
sodium phosphate 7-19 GM/118ML Enema 133 mL Bottle,63700001,CDM,,,250,RC,00132020140,NDC,facility,both,1,ML,1.6,1.13,Aetna First Health,Commercial,,1.36,85,,,0.71,1.36,percent of total billed charges,
sodium phosphate 7-19 GM/118ML Enema 133 mL Bottle,63700001,CDM,,,250,RC,00132011946,NDC,facility,both,1,ML,1.6,1.13,Aetna First Health,Commercial,,1.36,85,,,0.71,1.36,percent of total billed charges,
sorbitol 70 % Solution 30 mL Cup,63700001,CDM,,,250,RC,00121065930,NDC,facility,both,1,ML,1.62,1.15,Aetna First Health,Commercial,,1.38,85,,,0.72,1.38,percent of total billed charges,
docusate sodium 10 mg/mL Liquid 10 mL Cup,63700001,CDM,,,250,RC,00121054410,NDC,facility,both,1,ML,1.67,1.18,Aetna First Health,Commercial,,1.42,85,,,0.74,1.42,percent of total billed charges,
acetaminophen 325 MG/10.15ML Suspension 10.15 mL Cup,63700001,CDM,,,250,RC,00121188211,NDC,facility,both,1,ML,1.69,1.2,Aetna First Health,Commercial,,1.44,85,,,0.75,1.44,percent of total billed charges,
Calamine 8-8 % Lotion 118 mL Bottle,63700001,CDM,,,250,RC,00904253300,NDC,facility,both,1,ML,1.77,1.25,Aetna First Health,Commercial,,1.5,85,,,0.78,1.5,percent of total billed charges,
Senna 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,39328012005,NDC,facility,both,1,ML,1.88,1.33,Aetna First Health,Commercial,,1.6,85,,,0.83,1.6,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,17856823701,NDC,facility,both,1,ML,1.88,1.33,Aetna First Health,Commercial,,1.6,85,,,0.83,1.6,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,39328012005,NDC,facility,both,1,ML,1.88,1.33,Aetna First Health,Commercial,,1.6,85,,,0.83,1.6,percent of total billed charges,
loperamide 1 MG/5ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,50383061805,NDC,facility,both,1,ML,2.02,1.43,Aetna First Health,Commercial,,1.72,85,,,0.9,1.72,percent of total billed charges,
Calamine 8-8 % Lotion 177 mL Bottle,63700001,CDM,,,250,RC,00904253321,NDC,facility,both,1,ML,2.12,1.5,Aetna First Health,Commercial,,1.8,85,,,0.94,1.8,percent of total billed charges,
povidone iodine 10 % Solution 14.8 mL Bottle,63700001,CDM,,,250,RC,67618015005,NDC,facility,both,1,ML,2.13,1.51,Aetna First Health,Commercial,,1.81,85,,,0.94,1.81,percent of total billed charges,
sodium phosphate 7-19 GM/118ML Enema 133 mL Bottle,63700001,CDM,,,250,RC,00536741551,NDC,facility,both,1,ML,2.19,1.55,Aetna First Health,Commercial,,1.86,85,,,0.97,1.86,percent of total billed charges,
lanolin Cream 9 mL Box,63700001,CDM,,,250,RC,20451087121,NDC,facility,both,1,ML,2.28,1.61,Aetna First Health,Commercial,,1.94,85,,,1.01,1.94,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,00121174405,NDC,facility,both,1,ML,2.39,1.69,Aetna First Health,Commercial,,2.03,85,,,1.06,2.03,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,00121174400,NDC,facility,both,1,ML,2.39,1.69,Aetna First Health,Commercial,,2.03,85,,,1.06,2.03,percent of total billed charges,
mineral oil Enema 133 mL Bottle,63700001,CDM,,,250,RC,49348018520,NDC,facility,both,1,ML,2.39,1.69,Aetna First Health,Commercial,,2.03,85,,,1.06,2.03,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 10 mL Cup,63700001,CDM,,,250,RC,00121148800,NDC,facility,both,1,ML,2.42,1.71,Aetna First Health,Commercial,,2.06,85,,,1.07,2.06,percent of total billed charges,
emollient Lotion 237 mL Bottle,63700001,CDM,,,250,RC,54162081008,NDC,facility,both,1,ML,2.49,1.76,Aetna First Health,Commercial,,2.12,85,,,1.1,2.12,percent of total billed charges,
Acetaminophen 650 MG/20.3ML Suspension 20.3 mL Cup,63700001,CDM,,,250,RC,68094003059,NDC,facility,both,1,ML,2.71,1.92,Aetna First Health,Commercial,,2.3,85,,,1.2,2.3,percent of total billed charges,
docusate sodium 283 MG/5 ML Enema 5 mL Tube,63700001,CDM,,,250,RC,17433987603,NDC,facility,both,1,ML,2.8,1.98,Aetna First Health,Commercial,,2.38,85,,,1.24,2.38,percent of total billed charges,
docusate sodium 283 MG/5 ML Enema 5 mL Tube,63700001,CDM,,,250,RC,17433987600,NDC,facility,both,1,ML,2.8,1.98,Aetna First Health,Commercial,,2.38,85,,,1.24,2.38,percent of total billed charges,
Calamine 8-8 % Lotion 177 mL Bottle,63700001,CDM,,,250,RC,24385041396,NDC,facility,both,1,ML,2.92,2.07,Aetna First Health,Commercial,,2.48,85,,,1.29,2.48,percent of total billed charges,
magnesium hydroxide 400 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,00121043130,NDC,facility,both,1,ML,2.93,2.07,Aetna First Health,Commercial,,2.49,85,,,1.3,2.49,percent of total billed charges,
Senna 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,48433021905,NDC,facility,both,1,ML,2.97,2.1,Aetna First Health,Commercial,,2.52,85,,,1.32,2.52,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,48433021905,NDC,facility,both,1,ML,2.97,2.1,Aetna First Health,Commercial,,2.52,85,,,1.32,2.52,percent of total billed charges,
mineral oil Enema 133 mL Bottle,63700001,CDM,,,250,RC,00132030140,NDC,facility,both,1,ML,2.99,2.12,Aetna First Health,Commercial,,2.54,85,,,1.33,2.54,percent of total billed charges,
Enema Mineral Oil Enema 133 mL Bottle,63700001,CDM,,,250,RC,00132030140,NDC,facility,both,1,ML,2.99,2.12,Aetna First Health,Commercial,,2.54,85,,,1.33,2.54,percent of total billed charges,
HYDROmorphone 1 MG/ML Liquid 473 mL Bottle,63700001,CDM,,,250,RC,00054038663,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
HYDROmorphone 1 MG/ML Liquid 473 mL Bottle,63700001,CDM,,,250,RC,42858030416,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guaiFENesin 100 MG/5ML Liquid 5 mL Cup,63700001,CDM,,,250,RC,50383006305,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00054023755,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,63739063456,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,00121146515,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,66689003799,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,00121457730,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 250 MG/5ML Solution 5 mL Syringe,63700001,CDM,,,250,RC,09999800114,NDC,facility,both,1,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
docusate sodium 283 MG/5 ML Enema 5 mL Box,63700001,CDM,,,250,RC,17433987605,NDC,facility,both,1,ML,3.08,2.18,Aetna First Health,Commercial,,2.62,85,,,1.37,2.62,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,00121063805,NDC,facility,both,1,ML,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
dextromethorphan-guaifenesin 10-100 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,00121063800,NDC,facility,both,1,ML,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 30 mL Cup,63700001,CDM,,,250,RC,00121059530,NDC,facility,both,1,ML,3.15,2.23,Aetna First Health,Commercial,,2.68,85,,,1.4,2.68,percent of total billed charges,
sodium chloride 0.65 % Solution 45 mL Spray Bottle,63700001,CDM,,,250,RC,45802035758,NDC,facility,both,1,ML,3.17,2.24,Aetna First Health,Commercial,,2.69,85,,,1.4,2.69,percent of total billed charges,
emollient Lotion 177 mL Bottle,63700001,CDM,,,250,RC,52800048826,NDC,facility,both,1,ML,3.45,2.44,Aetna First Health,Commercial,,2.93,85,,,1.53,2.93,percent of total billed charges,
morphine 20 mg/mL Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094075458,NDC,facility,both,1,ML,3.67,2.6,Aetna First Health,Commercial,,3.12,85,,,1.63,3.12,percent of total billed charges,
morphine 20 mg/mL Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094075401,NDC,facility,both,1,ML,3.67,2.6,Aetna First Health,Commercial,,3.12,85,,,1.63,3.12,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,17856200203,NDC,facility,both,1,ML,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
calcium carbonate 1250 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121476605,NDC,facility,both,1,ML,3.84,2.72,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 236 mL Bottle,63700001,CDM,,,250,RC,00904131309,NDC,facility,both,1,ML,3.89,2.75,Aetna First Health,Commercial,,3.31,85,,,1.72,3.31,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,17856046203,NDC,facility,both,1,ML,3.89,2.75,Aetna First Health,Commercial,,3.31,85,,,1.72,3.31,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,66689003701,NDC,facility,both,1,ML,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,66689003750,NDC,facility,both,1,ML,3.99,2.82,Aetna First Health,Commercial,,3.39,85,,,1.77,3.39,percent of total billed charges,
phenylephrine 1 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,46122014903,NDC,facility,both,1,ML,4.05,2.87,Aetna First Health,Commercial,,3.44,85,,,1.79,3.44,percent of total billed charges,
sorbitol 70 % Solution 30 mL Bottle,63700001,CDM,,,250,RC,46287050030,NDC,facility,both,1,ML,4.19,2.97,Aetna First Health,Commercial,,3.56,85,,,1.86,3.56,percent of total billed charges,
benzoin compound Tincture 29 mL Bottle,63700001,CDM,,,250,RC,54162010001,NDC,facility,both,1,ML,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
lactulose 10 GM/15ML Solution 30 mL Cup,63700001,CDM,,,250,RC,66689003801,NDC,facility,both,1,ML,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
Lactulose 20 GM/30ML Solution 30 mL Cup,63700001,CDM,,,250,RC,66689003801,NDC,facility,both,1,ML,4.31,3.05,Aetna First Health,Commercial,,3.66,85,,,1.91,3.66,percent of total billed charges,
valproate 250 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121467505,NDC,facility,both,1,ML,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,17856110705,NDC,facility,both,1,ML,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
phenylephrine 1 % Solution 29.6 mL Bottle,63700001,CDM,,,250,RC,46122068903,NDC,facility,both,1,ML,4.4,3.12,Aetna First Health,Commercial,,3.74,85,,,1.95,3.74,percent of total billed charges,
povidone iodine vaginal 0.3 % Solution 274 mL Bottle,63700001,CDM,,,250,RC,41608008743,NDC,facility,both,1,ML,4.52,3.2,Aetna First Health,Commercial,,3.84,85,,,2,3.84,percent of total billed charges,
naphazoline-glycerin 0.012-0.25 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,78112025415,NDC,facility,both,1,ML,4.52,3.2,Aetna First Health,Commercial,,3.84,85,,,2,3.84,percent of total billed charges,
povidone iodine 10 % Solution 237 mL Bottle,63700001,CDM,,,250,RC,67618015009,NDC,facility,both,1,ML,4.62,3.27,Aetna First Health,Commercial,,3.93,85,,,2.05,3.93,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,68094000159,NDC,facility,both,1,ML,4.76,3.37,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
morphine 10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,68094000162,NDC,facility,both,1,ML,4.76,3.37,Aetna First Health,Commercial,,4.05,85,,,2.11,4.05,percent of total billed charges,
pyrithione zinc 1 % Shampoo 118 mL Bottle,63700001,CDM,,,250,RC,75137045558,NDC,facility,both,1,ML,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
Calamine 8-8 % Lotion 177 mL Bottle,63700001,CDM,,,250,RC,00395041396,NDC,facility,both,1,ML,4.78,3.38,Aetna First Health,Commercial,,4.06,85,,,2.12,4.06,percent of total billed charges,
Alum & Mag Hydroxide-Simeth 1200-1200-120 MG/30ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,57237031603,NDC,facility,both,1,ML,4.82,3.41,Aetna First Health,Commercial,,4.1,85,,,2.14,4.1,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094059959,NDC,facility,both,1,ML,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
sennosides 8.8 MG/5ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,17856045201,NDC,facility,both,1,ML,4.83,3.42,Aetna First Health,Commercial,,4.11,85,,,2.14,4.11,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121086840,NDC,facility,both,1,ML,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121481040,NDC,facility,both,1,ML,4.94,3.5,Aetna First Health,Commercial,,4.2,85,,,2.19,4.2,percent of total billed charges,
vitamin D3 (cholecalciferol) 10 mcg/mL (400 units/mL) Liquid 50 mL Bottle,63700001,CDM,,,250,RC,00536840080,NDC,facility,both,1,ML,4.95,3.5,Aetna First Health,Commercial,,4.21,85,,,2.19,4.21,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094059962,NDC,facility,both,1,ML,4.95,3.5,Aetna First Health,Commercial,,4.21,85,,,2.19,4.21,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121177505,NDC,facility,both,1,ML,5.06,3.58,Aetna First Health,Commercial,,4.3,85,,,2.24,4.3,percent of total billed charges,
ferrous sulfate 300 (60 Fe) mg/5 mL Solution 5 mL Cup,63700001,CDM,,,250,RC,00121053005,NDC,facility,both,1,ML,5.09,3.6,Aetna First Health,Commercial,,4.33,85,,,2.26,4.33,percent of total billed charges,
ferrous sulfate 300 (60 Fe) mg/5 mL Solution 5 mL Cup,63700001,CDM,,,250,RC,58526000557,NDC,facility,both,1,ML,5.14,3.64,Aetna First Health,Commercial,,4.37,85,,,2.28,4.37,percent of total billed charges,
morphine 20 mg/mL Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094004558,NDC,facility,both,1,ML,5.18,3.67,Aetna First Health,Commercial,,4.4,85,,,2.3,4.4,percent of total billed charges,
morphine 10 MG/0.5ML Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094004558,NDC,facility,both,1,ML,5.18,3.67,Aetna First Health,Commercial,,4.4,85,,,2.3,4.4,percent of total billed charges,
Acetaminophen 167 MG/5ML Liquid 237 mL Bottle,63700001,CDM,,,250,RC,00904584709,NDC,facility,both,1,ML,5.69,4.03,Aetna First Health,Commercial,,4.84,85,,,2.52,4.84,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,48433021415,NDC,facility,both,1,ML,6.14,4.35,Aetna First Health,Commercial,,5.22,85,,,2.72,5.22,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 10 mL Cup,63700001,CDM,,,250,RC,00121155010,NDC,facility,both,1,ML,6.15,4.35,Aetna First Health,Commercial,,5.23,85,,,2.73,5.23,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,66689010601,NDC,facility,both,1,ML,6.3,4.46,Aetna First Health,Commercial,,5.36,85,,,2.79,5.36,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,60687071444,NDC,facility,both,1,ML,6.3,4.46,Aetna First Health,Commercial,,5.36,85,,,2.79,5.36,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 30 mL Cup,63700001,CDM,,,250,RC,98886800188,NDC,facility,both,1,ML,6.3,4.46,Aetna First Health,Commercial,,5.36,85,,,2.79,5.36,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 236 mL Bottle,63700001,CDM,,,250,RC,01490003908,NDC,facility,both,1,ML,6.37,4.51,Aetna First Health,Commercial,,5.41,85,,,2.82,5.41,percent of total billed charges,
bismuth subsalicylate 262 MG/15ML Suspension 236 mL Bottle,63700001,CDM,,,250,RC,01490003956,NDC,facility,both,1,ML,6.37,4.51,Aetna First Health,Commercial,,5.41,85,,,2.82,5.41,percent of total billed charges,
mineral oil light 100 % Oil 25 mL Bottle,63700001,CDM,,,250,RC,54162018525,NDC,facility,both,1,ML,6.38,4.52,Aetna First Health,Commercial,,5.42,85,,,2.83,5.42,percent of total billed charges,
mineral oil light Oil 25 mL Bottle,63700001,CDM,,,250,RC,54162018525,NDC,facility,both,1,ML,6.38,4.52,Aetna First Health,Commercial,,5.42,85,,,2.83,5.42,percent of total billed charges,
metoclopramide 5 MG/5ML Solution 10 mL Cup,63700001,CDM,,,250,RC,00121057610,NDC,facility,both,1,ML,6.48,4.59,Aetna First Health,Commercial,,5.51,85,,,2.87,5.51,percent of total billed charges,
oxyCODONE 100 MG/5ML Concentrate 0.5 mL Syringe,63700001,CDM,,,250,RC,68094080101,NDC,facility,both,1,ML,6.55,4.64,Aetna First Health,Commercial,,5.57,85,,,2.9,5.57,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,69339013817,NDC,facility,both,1,ML,6.67,4.72,Aetna First Health,Commercial,,5.67,85,,,2.96,5.67,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,00121089315,NDC,facility,both,1,ML,6.67,4.72,Aetna First Health,Commercial,,5.67,85,,,2.96,5.67,percent of total billed charges,
benzocaine 20 % Liquid 13.3 mL Bottle,63700001,CDM,,,250,RC,10310032945,NDC,facility,both,1,ML,6.74,4.77,Aetna First Health,Commercial,,5.73,85,,,2.99,5.73,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,60687061644,NDC,facility,both,1,ML,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
saline Gel 22 mL Spray Bottle,63700001,CDM,,,250,RC,00225052848,NDC,facility,both,1,ML,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
valproate 250 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121467540,NDC,facility,both,1,ML,6.88,4.87,Aetna First Health,Commercial,,5.85,85,,,3.05,5.85,percent of total billed charges,
aluminum-magnesium hydroxide 200-200 MG/5ML Suspension 30 mL Cup,63700001,CDM,,,250,RC,00121176030,NDC,facility,both,1,ML,7.07,5.01,Aetna First Health,Commercial,,6.01,85,,,3.13,6.01,percent of total billed charges,
benzoin compound Tincture 59 mL Bottle,63700001,CDM,,,250,RC,00574911902,NDC,facility,both,1,ML,7.35,5.2,Aetna First Health,Commercial,,6.25,85,,,3.26,6.25,percent of total billed charges,
permethrin 1 % Liquid 59 mL Bottle,63700001,CDM,,,250,RC,49348015078,NDC,facility,both,1,ML,7.52,5.32,Aetna First Health,Commercial,,6.39,85,,,3.33,6.39,percent of total billed charges,
vitamin D3 (cholecalciferol) 10 mcg/mL (400 units/mL) Liquid 50 mL Bottle,63700001,CDM,,,250,RC,54838000650,NDC,facility,both,1,ML,7.65,5.42,Aetna First Health,Commercial,,6.5,85,,,3.39,6.5,percent of total billed charges,
mineral oil heavy Oil 472 mL Bottle,63700001,CDM,,,250,RC,54162019016,NDC,facility,both,1,ML,7.79,5.52,Aetna First Health,Commercial,,6.62,85,,,3.45,6.62,percent of total billed charges,
emollient Lotion 473 mL Bottle,63700001,CDM,,,250,RC,52800048856,NDC,facility,both,1,ML,7.8,5.52,Aetna First Health,Commercial,,6.63,85,,,3.46,6.63,percent of total billed charges,
phenylephrine 1 % Solution 29.6 mL Bottle,63700001,CDM,,,250,RC,00067208601,NDC,facility,both,1,ML,7.86,5.56,Aetna First Health,Commercial,,6.68,85,,,3.48,6.68,percent of total billed charges,
saliva substitute Solution 59 mL Bottle,63700001,CDM,,,250,RC,50930009802,NDC,facility,both,1,ML,7.88,5.58,Aetna First Health,Commercial,,6.7,85,,,3.49,6.7,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Syringe,63700001,CDM,,,250,RC,68094059958,NDC,facility,both,1,ML,8.07,5.71,Aetna First Health,Commercial,,6.86,85,,,3.58,6.86,percent of total billed charges,
acetaminophen-codeine 120-12 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121050405,NDC,facility,both,1,ML,8.23,5.83,Aetna First Health,Commercial,,7,85,,,3.65,7,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,69097016887,NDC,facility,both,1,ML,8.75,6.2,Aetna First Health,Commercial,,7.44,85,,,3.88,7.44,percent of total billed charges,
topiramate 25 MG/ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,52652900103,NDC,facility,both,1,ML,8.93,6.32,Aetna First Health,Commercial,,7.59,85,,,3.96,7.59,percent of total billed charges,
Pyrethrins-Piperonyl Butoxide 0.33-4 % Shampoo 118 mL Bottle,63700001,CDM,,,250,RC,00904252820,NDC,facility,both,1,ML,9.56,6.77,Aetna First Health,Commercial,,8.13,85,,,4.24,8.13,percent of total billed charges,
hypromellose 2.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,17238061015,NDC,facility,both,1,ML,9.74,6.9,Aetna First Health,Commercial,,8.28,85,,,4.32,8.28,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,69339013815,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00116200115,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,00121089340,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Box,63700001,CDM,,,250,RC,76204090024,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Box,63700001,CDM,,,250,RC,76204090001,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,76204090011,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
coal tar 0.5 % Shampoo 251 mL Bottle,63700001,CDM,,,250,RC,00904525944,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium phosphate 7-19 GM/118ML Enema 133 mL Bottle,63700001,CDM,,,250,RC,12462020104,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094059961,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,69097016864,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.9 % Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,00487930103,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.9 % Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,00487930133,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.9 % Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,00378698501,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.9 % Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,76204030003,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 3 % Nebulization Solution 15 mL Plas Cont,63700001,CDM,,,250,RC,00378699789,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 3 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,00487900360,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.9 % Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,49502083003,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Cup,63700001,CDM,,,250,RC,50383072017,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
chlorhexidine 0.12 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,53462000315,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
topiramate 25 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,52652900101,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,76204090012,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,00115993276,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,00115993278,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium phosphate 7-19 GM/118ML Enema 133 mL Bottle,63700001,CDM,,,250,RC,00904632078,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride (Inhalant) 7 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,50190014123,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride (Inhalant) 7 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,83490030760,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride (Inhalant) 7 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,00487900760,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,70756061212,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,70756061270,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride (Inhalant) 7 % Nebulization Solution 4 mL Plas Cont,63700001,CDM,,,250,RC,00487900730,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
sodium chloride 0.65 % Solution 45 mL Bottle,63700001,CDM,,,250,RC,69618005153,NDC,facility,both,1,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
hydroxypropyl methylcellulose 0.3 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00078051824,NDC,facility,both,1,ML,10.1,7.15,Aetna First Health,Commercial,,8.58,85,,,4.48,8.58,percent of total billed charges,
benzoin Liquid 120 mL Bottle,63700001,CDM,,,250,RC,54162010504,NDC,facility,both,1,ML,10.44,7.39,Aetna First Health,Commercial,,8.87,85,,,4.63,8.87,percent of total billed charges,
morphine 20 mg/mL Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094005601,NDC,facility,both,1,ML,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
morphine 10 MG/0.5ML Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094005601,NDC,facility,both,1,ML,10.5,7.43,Aetna First Health,Commercial,,8.92,85,,,4.65,8.92,percent of total billed charges,
permethrin 1 % Liquid 59 mL Bottle,63700001,CDM,,,250,RC,63736012003,NDC,facility,both,1,ML,10.71,7.58,Aetna First Health,Commercial,,9.1,85,,,4.75,9.1,percent of total billed charges,
lecithin-iosopropyl palmate oil Oil 100 mL Bottle,63700001,CDM,,,250,RC,51552055004,NDC,facility,both,1,ML,10.8,7.65,Aetna First Health,Commercial,,9.18,85,,,4.79,9.18,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,68094071459,NDC,facility,both,1,ML,10.98,7.77,Aetna First Health,Commercial,,9.33,85,,,4.87,9.33,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,66993002335,NDC,facility,both,1,ML,11.17,7.91,Aetna First Health,Commercial,,9.49,85,,,4.95,9.49,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,66993002327,NDC,facility,both,1,ML,11.17,7.91,Aetna First Health,Commercial,,9.49,85,,,4.95,9.49,percent of total billed charges,
povidone iodine 10 % Solution 946 mL Bottle,63700001,CDM,,,250,RC,52380190507,NDC,facility,both,1,ML,11.35,8.04,Aetna First Health,Commercial,,9.65,85,,,5.03,9.65,percent of total billed charges,
peppermint spirit SPIRIT 30 mL Bottle,63700001,CDM,,,250,RC,00395224391,NDC,facility,both,1,ML,11.66,8.26,Aetna First Health,Commercial,,9.91,85,,,5.17,9.91,percent of total billed charges,
phenylephrine 0.25 % Solution 15 mL Spray Bottle,63700001,CDM,,,250,RC,69536012515,NDC,facility,both,1,ML,11.76,8.33,Aetna First Health,Commercial,,10,85,,,5.21,10,percent of total billed charges,
benzoin compound Tincture 59 mL Bottle,63700001,CDM,,,250,RC,00395024392,NDC,facility,both,1,ML,11.95,8.46,Aetna First Health,Commercial,,10.16,85,,,5.3,10.16,percent of total billed charges,
lidocaine viscous 2 % Solution 20 mL Cup,63700001,CDM,,,250,RC,17856600203,NDC,facility,both,1,ML,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
haloperidol 2 MG/ML Concentrate 5 mL Cup,63700001,CDM,,,250,RC,00121058105,NDC,facility,both,1,ML,12.22,8.65,Aetna First Health,Commercial,,10.39,85,,,5.42,10.39,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,81033022015,NDC,facility,both,1,ML,12.23,8.66,Aetna First Health,Commercial,,10.4,85,,,5.42,10.4,percent of total billed charges,
metoclopramide 5 MG/5ML Solution 5 mL Syringe,63700001,CDM,,,250,RC,88886800063,NDC,facility,both,1,ML,12.25,8.67,Aetna First Health,Commercial,,10.41,85,,,5.43,10.41,percent of total billed charges,
permethrin 1 % Liquid 59 mL Bottle,63700001,CDM,,,250,RC,46122010846,NDC,facility,both,1,ML,12.3,8.71,Aetna First Health,Commercial,,10.46,85,,,5.45,10.46,percent of total billed charges,
vitamin D3 (cholecalciferol) 10 mcg/mL (400 units/mL) Liquid 50 mL Bottle,63700001,CDM,,,250,RC,00087086644,NDC,facility,both,1,ML,12.3,8.71,Aetna First Health,Commercial,,10.46,85,,,5.45,10.46,percent of total billed charges,
artificial saliva Solution 120 mL Bottle,63700001,CDM,,,250,RC,55299060104,NDC,facility,both,1,ML,12.78,9.05,Aetna First Health,Commercial,,10.86,85,,,5.66,10.86,percent of total billed charges,
penicillin v potassium 250 MG/5ML Recon Soln 100 mL Bottle,63700001,CDM,,,250,RC,67253020310,NDC,facility,both,1,ML,12.95,9.17,Aetna First Health,Commercial,,11.01,85,,,5.74,11.01,percent of total billed charges,
ferrous sulfate 300 (60 Fe) mg/5 mL Solution 5 mL Cup,63700001,CDM,,,250,RC,50268033611,NDC,facility,both,1,ML,13,9.2,Aetna First Health,Commercial,,11.05,85,,,5.76,11.05,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,66689079001,NDC,facility,both,1,ML,13.34,9.44,Aetna First Health,Commercial,,11.34,85,,,5.91,11.34,percent of total billed charges,
permethrin 1 % Liquid 59 mL Bottle,63700001,CDM,,,250,RC,63736012002,NDC,facility,both,1,ML,13.36,9.46,Aetna First Health,Commercial,,11.36,85,,,5.92,11.36,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,17856030601,NDC,facility,both,1,ML,13.58,9.61,Aetna First Health,Commercial,,11.54,85,,,6.02,11.54,percent of total billed charges,
morphine 20 mg/mL Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094004501,NDC,facility,both,1,ML,13.86,9.81,Aetna First Health,Commercial,,11.78,85,,,6.14,11.78,percent of total billed charges,
morphine 10 MG/0.5ML Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,68094004501,NDC,facility,both,1,ML,13.86,9.81,Aetna First Health,Commercial,,11.78,85,,,6.14,11.78,percent of total billed charges,
hydroxypropyl methylcellulose 0.3 % Solution 25 mL Bottle,63700001,CDM,,,250,RC,00078051816,NDC,facility,both,1,ML,14.1,9.98,Aetna First Health,Commercial,,11.98,85,,,6.25,11.98,percent of total billed charges,
metoclopramide 5 MG/5ML Solution 10 mL Cup,63700001,CDM,,,250,RC,00121157610,NDC,facility,both,1,ML,14.18,10.04,Aetna First Health,Commercial,,12.05,85,,,6.28,12.05,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,64950035445,NDC,facility,both,1,ML,14.28,10.11,Aetna First Health,Commercial,,12.14,85,,,6.33,12.14,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,60687041744,NDC,facility,both,1,ML,14.33,10.15,Aetna First Health,Commercial,,12.18,85,,,6.35,12.18,percent of total billed charges,
nystatin 100000 UNIT/ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121478505,NDC,facility,both,1,ML,14.72,10.42,Aetna First Health,Commercial,,12.51,85,,,6.52,12.51,percent of total billed charges,
Menthol (Topical Analgesic) 4 % Gel 3 mL Bottle,63700001,CDM,,,250,RC,59316010211,NDC,facility,both,1,ML,14.8,10.48,Aetna First Health,Commercial,,12.58,85,,,6.56,12.58,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 15 mL Cup,63700001,CDM,,,250,RC,00121059515,NDC,facility,both,1,ML,14.86,10.52,Aetna First Health,Commercial,,12.63,85,,,6.59,12.63,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,66689002301,NDC,facility,both,1,ML,14.91,10.56,Aetna First Health,Commercial,,12.67,85,,,6.61,12.67,percent of total billed charges,
HYDROcodone-acetaminophen 7.5-325 MG/15ML Solution 15 mL Cup,63700001,CDM,,,250,RC,66689002350,NDC,facility,both,1,ML,14.91,10.56,Aetna First Health,Commercial,,12.67,85,,,6.61,12.67,percent of total billed charges,
phenol-sodium borate 0.6-1.5 % Solution 178 mL Bottle,63700001,CDM,,,250,RC,45565010021,NDC,facility,both,1,ML,14.95,10.58,Aetna First Health,Commercial,,12.71,85,,,6.63,12.71,percent of total billed charges,
povidone-iodine 7.5 % Solution 118 mL Bottle,63700001,CDM,,,250,RC,67618015104,NDC,facility,both,1,ML,15.1,10.69,Aetna First Health,Commercial,,12.84,85,,,6.69,12.84,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00904682805,NDC,facility,both,1,ML,15.35,10.87,Aetna First Health,Commercial,,13.05,85,,,6.8,13.05,percent of total billed charges,
PHENobarbital 20 MG/5ML Elixir 7.5 mL Cup,63700001,CDM,,,250,RC,00121188407,NDC,facility,both,1,ML,15.38,10.89,Aetna First Health,Commercial,,13.07,85,,,6.82,13.07,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 30 mL Cup,63700001,CDM,,,250,RC,00121119030,NDC,facility,both,1,ML,16.17,11.45,Aetna First Health,Commercial,,13.74,85,,,7.17,13.74,percent of total billed charges,
sod citrate-citric acid 500-334 MG/5ML Solution 30 mL Cup,63700001,CDM,,,250,RC,00121119000,NDC,facility,both,1,ML,16.17,11.45,Aetna First Health,Commercial,,13.74,85,,,7.17,13.74,percent of total billed charges,
pentafluoroprop - tetrafluoroeth Aerosol 30 mL Can,63700001,CDM,,,250,RC,00386000804,NDC,facility,both,1,ML,16.24,11.5,Aetna First Health,Commercial,,13.8,85,,,7.2,13.8,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,62756027702,NDC,facility,both,1,ML,16.68,11.81,Aetna First Health,Commercial,,14.18,85,,,7.39,14.18,percent of total billed charges,
Pyrethrins-Piperonyl Butoxide 0.33-4 % Shampoo 118 mL Bottle,63700001,CDM,,,250,RC,49348044334,NDC,facility,both,1,ML,17.17,12.16,Aetna First Health,Commercial,,14.59,85,,,7.61,14.59,percent of total billed charges,
haloperidol 2 MG/ML Concentrate 15 mL Bottle,63700001,CDM,,,250,RC,00093960423,NDC,facility,both,1,ML,17.48,12.38,Aetna First Health,Commercial,,14.86,85,,,7.75,14.86,percent of total billed charges,
midazolam 2 MG/ML Syrup 2.5 mL Cup,63700001,CDM,,,250,RC,68094076259,NDC,facility,both,1,ML,18.45,13.06,Aetna First Health,Commercial,,15.68,85,,,8.18,15.68,percent of total billed charges,
midazolam 2 MG/ML Syrup 2.5 mL Cup,63700001,CDM,,,250,RC,68094076262,NDC,facility,both,1,ML,18.45,13.06,Aetna First Health,Commercial,,15.68,85,,,8.18,15.68,percent of total billed charges,
midazolam 2 MG/ML Syrup 2.5 mL Cup,63700001,CDM,,,250,RC,60687057603,NDC,facility,both,1,ML,18.66,13.21,Aetna First Health,Commercial,,15.86,85,,,8.27,15.86,percent of total billed charges,
hydrogen peroxide 3 % Solution 237 mL Bottle,63700001,CDM,,,250,RC,00869470410,NDC,facility,both,1,ML,18.8,13.31,Aetna First Health,Commercial,,15.98,85,,,8.33,15.98,percent of total billed charges,
charcoal activated Liquid 120 mL Bottle,63700001,CDM,,,250,RC,00574012104,NDC,facility,both,1,ML,19.98,14.15,Aetna First Health,Commercial,,16.98,85,,,8.86,16.98,percent of total billed charges,
charcoal activated Liquid 120 mL Tube,63700001,CDM,,,250,RC,00574012174,NDC,facility,both,1,ML,19.98,14.15,Aetna First Health,Commercial,,16.98,85,,,8.86,16.98,percent of total billed charges,
charcoal activated Liquid 120 mL Bottle,63700001,CDM,,,250,RC,00574052104,NDC,facility,both,1,ML,19.98,14.15,Aetna First Health,Commercial,,16.98,85,,,8.86,16.98,percent of total billed charges,
charcoal activated Liquid 120 mL Tube,63700001,CDM,,,250,RC,00574052174,NDC,facility,both,1,ML,19.98,14.15,Aetna First Health,Commercial,,16.98,85,,,8.86,16.98,percent of total billed charges,
Scope Solution 252 mL Bottle,63700001,CDM,,,250,RC,98886800102,NDC,facility,both,1,ML,20.16,14.27,Aetna First Health,Commercial,,17.14,85,,,8.93,17.14,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,43598040905,NDC,facility,both,1,ML,20.6,14.58,Aetna First Health,Commercial,,17.51,85,,,9.13,17.51,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121483940,NDC,facility,both,1,ML,20.65,14.62,Aetna First Health,Commercial,,17.55,85,,,9.15,17.55,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,64950035405,NDC,facility,both,1,ML,20.65,14.62,Aetna First Health,Commercial,,17.55,85,,,9.15,17.55,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121483905,NDC,facility,both,1,ML,20.65,14.62,Aetna First Health,Commercial,,17.55,85,,,9.15,17.55,percent of total billed charges,
hypromellose 2.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,54799050315,NDC,facility,both,1,ML,20.7,14.66,Aetna First Health,Commercial,,17.6,85,,,9.17,17.6,percent of total billed charges,
chlorhexidine 0.12 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00116200116,NDC,facility,both,1,ML,20.81,14.73,Aetna First Health,Commercial,,17.69,85,,,9.22,17.69,percent of total billed charges,
chlorhexidine 0.12 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121089316,NDC,facility,both,1,ML,20.81,14.73,Aetna First Health,Commercial,,17.69,85,,,9.22,17.69,percent of total billed charges,
chlorhexidine 0.12 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,16571012848,NDC,facility,both,1,ML,20.81,14.73,Aetna First Health,Commercial,,17.69,85,,,9.22,17.69,percent of total billed charges,
acetic acid 0.25 % Solution 250 mL Plas Cont,63700001,CDM,,,250,RC,00409614322,NDC,facility,both,1,ML,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
acetic acid 0.25 % Solution 250 mL Flex Cont,63700001,CDM,,,250,RC,00990614322,NDC,facility,both,1,ML,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,17856101101,NDC,facility,both,1,ML,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
midazolam 2 MG/ML Syrup 5 mL Cup,63700001,CDM,,,250,RC,68094076462,NDC,facility,both,1,ML,21.39,15.14,Aetna First Health,Commercial,,18.18,85,,,9.48,18.18,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,00121482705,NDC,facility,both,1,ML,21.7,15.36,Aetna First Health,Commercial,,18.44,85,,,9.62,18.44,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,69097016832,NDC,facility,both,1,ML,22.46,15.9,Aetna First Health,Commercial,,19.09,85,,,9.95,19.09,percent of total billed charges,
phenytoin 125 MG/5ML Suspension 4 mL Cup,63700001,CDM,,,250,RC,60687027562,NDC,facility,both,1,ML,23.45,16.6,Aetna First Health,Commercial,,19.93,85,,,10.39,19.93,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,66689040101,NDC,facility,both,1,ML,24.15,17.1,Aetna First Health,Commercial,,20.53,85,,,10.7,20.53,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,66689040150,NDC,facility,both,1,ML,24.15,17.1,Aetna First Health,Commercial,,20.53,85,,,10.7,20.53,percent of total billed charges,
oxyCODONE 5 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,60687040640,NDC,facility,both,1,ML,24.5,17.35,Aetna First Health,Commercial,,20.82,85,,,10.86,20.82,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,00904726966,NDC,facility,both,1,ML,25.1,17.77,Aetna First Health,Commercial,,21.34,85,,,11.12,21.34,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,70748017501,NDC,facility,both,1,ML,25.66,18.17,Aetna First Health,Commercial,,21.81,85,,,11.37,21.81,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,69097016848,NDC,facility,both,1,ML,25.66,18.17,Aetna First Health,Commercial,,21.81,85,,,11.37,21.81,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,60687077079,NDC,facility,both,1,ML,25.66,18.17,Aetna First Health,Commercial,,21.81,85,,,11.37,21.81,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,60687077083,NDC,facility,both,1,ML,25.66,18.17,Aetna First Health,Commercial,,21.81,85,,,11.37,21.81,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,70748025730,NDC,facility,both,1,ML,25.66,18.17,Aetna First Health,Commercial,,21.81,85,,,11.37,21.81,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,70748025760,NDC,facility,both,1,ML,25.66,18.17,Aetna First Health,Commercial,,21.81,85,,,11.37,21.81,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,70748017530,NDC,facility,both,1,ML,25.66,18.17,Aetna First Health,Commercial,,21.81,85,,,11.37,21.81,percent of total billed charges,
magnesium citrate 1.745 GM/30ML Solution 296 mL Bottle,63700001,CDM,,,250,RC,87701040244,NDC,facility,both,1,ML,26.64,18.86,Aetna First Health,Commercial,,22.64,85,,,11.81,22.64,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,50268074511,NDC,facility,both,1,ML,27.51,19.48,Aetna First Health,Commercial,,23.38,85,,,12.19,23.38,percent of total billed charges,
phenol 1.5 % 1.5 % Liquid 29.57 mL Bottle,63700001,CDM,,,250,RC,58980082010,NDC,facility,both,1,ML,27.77,19.66,Aetna First Health,Commercial,,23.6,85,,,12.31,23.6,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,17856154201,NDC,facility,both,1,ML,27.78,19.67,Aetna First Health,Commercial,,23.61,85,,,12.31,23.61,percent of total billed charges,
charcoal activated Liquid 240 mL Tube,63700001,CDM,,,250,RC,00574012176,NDC,facility,both,1,ML,28.44,20.14,Aetna First Health,Commercial,,24.17,85,,,12.6,24.17,percent of total billed charges,
levalbuterol 1.25 MG/3ML Nebulization Solution 3 mL Plas Cont,63700001,CDM,,,250,RC,63402051324,NDC,facility,both,1,ML,28.57,20.23,Aetna First Health,Commercial,,24.28,85,,,12.66,24.28,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,50268073211,NDC,facility,both,1,ML,28.7,20.32,Aetna First Health,Commercial,,24.4,85,,,12.72,24.4,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,50268073212,NDC,facility,both,1,ML,28.7,20.32,Aetna First Health,Commercial,,24.4,85,,,12.72,24.4,percent of total billed charges,
hypromellose 2.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,17478006412,NDC,facility,both,1,ML,29.05,20.57,Aetna First Health,Commercial,,24.69,85,,,12.87,24.69,percent of total billed charges,
hypromellose 2.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,59390018213,NDC,facility,both,1,ML,29.63,20.98,Aetna First Health,Commercial,,25.19,85,,,13.13,25.19,percent of total billed charges,
aluminum chloride hexahydrate 20 % Solution 35 mL Bottle,63700001,CDM,,,250,RC,00096070735,NDC,facility,both,1,ML,29.77,21.08,Aetna First Health,Commercial,,25.3,85,,,13.19,25.3,percent of total billed charges,
chlorhexidine 0.12 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00126027216,NDC,facility,both,1,ML,30.27,21.43,Aetna First Health,Commercial,,25.73,85,,,13.42,25.73,percent of total billed charges,
permethrin 1 % Liquid 59 mL Bottle,63700001,CDM,,,250,RC,63736024782,NDC,facility,both,1,ML,31.15,22.05,Aetna First Health,Commercial,,26.48,85,,,13.81,26.48,percent of total billed charges,
aluminum chloride hexahydrate 20 % Solution 37.5 mL Bottle,63700001,CDM,,,250,RC,00096070737,NDC,facility,both,1,ML,31.2,22.09,Aetna First Health,Commercial,,26.52,85,,,13.83,26.52,percent of total billed charges,
sodium polystyrene sulfonate 15 GM/60ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,00574200202,NDC,facility,both,1,ML,31.5,22.3,Aetna First Health,Commercial,,26.78,85,,,13.96,26.78,percent of total billed charges,
sodium polystyrene sulfonate 15 GM/60ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,00574200302,NDC,facility,both,1,ML,31.5,22.3,Aetna First Health,Commercial,,26.78,85,,,13.96,26.78,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094004359,NDC,facility,both,1,ML,31.57,22.35,Aetna First Health,Commercial,,26.83,85,,,13.99,26.83,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094004361,NDC,facility,both,1,ML,31.57,22.35,Aetna First Health,Commercial,,26.83,85,,,13.99,26.83,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,60687073856,NDC,facility,both,1,ML,31.82,22.53,Aetna First Health,Commercial,,27.05,85,,,14.1,27.05,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094004362,NDC,facility,both,1,ML,31.85,22.55,Aetna First Health,Commercial,,27.07,85,,,14.12,27.07,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094017159,NDC,facility,both,1,ML,32.83,23.24,Aetna First Health,Commercial,,27.91,85,,,14.55,27.91,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094017161,NDC,facility,both,1,ML,32.83,23.24,Aetna First Health,Commercial,,27.91,85,,,14.55,27.91,percent of total billed charges,
charcoal activated Liquid 120 mL Bottle,63700001,CDM,,,250,RC,66689020204,NDC,facility,both,1,ML,32.94,23.32,Aetna First Health,Commercial,,28,85,,,14.6,28,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094017162,NDC,facility,both,1,ML,32.97,23.34,Aetna First Health,Commercial,,28.02,85,,,14.61,28.02,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,00121074710,NDC,facility,both,1,ML,35.53,25.16,Aetna First Health,Commercial,,30.2,85,,,15.75,30.2,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,69339014801,NDC,facility,both,1,ML,35.53,25.16,Aetna First Health,Commercial,,30.2,85,,,15.75,30.2,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,00121097410,NDC,facility,both,1,ML,35.53,25.16,Aetna First Health,Commercial,,30.2,85,,,15.75,30.2,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,00121074740,NDC,facility,both,1,ML,35.53,25.16,Aetna First Health,Commercial,,30.2,85,,,15.75,30.2,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,60687073842,NDC,facility,both,1,ML,35.88,25.4,Aetna First Health,Commercial,,30.5,85,,,15.9,30.5,percent of total billed charges,
sucralfate 1 GM/10ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,66689079050,NDC,facility,both,1,ML,36.3,25.7,Aetna First Health,Commercial,,30.85,85,,,16.09,30.85,percent of total billed charges,
selenium sulfide 2.5 % Lotion 120 mL Bottle,63700001,CDM,,,250,RC,45802004064,NDC,facility,both,1,ML,39.84,28.21,Aetna First Health,Commercial,,33.86,85,,,17.66,33.86,percent of total billed charges,
potassium iodide 1 GM/ML Solution 30 mL Bottle,63700001,CDM,,,250,RC,00245000331,NDC,facility,both,1,ML,40.22,28.48,Aetna First Health,Commercial,,34.19,85,,,17.83,34.19,percent of total billed charges,
hydrocortisone 100 MG/60ML Enema 60 mL Bottle,63700001,CDM,,,250,RC,00574202001,NDC,facility,both,1,ML,40.56,28.72,Aetna First Health,Commercial,,34.48,85,,,17.98,34.48,percent of total billed charges,
biotene dry mouth moisturizing Solution 236 mL Bottle,63700001,CDM,,,250,RC,50930009808,NDC,facility,both,1,ML,41.54,29.41,Aetna First Health,Commercial,,35.31,85,,,18.41,35.31,percent of total billed charges,
Iodine 2 % Tincture 473 mL Bottle,63700001,CDM,,,250,RC,00395121316,NDC,facility,both,1,ML,41.86,29.64,Aetna First Health,Commercial,,35.58,85,,,18.55,35.58,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,00121168015,NDC,facility,both,1,ML,42.16,29.85,Aetna First Health,Commercial,,35.84,85,,,18.69,35.84,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,00121494815,NDC,facility,both,1,ML,42.16,29.85,Aetna First Health,Commercial,,35.84,85,,,18.69,35.84,percent of total billed charges,
hydroxypropyl methylcellulose 0.5 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,00998040815,NDC,facility,both,1,ML,42.64,30.19,Aetna First Health,Commercial,,36.24,85,,,18.9,36.24,percent of total billed charges,
charcoal activated Liquid 240 mL Bottle,63700001,CDM,,,250,RC,66689020108,NDC,facility,both,1,ML,45,31.86,Aetna First Health,Commercial,,38.25,85,,,19.94,38.25,percent of total billed charges,
cottonseed oil Oil 480 mL Bottle,63700001,CDM,,,250,RC,00395067716,NDC,facility,both,1,ML,48.24,34.15,Aetna First Health,Commercial,,41,85,,,21.38,41,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,66689004701,NDC,facility,both,1,ML,48.25,34.16,Aetna First Health,Commercial,,41.01,85,,,21.38,41.01,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,66689004750,NDC,facility,both,1,ML,48.25,34.16,Aetna First Health,Commercial,,41.01,85,,,21.38,41.01,percent of total billed charges,
hydrocortisone 100 MG/60ML Enema 60 mL Bottle,63700001,CDM,,,250,RC,00574202007,NDC,facility,both,1,ML,48.48,34.32,Aetna First Health,Commercial,,41.21,85,,,21.49,41.21,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,60687034144,NDC,facility,both,1,ML,48.72,34.49,Aetna First Health,Commercial,,41.41,85,,,21.59,41.41,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,60687034171,NDC,facility,both,1,ML,48.72,34.49,Aetna First Health,Commercial,,41.41,85,,,21.59,41.41,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,00143985375,NDC,facility,both,1,ML,49.88,35.32,Aetna First Health,Commercial,,42.4,85,,,22.11,42.4,percent of total billed charges,
phytonadione 1 MG/0.5 ML Solution 0.5 mL Ampule,63700001,CDM,,,250,RC,00409915701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
phytonadione 1 MG/0.5 ML Solution 0.5 mL Ampule,63700001,CDM,,,250,RC,00409915731,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetic acid 0.25 % Solution 500 mL Plas Cont,63700001,CDM,,,250,RC,00264230410,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
caffeine citrate 20 mg/mL 3 mL Vial,63700001,CDM,,,250,RC,51754050001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 5 mL Box,63700001,CDM,,,250,RC,50268008612,NDC,facility,both,1,ML,53.18,37.65,Aetna First Health,Commercial,,45.2,85,,,23.57,45.2,percent of total billed charges,
mesalamine 4 g Enema 60 mL Bottle,63700001,CDM,,,250,RC,45802009851,NDC,facility,both,1,ML,53.52,37.89,Aetna First Health,Commercial,,45.49,85,,,23.72,45.49,percent of total billed charges,
mesalamine 4 g Enema 60 mL Bottle,63700001,CDM,,,250,RC,45802009846,NDC,facility,both,1,ML,53.52,37.89,Aetna First Health,Commercial,,45.49,85,,,23.72,45.49,percent of total billed charges,
mesalamine 4 g Enema 60 mL Bottle,63700001,CDM,,,250,RC,62559042007,NDC,facility,both,1,ML,54.48,38.57,Aetna First Health,Commercial,,46.31,85,,,24.15,46.31,percent of total billed charges,
phytonadione 1 MG/0.5 ML Solution 0.5 mL Syringe,63700001,CDM,,,250,RC,76329124001,NDC,facility,both,1,ML,55.64,39.39,Aetna First Health,Commercial,,47.29,85,,,24.66,47.29,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,16714029401,NDC,facility,both,1,ML,57.23,40.52,Aetna First Health,Commercial,,48.65,85,,,25.36,48.65,percent of total billed charges,
coenzyme Q10 30 MG/5ML Liquid 473 mL Bottle,63700001,CDM,,,250,RC,17204044595,NDC,facility,both,1,ML,57.47,40.69,Aetna First Health,Commercial,,48.85,85,,,25.47,48.85,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,66689004730,NDC,facility,both,1,ML,59.17,41.89,Aetna First Health,Commercial,,50.29,85,,,26.22,50.29,percent of total billed charges,
mineral oil light Oil 2 mL Vial,63700001,CDM,,,250,RC,63323025402,NDC,facility,both,1,ML,60.52,42.85,Aetna First Health,Commercial,,51.44,85,,,26.82,51.44,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 15 mL Cup,63700001,CDM,,,250,RC,60687062844,NDC,facility,both,1,ML,60.9,43.12,Aetna First Health,Commercial,,51.76,85,,,26.99,51.76,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 125 mL Bottle,63700001,CDM,,,250,RC,00143985316,NDC,facility,both,1,ML,61.25,43.36,Aetna First Health,Commercial,,52.06,85,,,27.15,52.06,percent of total billed charges,
formoterol 20 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,00378163193,NDC,facility,both,1,ML,64.17,45.43,Aetna First Health,Commercial,,54.54,85,,,28.44,54.54,percent of total billed charges,
formoterol 20 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,00378163132,NDC,facility,both,1,ML,64.17,45.43,Aetna First Health,Commercial,,54.54,85,,,28.44,54.54,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,70748025701,NDC,facility,both,1,ML,64.83,45.9,Aetna First Health,Commercial,,55.11,85,,,28.73,55.11,percent of total billed charges,
charcoal activated Liquid 240 mL Bottle,63700001,CDM,,,250,RC,00574052108,NDC,facility,both,1,ML,66.36,46.98,Aetna First Health,Commercial,,56.41,85,,,29.41,56.41,percent of total billed charges,
fluticasone propionate 50 MCG/ACT Suspension 15.8 mL Bottle,63700001,CDM,,,250,RC,00536118365,NDC,facility,both,1,ML,67.75,47.97,Aetna First Health,Commercial,,57.59,85,,,30.03,57.59,percent of total billed charges,
haloperidol 2 MG/ML Concentrate 15 mL Bottle,63700001,CDM,,,250,RC,54838050115,NDC,facility,both,1,ML,73.03,51.71,Aetna First Health,Commercial,,62.08,85,,,32.37,62.08,percent of total billed charges,
formoterol 20 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,49502060595,NDC,facility,both,1,ML,78.06,55.27,Aetna First Health,Commercial,,66.35,85,,,34.6,66.35,percent of total billed charges,
formoterol 20 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,49502060561,NDC,facility,both,1,ML,78.06,55.27,Aetna First Health,Commercial,,66.35,85,,,34.6,66.35,percent of total billed charges,
formoterol 20 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,49502060530,NDC,facility,both,1,ML,78.07,55.27,Aetna First Health,Commercial,,66.36,85,,,34.6,66.36,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,00781613957,NDC,facility,both,1,ML,78.75,55.76,Aetna First Health,Commercial,,66.94,85,,,34.9,66.94,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,63402091130,NDC,facility,both,1,ML,78.79,55.78,Aetna First Health,Commercial,,66.97,85,,,34.92,66.97,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,27437005501,NDC,facility,both,1,ML,78.79,55.78,Aetna First Health,Commercial,,66.97,85,,,34.92,66.97,percent of total billed charges,
arformoterol 15 MCG/2ML Nebulization Solution 2 mL Plas Cont,63700001,CDM,,,250,RC,63402091101,NDC,facility,both,1,ML,78.8,55.79,Aetna First Health,Commercial,,66.98,85,,,34.92,66.98,percent of total billed charges,
fluocinolone acetonide 0.01 % Solution 60 mL Bottle,63700001,CDM,,,250,RC,21922000301,NDC,facility,both,1,ML,79.92,56.58,Aetna First Health,Commercial,,67.93,85,,,35.42,67.93,percent of total billed charges,
hydrocortisone 100 MG/60ML Enema 60 mL Bottle,63700001,CDM,,,250,RC,62559013807,NDC,facility,both,1,ML,85.68,60.66,Aetna First Health,Commercial,,72.83,85,,,37.97,72.83,percent of total billed charges,
sodium polystyrene sulfonate 15 GM/60ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,46287000660,NDC,facility,both,1,ML,86.73,61.4,Aetna First Health,Commercial,,73.72,85,,,38.44,73.72,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 125 mL Bottle,63700001,CDM,,,250,RC,16714029402,NDC,facility,both,1,ML,87.06,61.64,Aetna First Health,Commercial,,74,85,,,38.58,74,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 75 mL Bottle,63700001,CDM,,,250,RC,00093867578,NDC,facility,both,1,ML,100.8,71.37,Aetna First Health,Commercial,,85.68,85,,,44.67,85.68,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 5 mL Box,63700001,CDM,,,250,RC,60687053478,NDC,facility,both,1,ML,103.76,73.46,Aetna First Health,Commercial,,88.2,85,,,45.99,88.2,percent of total billed charges,
phytonadione 1 mL Ampule,63700001,CDM,,,250,RC,00409915825,NDC,facility,both,1,ML,107.98,76.45,Aetna First Health,Commercial,,91.78,85,,,47.86,91.78,percent of total billed charges,
phytonadione 1 mL Ampule,63700001,CDM,,,250,RC,00409915801,NDC,facility,both,1,ML,110.18,78.01,Aetna First Health,Commercial,,93.65,85,,,48.83,93.65,percent of total billed charges,
acetic acid 2 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,50383088915,NDC,facility,both,1,ML,112.02,79.31,Aetna First Health,Commercial,,95.22,85,,,49.65,95.22,percent of total billed charges,
acetic acid 2 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,60432074115,NDC,facility,both,1,ML,112.02,79.31,Aetna First Health,Commercial,,95.22,85,,,49.65,95.22,percent of total billed charges,
acetic acid 2 % Solution 15 mL Bottle,63700001,CDM,,,250,RC,52817081615,NDC,facility,both,1,ML,112.02,79.31,Aetna First Health,Commercial,,95.22,85,,,49.65,95.22,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 5 mL Packet,63700001,CDM,,,250,RC,00173054700,NDC,facility,both,1,ML,116.04,82.16,Aetna First Health,Commercial,,98.63,85,,,51.43,98.63,percent of total billed charges,
atovaquone 750 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,60687053440,NDC,facility,both,1,ML,118.58,83.95,Aetna First Health,Commercial,,100.79,85,,,52.55,100.79,percent of total billed charges,
clobetasol 0.05 % Solution 25 mL Bottle,63700001,CDM,,,250,RC,51672129302,NDC,facility,both,1,ML,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
clobetasol 0.05 % Solution 25 mL Bottle,63700001,CDM,,,250,RC,68462053228,NDC,facility,both,1,ML,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
Zidovudine 50 MG/5ML Syrup 240 mL Bottle,63700001,CDM,,,250,RC,65862004824,NDC,facility,both,1,ML,126,89.21,Aetna First Health,Commercial,,107.1,85,,,55.84,107.1,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 125 mL Bottle,63700001,CDM,,,250,RC,00781613954,NDC,facility,both,1,ML,131.25,92.93,Aetna First Health,Commercial,,111.56,85,,,58.17,111.56,percent of total billed charges,
amoxicillin-clavulanate 600-42.9 MG/5ML Recon Susp 125 mL Bottle,63700001,CDM,,,250,RC,00093867575,NDC,facility,both,1,ML,161.44,114.3,Aetna First Health,Commercial,,137.22,85,,,71.55,137.22,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,48433020016,NDC,facility,both,1,ML,163.89,116.03,Aetna First Health,Commercial,,139.31,85,,,72.64,139.31,percent of total billed charges,
niMODipine 6 MG/ML Solution 5 mL Syringe,63700001,CDM,,,250,RC,24338023005,NDC,facility,both,1,ML,171.5,121.42,Aetna First Health,Commercial,,145.78,85,,,76.01,145.78,percent of total billed charges,
niMODipine 6 MG/ML Solution 5 mL Box,63700001,CDM,,,250,RC,24338023012,NDC,facility,both,1,ML,171.52,121.44,Aetna First Health,Commercial,,145.79,85,,,76.02,145.79,percent of total billed charges,
levOCARNitine 1 GM/10ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,54482014801,NDC,facility,both,1,ML,173.46,122.81,Aetna First Health,Commercial,,147.44,85,,,76.88,147.44,percent of total billed charges,
clobetasol 0.05 % Lotion 59 mL Bottle,63700001,CDM,,,250,RC,52565005502,NDC,facility,both,1,ML,180.07,127.49,Aetna First Health,Commercial,,153.06,85,,,79.81,153.06,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,48433021501,NDC,facility,both,1,ML,182.11,128.93,Aetna First Health,Commercial,,154.79,85,,,80.71,154.79,percent of total billed charges,
aluminum acetate solution Solution 480 mL Bottle,63700001,CDM,,,250,RC,49452031001,NDC,facility,both,1,ML,196.56,139.16,Aetna First Health,Commercial,,167.08,85,,,87.12,167.08,percent of total billed charges,
sodium chloride 4 MEQ/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00536137785,NDC,facility,both,1,ML,206.94,146.51,Aetna First Health,Commercial,,175.9,85,,,91.72,175.9,percent of total billed charges,
butorphanol 10 MG/ML Solution 2.5 mL Bottle,63700001,CDM,,,250,RC,60505081301,NDC,facility,both,1,ML,225.6,159.72,Aetna First Health,Commercial,,191.76,85,,,99.99,191.76,percent of total billed charges,
clobetasol 0.05 % Solution 50 mL Bottle,63700001,CDM,,,250,RC,51672129303,NDC,facility,both,1,ML,240,169.92,Aetna First Health,Commercial,,204,85,,,106.37,204,percent of total billed charges,
betamethasone valerate 0.1 % Lotion 60 mL Bottle,63700001,CDM,,,250,RC,00168004160,NDC,facility,both,1,ML,240,169.92,Aetna First Health,Commercial,,204,85,,,106.37,204,percent of total billed charges,
betamethasone valerate 0.1 % Lotion 60 mL Bottle,63700001,CDM,,,250,RC,54879000460,NDC,facility,both,1,ML,240.72,170.43,Aetna First Health,Commercial,,204.61,85,,,106.69,204.61,percent of total billed charges,
butorphanol 10 MG/ML Solution 2.5 mL Bottle,63700001,CDM,,,250,RC,00378963943,NDC,facility,both,1,ML,253.64,179.58,Aetna First Health,Commercial,,215.59,85,,,112.41,215.59,percent of total billed charges,
theophylline 80 MG/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,54838055680,NDC,facility,both,1,ML,261.57,185.19,Aetna First Health,Commercial,,222.33,85,,,115.93,222.33,percent of total billed charges,
theophylline 80 MG/15ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,27808003301,NDC,facility,both,1,ML,261.57,185.19,Aetna First Health,Commercial,,222.33,85,,,115.93,222.33,percent of total billed charges,
clobetasol 0.05 % Lotion 118 mL Bottle,63700001,CDM,,,250,RC,52565005504,NDC,facility,both,1,ML,269.98,191.15,Aetna First Health,Commercial,,229.48,85,,,119.66,229.48,percent of total billed charges,
sodium polystyrene sulfonate 15 GM/60ML Suspension 60 mL Bottle,63700001,CDM,,,250,RC,00054037951,NDC,facility,both,1,ML,315,223.02,Aetna First Health,Commercial,,267.75,85,,,139.61,267.75,percent of total billed charges,
fluocinolone acetonide 0.01 % Solution 60 mL Bottle,63700001,CDM,,,250,RC,52565001259,NDC,facility,both,1,ML,319.92,226.5,Aetna First Health,Commercial,,271.93,85,,,141.79,271.93,percent of total billed charges,
Prednisolon-Moxiflox-Bromfenac 1-0.5-0.075 % Solution 8 mL Bottle,63700001,CDM,,,250,RC,71384034008,NDC,facility,both,1,ML,320,226.56,Aetna First Health,Commercial,,272,85,,,141.82,272,percent of total billed charges,
clobetasol 0.05 % Solution 25 mL Bottle,63700001,CDM,,,250,RC,00472040225,NDC,facility,both,1,ML,330.1,233.71,Aetna First Health,Commercial,,280.59,85,,,146.3,280.59,percent of total billed charges,
neomycin-polymyxin-hydrocortisone 1 % Solution 10 mL Bottle,63700001,CDM,,,250,RC,24208063110,NDC,facility,both,1,ML,335.6,237.6,Aetna First Health,Commercial,,285.26,85,,,148.74,285.26,percent of total billed charges,
neomycin-polymyxin-hydrocortisone 1 % Solution 10 mL Bottle,63700001,CDM,,,250,RC,61314064610,NDC,facility,both,1,ML,335.6,237.6,Aetna First Health,Commercial,,285.26,85,,,148.74,285.26,percent of total billed charges,
neomycin-polymyxin-hydrocortisone 3.5-10000-1 Solution 10 mL Bottle,63700001,CDM,,,250,RC,24208063110,NDC,facility,both,1,ML,335.6,237.6,Aetna First Health,Commercial,,285.26,85,,,148.74,285.26,percent of total billed charges,
neomycin-polymyxin-hydrocortisone 3.5-10000-1 Solution 10 mL Bottle,63700001,CDM,,,250,RC,61314064610,NDC,facility,both,1,ML,335.6,237.6,Aetna First Health,Commercial,,285.26,85,,,148.74,285.26,percent of total billed charges,
Methylnaltrexone 12 MG/0.6ML Solution 0.6 mL Vial,63700001,CDM,,,250,RC,65649055102,NDC,facility,both,1,ML,360.7,255.38,Aetna First Health,Commercial,,306.59,85,,,159.86,306.59,percent of total billed charges,
Methylnaltrexone 12 MG/0.6ML Solution 0.6 mL Syringe,63700001,CDM,,,250,RC,65649055103,NDC,facility,both,1,ML,360.7,255.38,Aetna First Health,Commercial,,306.59,85,,,159.86,306.59,percent of total billed charges,
cefUROXime 250 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,00173074110,NDC,facility,both,1,ML,381.85,270.35,Aetna First Health,Commercial,,324.57,85,,,169.24,324.57,percent of total billed charges,
bimatoprost 0.03 % Solution 2.5 mL Bottle,63700001,CDM,,,250,RC,68180042901,NDC,facility,both,1,ML,430.8,305.01,Aetna First Health,Commercial,,366.18,85,,,190.93,366.18,percent of total billed charges,
lindane 1 % Shampoo 60 mL Bottle,63700001,CDM,,,250,RC,60432083460,NDC,facility,both,1,ML,438,310.1,Aetna First Health,Commercial,,372.3,85,,,194.12,372.3,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Lotion 60 mL Bottle,63700001,CDM,,,250,RC,51672134004,NDC,facility,both,1,ML,473.28,335.08,Aetna First Health,Commercial,,402.29,85,,,209.76,402.29,percent of total billed charges,
clobetasol 0.05 % Solution 50 mL Bottle,63700001,CDM,,,250,RC,60432013350,NDC,facility,both,1,ML,520,368.16,Aetna First Health,Commercial,,442,85,,,230.46,442,percent of total billed charges,
hydrocortisone-acetic acid 1-2 % Solution 10 mL Bottle,63700001,CDM,,,250,RC,51672300701,NDC,facility,both,1,ML,541.84,383.62,Aetna First Health,Commercial,,460.56,85,,,240.14,460.56,percent of total billed charges,
fluocinolone acetonide 0.01 % Solution 60 mL Bottle,63700001,CDM,,,250,RC,51672136504,NDC,facility,both,1,ML,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
augmented betamethasone dipropionate 0.05 % Lotion 60 mL Bottle,63700001,CDM,,,250,RC,00168026760,NDC,facility,both,1,ML,602.16,426.33,Aetna First Health,Commercial,,511.84,85,,,266.88,511.84,percent of total billed charges,
hydrocortisone-acetic acid 1-2 % Solution 10 mL Bottle,63700001,CDM,,,250,RC,50383090110,NDC,facility,both,1,ML,644.48,456.29,Aetna First Health,Commercial,,547.81,85,,,285.63,547.81,percent of total billed charges,
clobetasol 0.05 % Lotion 59 mL Bottle,63700001,CDM,,,250,RC,00472040492,NDC,facility,both,1,ML,910.72,644.79,Aetna First Health,Commercial,,774.11,85,,,403.63,774.11,percent of total billed charges,
desonide 0.05 % Lotion 59 mL Bottle,63700001,CDM,,,250,RC,00472080302,NDC,facility,both,1,ML,947.54,670.86,Aetna First Health,Commercial,,805.41,85,,,419.95,805.41,percent of total billed charges,
desonide 0.05 % Lotion 59 mL Bottle,63700001,CDM,,,250,RC,68462051339,NDC,facility,both,1,ML,947.54,670.86,Aetna First Health,Commercial,,805.41,85,,,419.95,805.41,percent of total billed charges,
Exenatide 5 MCG/0.02ML solution pen-injector 1.2 mL Pen,63700001,CDM,,,250,RC,66780021007,NDC,facility,both,1,ML,960.95,680.35,Aetna First Health,Commercial,,816.81,85,,,425.89,816.81,percent of total billed charges,
Corona Ointment 7 oz Tube,63700001,CDM,,,250,RC,98886800104,NDC,facility,both,1,UN,19.64,13.91,Aetna First Health,Commercial,,16.69,85,,,8.7,16.69,percent of total billed charges,
Bag Balm Ointment 10 oz Can,63700001,CDM,,,250,RC,98886800103,NDC,facility,both,1,UN,43.08,30.5,Aetna First Health,Commercial,,36.62,85,,,19.09,36.62,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 10.15 mL Cup,63700001,CDM,,,250,RC,00121188211,NDC,facility,both,1.00062,ML,1.69,1.2,Aetna First Health,Commercial,,1.44,85,,,0.75,1.44,percent of total billed charges,
levothyroxine 88 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,42292003801,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687048611,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134401,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183301,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180096801,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,42292003820,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687048601,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 30 Each Box,63700001,CDM,,,250,RC,72305008830,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518392,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378180777,NDC,facility,both,1.13636,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 88 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074659490,NDC,facility,both,1.13636,EA,6.27,4.44,Aetna First Health,Commercial,,5.33,85,,,2.78,5.33,percent of total billed charges,
morphine 10 MG/5ML Solution 100 mL Bottle,63700001,CDM,,,250,RC,00054023749,NDC,facility,both,1.25,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079044101,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687047511,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134301,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183201,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180096701,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079044120,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687047501,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 75 MCG Tablet 30 Each Box,63700001,CDM,,,250,RC,72305007530,NDC,facility,both,1.33333,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
povidone iodine vaginal 0.3 % Solution 274 mL Box,63700001,CDM,,,250,RC,00132874302,NDC,facility,both,1.4562,ML,6.58,4.66,Aetna First Health,Commercial,,5.59,85,,,2.92,5.59,percent of total billed charges,
felbamate 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,72578005601,NDC,facility,both,1.5,EA,7.32,5.18,Aetna First Health,Commercial,,6.22,85,,,3.24,6.22,percent of total billed charges,
felbamate 400 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,51525043001,NDC,facility,both,1.5,EA,19.81,14.03,Aetna First Health,Commercial,,16.84,85,,,8.78,16.84,percent of total billed charges,
felbamate 400 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,65162073403,NDC,facility,both,1.5,EA,12.6,8.92,Aetna First Health,Commercial,,10.71,85,,,5.58,10.71,percent of total billed charges,
lisdexamfetamine 20 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00406511201,NDC,facility,both,1.5,EA,48.47,34.32,Aetna First Health,Commercial,,41.2,85,,,21.48,41.2,percent of total billed charges,
lisdexamfetamine 20 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59417010210,NDC,facility,both,1.5,EA,67.86,48.04,Aetna First Health,Commercial,,57.68,85,,,30.08,57.68,percent of total billed charges,
neostigmine methylsulfate 1 mg/mL 10 mL Vial,63700001,CDM,,,250,RC,76014000333,NDC,facility,both,1.5,ML,61.97,43.87,Aetna First Health,Commercial,,52.67,85,,,27.47,52.67,percent of total billed charges,
neostigmine methylsulfate 1 mg/mL 10 mL Vial,63700001,CDM,,,250,RC,63323041510,NDC,facility,both,1.5,ML,94.5,66.91,Aetna First Health,Commercial,,80.32,85,,,41.88,80.32,percent of total billed charges,
pyRIDostigmine 60 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,68682030705,NDC,facility,both,1.66667,ML,13.75,9.74,Aetna First Health,Commercial,,11.69,85,,,6.09,11.69,percent of total billed charges,
pyRIDostigmine 60 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00187301220,NDC,facility,both,1.66667,ML,20.24,14.33,Aetna First Health,Commercial,,17.2,85,,,8.97,17.2,percent of total billed charges,
brexpiprazole 0.25 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,59148003513,NDC,facility,both,2,EA,343.36,243.1,Aetna First Health,Commercial,,291.86,85,,,152.18,291.86,percent of total billed charges,
clonazePAM 0.125 MG Tablet Disintegrating 1 Each Blister,63700001,CDM,,,250,RC,49884030652,NDC,facility,both,2,EA,6.44,4.56,Aetna First Health,Commercial,,5.47,85,,,2.85,5.47,percent of total billed charges,
clonazePAM 0.125 MG Tablet Disintegrating 60 Each Bottle,63700001,CDM,,,250,RC,57664078386,NDC,facility,both,2,EA,6.55,4.64,Aetna First Health,Commercial,,5.57,85,,,2.9,5.57,percent of total billed charges,
clonazePAM 0.125 MG Tablet Disintegrating 60 Each Box,63700001,CDM,,,250,RC,49884030602,NDC,facility,both,2,EA,6.47,4.58,Aetna First Health,Commercial,,5.5,85,,,2.87,5.5,percent of total billed charges,
clonazePAM 0.125 MG Tablet Disintegrating 60 Each Box,63700001,CDM,,,250,RC,00555009496,NDC,facility,both,2,EA,6.55,4.64,Aetna First Health,Commercial,,5.57,85,,,2.9,5.57,percent of total billed charges,
desvenlafaxine succinate ER 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,59762121003,NDC,facility,both,2,EA,4.64,3.29,Aetna First Health,Commercial,,3.94,85,,,2.06,3.94,percent of total billed charges,
desvenlafaxine succinate ER 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,51991000633,NDC,facility,both,2,EA,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
desvenlafaxine succinate ER 25 MG Tablet Extended Release 24 Hour 30 Each Bottle,63700001,CDM,,,250,RC,00054060313,NDC,facility,both,2,EA,6.83,4.84,Aetna First Health,Commercial,,5.81,85,,,3.03,5.81,percent of total billed charges,
diclofenac EC 25 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,00781178501,NDC,facility,both,2,EA,7.46,5.28,Aetna First Health,Commercial,,6.34,85,,,3.31,6.34,percent of total billed charges,
diclofenac EC 25 MG Tablet Delayed Release 100 Each Bottle,63700001,CDM,,,250,RC,68001027900,NDC,facility,both,2,EA,7.46,5.28,Aetna First Health,Commercial,,6.34,85,,,3.31,6.34,percent of total billed charges,
glucose 4 GM Tablet Chewable 1 Each Blister,63700001,CDM,,,250,RC,17856161001,NDC,facility,both,2,EA,4.2,2.97,Aetna First Health,Commercial,,3.57,85,,,1.86,3.57,percent of total billed charges,
glucose 4 GM Tablet Chewable 10 Each Bottle,63700001,CDM,,,250,RC,87701042601,NDC,facility,both,2,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
glucose 4 GM Tablet Chewable 10 Each Bottle,63700001,CDM,,,250,RC,00904589615,NDC,facility,both,2,EA,0.56,0.4,Aetna First Health,Commercial,,0.48,85,,,0.25,0.48,percent of total billed charges,
glucose 4 GM Tablet Chewable 10 Each Tube,63700001,CDM,,,250,RC,80681010000,NDC,facility,both,2,EA,0.71,0.5,Aetna First Health,Commercial,,0.6,85,,,0.31,0.6,percent of total billed charges,
glucose 4 GM Tablet Chewable 10 Each Tube,63700001,CDM,,,250,RC,87701042599,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
indinavir 200 MG capsule 360 Each Bottle,63700001,CDM,,,250,RC,00006057143,NDC,facility,both,2,EA,8.88,6.29,Aetna First Health,Commercial,,7.55,85,,,3.94,7.55,percent of total billed charges,
isavuconazonium 186 MG capsule 14 Each Box,63700001,CDM,,,250,RC,00469052014,NDC,facility,both,2,EA,706.77,500.39,Aetna First Health,Commercial,,600.75,85,,,313.24,600.75,percent of total billed charges,
lacosamide 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687067611,NDC,facility,both,2,EA,13.75,9.74,Aetna First Health,Commercial,,11.69,85,,,6.09,11.69,percent of total billed charges,
lacosamide 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,47335091886,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lacosamide 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,31722081260,NDC,facility,both,2,EA,3.02,2.14,Aetna First Health,Commercial,,2.57,85,,,1.34,2.57,percent of total billed charges,
lacosamide 50 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,00131247735,NDC,facility,both,2,EA,82.45,58.37,Aetna First Health,Commercial,,70.08,85,,,36.54,70.08,percent of total billed charges,
lacosamide 50 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,00904724468,NDC,facility,both,2,EA,8.62,6.1,Aetna First Health,Commercial,,7.33,85,,,3.82,7.33,percent of total billed charges,
lacosamide 50 MG Tablet 60 Each Box,63700001,CDM,,,250,RC,00131247760,NDC,facility,both,2,EA,90.7,64.22,Aetna First Health,Commercial,,77.1,85,,,40.2,77.1,percent of total billed charges,
LAPAtinib 250 MG Tablet 150 Each Bottle,63700001,CDM,,,250,RC,00173075200,NDC,facility,both,2,EA,246.11,174.25,Aetna First Health,Commercial,,209.19,85,,,109.08,209.19,percent of total billed charges,
levothyroxine 75 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,00074518211,NDC,facility,both,2,EA,11.03,7.81,Aetna First Health,Commercial,,9.38,85,,,4.89,9.38,percent of total billed charges,
levothyroxine 88 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378180701,NDC,facility,both,2,EA,3.26,2.31,Aetna First Health,Commercial,,2.77,85,,,1.44,2.77,percent of total billed charges,
Magnesium Cl-Calcium Carbonate 71.5-119 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,67618010760,NDC,facility,both,2,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Magnesium Cl-Calcium Carbonate 71.5-119 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,69315020906,NDC,facility,both,2,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
Magnesium Cl-Calcium Carbonate 71.5-119 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,67618000005,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
mesalamine 800 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687040895,NDC,facility,both,2,EA,95.69,67.75,Aetna First Health,Commercial,,81.34,85,,,42.41,81.34,percent of total billed charges,
mesalamine 800 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,00430078327,NDC,facility,both,2,EA,39.85,28.21,Aetna First Health,Commercial,,33.87,85,,,17.66,33.87,percent of total billed charges,
mesalamine 800 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,68382048428,NDC,facility,both,2,EA,43.46,30.77,Aetna First Health,Commercial,,36.94,85,,,19.26,36.94,percent of total billed charges,
mesalamine 800 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,68382064928,NDC,facility,both,2,EA,43.46,30.77,Aetna First Health,Commercial,,36.94,85,,,19.26,36.94,percent of total billed charges,
mesalamine 800 MG Tablet Delayed Release 180 Each Bottle,63700001,CDM,,,250,RC,68382043528,NDC,facility,both,2,EA,51.93,36.77,Aetna First Health,Commercial,,44.14,85,,,23.02,44.14,percent of total billed charges,
mesalamine 800 MG Tablet Delayed Release 30 Each Box,63700001,CDM,,,250,RC,60687040825,NDC,facility,both,2,EA,95.67,67.73,Aetna First Health,Commercial,,81.32,85,,,42.4,81.32,percent of total billed charges,
mesalamine EC 1.2 g Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687039795,NDC,facility,both,2,EA,72.8,51.54,Aetna First Health,Commercial,,61.88,85,,,32.26,61.88,percent of total billed charges,
mesalamine EC 1.2 g Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,00591224522,NDC,facility,both,2,EA,31.12,22.03,Aetna First Health,Commercial,,26.45,85,,,13.79,26.45,percent of total billed charges,
mesalamine EC 1.2 g Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,68382071119,NDC,facility,both,2,EA,31.12,22.03,Aetna First Health,Commercial,,26.45,85,,,13.79,26.45,percent of total billed charges,
mesalamine EC 1.2 g Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,16714083001,NDC,facility,both,2,EA,33.57,23.77,Aetna First Health,Commercial,,28.53,85,,,14.88,28.53,percent of total billed charges,
mesalamine EC 1.2 g Tablet Delayed Release 120 Each Bottle,63700001,CDM,,,250,RC,54092047612,NDC,facility,both,2,EA,65.53,46.4,Aetna First Health,Commercial,,55.7,85,,,29.04,55.7,percent of total billed charges,
mesalamine EC 1.2 g Tablet Delayed Release 30 Each Box,63700001,CDM,,,250,RC,60687039725,NDC,facility,both,2,EA,72.8,51.54,Aetna First Health,Commercial,,61.88,85,,,32.26,61.88,percent of total billed charges,
methylcellulose 500 MG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,24385046678,NDC,facility,both,2,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
morphine 5 MG Suppository 12 Each Box,63700001,CDM,,,250,RC,00574711012,NDC,facility,both,2,EA,28,19.82,Aetna First Health,Commercial,,23.8,85,,,12.41,23.8,percent of total billed charges,
voriconazole 50 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687029411,NDC,facility,both,2,EA,65.92,46.67,Aetna First Health,Commercial,,56.03,85,,,29.22,56.03,percent of total billed charges,
voriconazole 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,68462057230,NDC,facility,both,2,EA,15.17,10.74,Aetna First Health,Commercial,,12.89,85,,,6.72,12.89,percent of total billed charges,
voriconazole 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00378162693,NDC,facility,both,2,EA,65.67,46.49,Aetna First Health,Commercial,,55.82,85,,,29.1,55.82,percent of total billed charges,
voriconazole 50 MG Tablet 30 Each Bottle,63700001,CDM,,,250,RC,00049317030,NDC,facility,both,2,EA,128.99,91.32,Aetna First Health,Commercial,,109.64,85,,,57.17,109.64,percent of total billed charges,
voriconazole 50 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,00904659604,NDC,facility,both,2,EA,56.68,40.13,Aetna First Health,Commercial,,48.18,85,,,25.12,48.18,percent of total billed charges,
voriconazole 50 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,51079016403,NDC,facility,both,2,EA,59.72,42.28,Aetna First Health,Commercial,,50.76,85,,,26.47,50.76,percent of total billed charges,
voriconazole 50 MG Tablet 30 Each Box,63700001,CDM,,,250,RC,60687029421,NDC,facility,both,2,EA,65.92,46.67,Aetna First Health,Commercial,,56.03,85,,,29.22,56.03,percent of total billed charges,
zonisamide 25 MG capsule 1 Each Blister,63700001,CDM,,,250,RC,68084019011,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68462012801,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,68001024200,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 25 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00378672501,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
zonisamide 25 MG capsule 100 Each Box,63700001,CDM,,,250,RC,68084019001,NDC,facility,both,2,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 250 MG/5ML Solution 470 mL Bottle,63700001,CDM,,,250,RC,50383031147,NDC,facility,both,2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,65162069890,NDC,facility,both,2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 250 MG/5ML Solution 470 mL Bottle,63700001,CDM,,,250,RC,42192060816,NDC,facility,both,2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
diazePAM 5 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,00054318863,NDC,facility,both,2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloBAZam 2.5 MG/ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,66689005804,NDC,facility,both,2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
gabapentin 250 MG/5ML Solution 470 mL Bottle,63700001,CDM,,,250,RC,59762502501,NDC,facility,both,2,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
cloBAZam 2.5 MG/ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,67877065861,NDC,facility,both,2,ML,3.21,2.27,Aetna First Health,Commercial,,2.73,85,,,1.42,2.73,percent of total billed charges,
cloBAZam 2.5 MG/ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,69238153502,NDC,facility,both,2,ML,3.27,2.32,Aetna First Health,Commercial,,2.78,85,,,1.45,2.78,percent of total billed charges,
gabapentin 250 MG/5ML Solution 470 mL Bottle,63700001,CDM,,,250,RC,00071201223,NDC,facility,both,2,ML,3.53,2.5,Aetna First Health,Commercial,,3,85,,,1.56,3,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,00121182810,NDC,facility,both,2,ML,3.66,2.59,Aetna First Health,Commercial,,3.11,85,,,1.62,3.11,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,00121182800,NDC,facility,both,2,ML,3.66,2.59,Aetna First Health,Commercial,,3.11,85,,,1.62,3.11,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094050359,NDC,facility,both,2,ML,3.93,2.78,Aetna First Health,Commercial,,3.34,85,,,1.74,3.34,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 10 mL Cup,63700001,CDM,,,250,RC,68094050361,NDC,facility,both,2,ML,3.93,2.78,Aetna First Health,Commercial,,3.34,85,,,1.74,3.34,percent of total billed charges,
cloBAZam 2.5 MG/ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,69452011645,NDC,facility,both,2,ML,7.88,5.58,Aetna First Health,Commercial,,6.7,85,,,3.49,6.7,percent of total billed charges,
cloBAZam 2.5 MG/ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,00832058525,NDC,facility,both,2,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
cloBAZam 2.5 MG/ML Suspension 120 mL Bottle,63700001,CDM,,,250,RC,59651040112,NDC,facility,both,2,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
potassium chloride 20 MEQ/15ML (10%) Solution 7.5 mL Syringe,63700001,CDM,,,250,RC,88886800058,NDC,facility,both,2,ML,24.5,17.35,Aetna First Health,Commercial,,20.82,85,,,10.86,20.82,percent of total billed charges,
OXcarbazepine 300 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,50268064905,NDC,facility,both,2,ML,39.06,27.65,Aetna First Health,Commercial,,33.2,85,,,17.31,33.2,percent of total billed charges,
OXcarbazepine 300 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094012359,NDC,facility,both,2,ML,50.86,36.01,Aetna First Health,Commercial,,43.23,85,,,22.54,43.23,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,60687076240,NDC,facility,both,2.03125,ML,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121096605,NDC,facility,both,2.03125,ML,3.53,2.5,Aetna First Health,Commercial,,3,85,,,1.56,3,percent of total billed charges,
acetaminophen 160 MG/5ML Solution 5 mL Cup,63700001,CDM,,,250,RC,81033000205,NDC,facility,both,2.03125,ML,5.33,3.77,Aetna First Health,Commercial,,4.53,85,,,2.36,4.53,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094023161,NDC,facility,both,2.03125,ML,6.4,4.53,Aetna First Health,Commercial,,5.44,85,,,2.84,5.44,percent of total billed charges,
cyanocobalamin 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00536354201,NDC,facility,both,2.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 100 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,80681007100,NDC,facility,both,2.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
cyanocobalamin 100 MCG Tablet 130 Each Bottle,63700001,CDM,,,250,RC,00904113213,NDC,facility,both,2.5,EA,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,16714035801,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,31722057447,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121079916,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methadone 5 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,00054355563,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00781614116,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,60432083116,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00472023516,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,50383024116,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,10702016450,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,27808005901,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
methylphenidate 10 MG/5ML Solution 500 mL Bottle,63700001,CDM,,,250,RC,51991061250,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,51991065116,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine-codeine 6.25-10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,50383080416,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine-codeine 6.25-10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,60432060616,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine-codeine 6.25-10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00603158558,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine-codeine 6.25-10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00121092816,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
promethazine-codeine 6.25-10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,27808006502,NDC,facility,both,2.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
FLUoxetine 20 MG/5ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,00832603212,NDC,facility,both,2.5,ML,3.66,2.59,Aetna First Health,Commercial,,3.11,85,,,1.62,3.11,percent of total billed charges,
midazolam 2 MG/ML Syrup 118 mL Bottle,63700001,CDM,,,250,RC,00574015004,NDC,facility,both,2.5,ML,4.82,3.41,Aetna First Health,Commercial,,4.1,85,,,2.14,4.1,percent of total billed charges,
FLUoxetine 20 MG/5ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,54838052340,NDC,facility,both,2.5,ML,5.03,3.56,Aetna First Health,Commercial,,4.28,85,,,2.23,4.28,percent of total billed charges,
FLUoxetine 20 MG/5ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,65862030612,NDC,facility,both,2.5,ML,5.03,3.56,Aetna First Health,Commercial,,4.28,85,,,2.23,4.28,percent of total billed charges,
famotidine 40 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,68180015001,NDC,facility,both,2.5,ML,5.25,3.72,Aetna First Health,Commercial,,4.46,85,,,2.33,4.46,percent of total billed charges,
famotidine 40 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,70954031610,NDC,facility,both,2.5,ML,6.33,4.48,Aetna First Health,Commercial,,5.38,85,,,2.81,5.38,percent of total billed charges,
midazolam 2 MG/ML Syrup 118 mL Bottle,63700001,CDM,,,250,RC,00054356699,NDC,facility,both,2.5,ML,9.64,6.83,Aetna First Health,Commercial,,8.19,85,,,4.27,8.19,percent of total billed charges,
levETIRAcetam 100 MG/ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,50474000148,NDC,facility,both,2.5,ML,11.69,8.28,Aetna First Health,Commercial,,9.94,85,,,5.18,9.94,percent of total billed charges,
famotidine 40 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,68382044405,NDC,facility,both,2.5,ML,17.28,12.23,Aetna First Health,Commercial,,14.69,85,,,7.66,14.69,percent of total billed charges,
digoxin 0.05 MG/ML Solution 60 mL Bottle,63700001,CDM,,,250,RC,66689032702,NDC,facility,both,2.5,ML,17.35,12.28,Aetna First Health,Commercial,,14.75,85,,,7.69,14.75,percent of total billed charges,
digoxin 0.05 MG/ML Solution 60 mL Bottle,63700001,CDM,,,250,RC,00054005746,NDC,facility,both,2.5,ML,20.41,14.45,Aetna First Health,Commercial,,17.35,85,,,9.05,17.35,percent of total billed charges,
famotidine 40 MG/5ML Recon Susp 50 mL Bottle,63700001,CDM,,,250,RC,65649021124,NDC,facility,both,2.5,ML,34.34,24.31,Aetna First Health,Commercial,,29.19,85,,,15.22,29.19,percent of total billed charges,
lisdexamfetamine Dimesylate 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,00406511101,NDC,facility,both,3,EA,96.95,68.64,Aetna First Health,Commercial,,82.41,85,,,42.97,82.41,percent of total billed charges,
lisdexamfetamine Dimesylate 10 MG capsule 100 Each Bottle,63700001,CDM,,,250,RC,59417010110,NDC,facility,both,3,EA,135.72,96.09,Aetna First Health,Commercial,,115.36,85,,,60.15,115.36,percent of total billed charges,
posaconazole 100 MG Tablet Delayed Release 1 Each Blister,63700001,CDM,,,250,RC,60687052311,NDC,facility,both,3,EA,495.25,350.64,Aetna First Health,Commercial,,420.96,85,,,219.49,420.96,percent of total billed charges,
posaconazole 100 MG Tablet Delayed Release 20 Each Box,63700001,CDM,,,250,RC,60687052394,NDC,facility,both,3,EA,495.25,350.64,Aetna First Health,Commercial,,420.96,85,,,219.49,420.96,percent of total billed charges,
posaconazole 100 MG Tablet Delayed Release 30 Each Box,63700001,CDM,,,250,RC,60687052321,NDC,facility,both,3,EA,495.25,350.64,Aetna First Health,Commercial,,420.96,85,,,219.49,420.96,percent of total billed charges,
posaconazole 100 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,00527213335,NDC,facility,both,3,EA,148.18,104.91,Aetna First Health,Commercial,,125.95,85,,,65.67,125.95,percent of total billed charges,
posaconazole 100 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,00254204502,NDC,facility,both,3,EA,169.75,120.18,Aetna First Health,Commercial,,144.29,85,,,75.23,144.29,percent of total billed charges,
posaconazole 100 MG Tablet Delayed Release 60 Each Bottle,63700001,CDM,,,250,RC,00085432402,NDC,facility,both,3,EA,719.57,509.46,Aetna First Health,Commercial,,611.63,85,,,318.91,611.63,percent of total billed charges,
FLUoxetine 20 MG/5ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,00093610812,NDC,facility,both,3,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094058761,NDC,facility,both,3,ML,3.74,2.65,Aetna First Health,Commercial,,3.18,85,,,1.66,3.18,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094058759,NDC,facility,both,3,ML,3.74,2.65,Aetna First Health,Commercial,,3.18,85,,,1.66,3.18,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094058762,NDC,facility,both,3,ML,3.78,2.68,Aetna First Health,Commercial,,3.21,85,,,1.68,3.21,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094023159,NDC,facility,both,3,ML,4.05,2.87,Aetna First Health,Commercial,,3.44,85,,,1.79,3.44,percent of total billed charges,
FLUoxetine 20 MG/5ML Solution 120 mL Bottle,63700001,CDM,,,250,RC,00121072104,NDC,facility,both,3,ML,4.39,3.11,Aetna First Health,Commercial,,3.73,85,,,1.95,3.73,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121178105,NDC,facility,both,3,ML,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121178100,NDC,facility,both,3,ML,5.22,3.7,Aetna First Health,Commercial,,4.44,85,,,2.31,4.44,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094001559,NDC,facility,both,3,ML,5.33,3.77,Aetna First Health,Commercial,,4.53,85,,,2.36,4.53,percent of total billed charges,
acetaminophen 160 MG/5ML Suspension 5 mL Syringe,63700001,CDM,,,250,RC,68094058758,NDC,facility,both,3,ML,6.01,4.26,Aetna First Health,Commercial,,5.11,85,,,2.66,5.11,percent of total billed charges,
levothyroxine 25 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,51079044401,NDC,facility,both,4,EA,6.16,4.36,Aetna First Health,Commercial,,5.24,85,,,2.73,5.24,percent of total billed charges,
levothyroxine 25 MCG Tablet 1 Each Blister,63700001,CDM,,,250,RC,60687045311,NDC,facility,both,4,EA,6.52,4.62,Aetna First Health,Commercial,,5.54,85,,,2.89,5.54,percent of total billed charges,
levothyroxine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,68180096501,NDC,facility,both,4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
levothyroxine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,69238183001,NDC,facility,both,4,EA,3.12,2.21,Aetna First Health,Commercial,,2.65,85,,,1.38,2.65,percent of total billed charges,
levothyroxine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00527134101,NDC,facility,both,4,EA,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
levothyroxine 25 MCG Tablet 100 Each Bottle,63700001,CDM,,,250,RC,00378180001,NDC,facility,both,4,EA,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
levothyroxine 25 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,51079044420,NDC,facility,both,4,EA,6.15,4.35,Aetna First Health,Commercial,,5.23,85,,,2.73,5.23,percent of total billed charges,
levothyroxine 25 MCG Tablet 100 Each Box,63700001,CDM,,,250,RC,60687045301,NDC,facility,both,4,EA,6.52,4.62,Aetna First Health,Commercial,,5.54,85,,,2.89,5.54,percent of total billed charges,
levothyroxine 25 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00378180077,NDC,facility,both,4,EA,4.62,3.27,Aetna First Health,Commercial,,3.93,85,,,2.05,3.93,percent of total billed charges,
levothyroxine 25 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00781518092,NDC,facility,both,4,EA,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
levothyroxine 25 MCG Tablet 90 Each Bottle,63700001,CDM,,,250,RC,00074434190,NDC,facility,both,4,EA,22.09,15.64,Aetna First Health,Commercial,,18.78,85,,,9.79,18.78,percent of total billed charges,
mesalamine 250 MG Capsule Extended Release 240 Each Bottle,63700001,CDM,,,250,RC,54092018981,NDC,facility,both,4,EA,30.09,21.3,Aetna First Health,Commercial,,25.58,85,,,13.34,25.58,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00904680161,NDC,facility,both,4,EA,10.56,7.48,Aetna First Health,Commercial,,8.98,85,,,4.68,8.98,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 100 Each Box,63700001,CDM,,,250,RC,00310028039,NDC,facility,both,4,EA,106.46,75.37,Aetna First Health,Commercial,,90.49,85,,,47.18,90.49,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,68001051106,NDC,facility,both,4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,16729013212,NDC,facility,both,4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,68001059806,NDC,facility,both,4,EA,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,71093013502,NDC,facility,both,4,EA,4.66,3.3,Aetna First Health,Commercial,,3.96,85,,,2.07,3.96,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,49884080502,NDC,facility,both,4,EA,91.98,65.12,Aetna First Health,Commercial,,78.18,85,,,40.77,78.18,percent of total billed charges,
QUEtiapine XR 50 MG Tablet Extended Release 24 Hour 60 Each Bottle,63700001,CDM,,,250,RC,00310028060,NDC,facility,both,4,EA,106.46,75.37,Aetna First Health,Commercial,,90.49,85,,,47.18,90.49,percent of total billed charges,
rivaroxaban 2.5 MG Tablet 1 Each Blister,63700001,CDM,,,250,RC,50458057701,NDC,facility,both,4,EA,132.86,94.06,Aetna First Health,Commercial,,112.93,85,,,58.88,112.93,percent of total billed charges,
rivaroxaban 2.5 MG Tablet 100 Each Box,63700001,CDM,,,250,RC,50458057710,NDC,facility,both,4,EA,132.9,94.09,Aetna First Health,Commercial,,112.96,85,,,58.9,112.96,percent of total billed charges,
rivaroxaban 2.5 MG Tablet 60 Each Bottle,63700001,CDM,,,250,RC,50458057760,NDC,facility,both,4,EA,132.9,94.09,Aetna First Health,Commercial,,112.96,85,,,58.9,112.96,percent of total billed charges,
tinidazole 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,42799020801,NDC,facility,both,4,EA,38.5,27.26,Aetna First Health,Commercial,,32.72,85,,,17.06,32.72,percent of total billed charges,
tinidazole 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00054034807,NDC,facility,both,4,EA,113.68,80.49,Aetna First Health,Commercial,,96.63,85,,,50.38,96.63,percent of total billed charges,
tinidazole 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,43386055102,NDC,facility,both,4,EA,177.59,125.73,Aetna First Health,Commercial,,150.95,85,,,78.71,150.95,percent of total billed charges,
tinidazole 500 MG Tablet 20 Each Bottle,63700001,CDM,,,250,RC,00178850020,NDC,facility,both,4,EA,199.84,141.49,Aetna First Health,Commercial,,169.86,85,,,88.57,169.86,percent of total billed charges,
phenytoin 125 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,60432013108,NDC,facility,both,4,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin 125 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,51672406901,NDC,facility,both,4,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin 125 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,00472500208,NDC,facility,both,4,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
phenytoin 125 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,59762053101,NDC,facility,both,4,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121091805,NDC,facility,both,4,ML,3.9,2.76,Aetna First Health,Commercial,,3.32,85,,,1.73,3.32,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121091400,NDC,facility,both,4,ML,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121091405,NDC,facility,both,4,ML,4.38,3.1,Aetna First Health,Commercial,,3.72,85,,,1.94,3.72,percent of total billed charges,
phenytoin 125 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,66689077508,NDC,facility,both,4,ML,4.42,3.13,Aetna First Health,Commercial,,3.76,85,,,1.96,3.76,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094049461,NDC,facility,both,4,ML,4.71,3.33,Aetna First Health,Commercial,,4,85,,,2.09,4,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094049462,NDC,facility,both,4,ML,4.71,3.33,Aetna First Health,Commercial,,4,85,,,2.09,4,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094049459,NDC,facility,both,4,ML,4.71,3.33,Aetna First Health,Commercial,,4,85,,,2.09,4,percent of total billed charges,
phenytoin 125 MG/5ML Suspension 237 mL Bottle,63700001,CDM,,,250,RC,00071221420,NDC,facility,both,4,ML,5.03,3.56,Aetna First Health,Commercial,,4.28,85,,,2.23,4.28,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094060059,NDC,facility,both,4,ML,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,68094060062,NDC,facility,both,4,ML,5.1,3.61,Aetna First Health,Commercial,,4.34,85,,,2.26,4.34,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,66689033901,NDC,facility,both,4,ML,5.52,3.91,Aetna First Health,Commercial,,4.69,85,,,2.45,4.69,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121477405,NDC,facility,both,4,ML,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,50383058405,NDC,facility,both,4,ML,9.1,6.44,Aetna First Health,Commercial,,7.74,85,,,4.03,7.74,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,66689000901,NDC,facility,both,4,ML,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,66689000950,NDC,facility,both,4,ML,9.8,6.94,Aetna First Health,Commercial,,8.33,85,,,4.34,8.33,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,00121183605,NDC,facility,both,4,ML,10.22,7.24,Aetna First Health,Commercial,,8.69,85,,,4.53,8.69,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Syringe,63700001,CDM,,,250,RC,68094003701,NDC,facility,both,4,ML,11.28,7.99,Aetna First Health,Commercial,,9.59,85,,,5,9.59,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Syringe,63700001,CDM,,,250,RC,68094049458,NDC,facility,both,4,ML,13.92,9.86,Aetna First Health,Commercial,,11.83,85,,,6.17,11.83,percent of total billed charges,
ibuprofen 100 MG/5ML Suspension 5 mL Cup,63700001,CDM,,,250,RC,17856530905,NDC,facility,both,4,ML,18.48,13.08,Aetna First Health,Commercial,,15.71,85,,,8.19,15.71,percent of total billed charges,
colestipol 5 GM Granules 450 g Bottle,63700001,CDM,,,250,RC,00009037005,NDC,facility,both,5,GM,7.09,5.02,Aetna First Health,Commercial,,6.03,85,,,3.14,6.03,percent of total billed charges,
ferrous sulfate 220 (44 Fe) MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,50383077816,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multiple vitamin with minerals Liquid 236 mL Bottle,63700001,CDM,,,250,RC,00536279059,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multiple vitamin with minerals Liquid 236 mL Bottle,63700001,CDM,,,250,RC,00005434462,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multiple vitamin with minerals Liquid 236 mL Bottle,63700001,CDM,,,250,RC,69618000858,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,00603107554,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,00121077504,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
amantadine 50 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,60432009316,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multiple vitamin with minerals Liquid 237 mL Bottle,63700001,CDM,,,250,RC,54838001070,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
multiple vitamin with minerals Liquid 236 mL Bottle,63700001,CDM,,,250,RC,76518001008,NDC,facility,both,5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,50383008704,NDC,facility,both,5,ML,0.68,0.48,Aetna First Health,Commercial,,0.58,85,,,0.3,0.58,percent of total billed charges,
potassium & sodium citrate with citric acid 550-500-334 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,60258000216,NDC,facility,both,5,ML,0.94,0.67,Aetna First Health,Commercial,,0.8,85,,,0.42,0.8,percent of total billed charges,
valproate 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121067516,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproate 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,50383079216,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproate 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,60432062116,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproate 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121067585,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ferrous sulfate 220 (44 Fe) MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,54838000180,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
ferrous sulfate 220 (44 Fe) MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,57896070916,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amantadine 50 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121064616,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
multiple vitamin with minerals Liquid 236 mL Bottle,63700001,CDM,,,250,RC,00573051330,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121057616,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
amantadine 50 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,50383080716,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine 10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,60432015016,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproate 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,62559026616,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
metoclopramide 5 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,62559019016,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
guaiFENesin - codeine 100-10 MG/5ML Solution 118 mL Bottle,63700001,CDM,,,250,RC,69367027204,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
hydrOXYzine 10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,10702005216,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
valproate 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00603184158,NDC,facility,both,5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
lacosamide 10 MG/ML Solution 200 mL Bottle,63700001,CDM,,,250,RC,67877073295,NDC,facility,both,5,ML,3.01,2.13,Aetna First Health,Commercial,,2.56,85,,,1.33,2.56,percent of total billed charges,
hydrOXYzine 10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,54838050280,NDC,facility,both,5,ML,3.57,2.53,Aetna First Health,Commercial,,3.03,85,,,1.58,3.03,percent of total billed charges,
escitalopram 5 MG/5ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,65162070588,NDC,facility,both,5,ML,7.67,5.43,Aetna First Health,Commercial,,6.52,85,,,3.4,6.52,percent of total billed charges,
lacosamide 10 MG/ML Solution 200 mL Bottle,63700001,CDM,,,250,RC,70954048810,NDC,facility,both,5,ML,7.81,5.53,Aetna First Health,Commercial,,6.64,85,,,3.46,6.64,percent of total billed charges,
cefprozil 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,16714039703,NDC,facility,both,5,ML,9.59,6.79,Aetna First Health,Commercial,,8.15,85,,,4.25,8.15,percent of total billed charges,
cefprozil 250 MG/5ML Recon Susp 100 mL Bottle,63700001,CDM,,,250,RC,68180040203,NDC,facility,both,5,ML,9.96,7.05,Aetna First Health,Commercial,,8.47,85,,,4.41,8.47,percent of total billed charges,
escitalopram 5 MG/5ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,31722056924,NDC,facility,both,5,ML,11.1,7.86,Aetna First Health,Commercial,,9.43,85,,,4.92,9.43,percent of total billed charges,
escitalopram 5 MG/5ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,65862024824,NDC,facility,both,5,ML,11.1,7.86,Aetna First Health,Commercial,,9.43,85,,,4.92,9.43,percent of total billed charges,
doxycycline calcium 50 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00069097193,NDC,facility,both,5,ML,11.31,8.01,Aetna First Health,Commercial,,9.61,85,,,5.01,9.61,percent of total billed charges,
escitalopram 5 MG/5ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,54838055170,NDC,facility,both,5,ML,11.67,8.26,Aetna First Health,Commercial,,9.92,85,,,5.17,9.92,percent of total billed charges,
hydrOXYzine 10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,62135050247,NDC,facility,both,5,ML,18.5,13.1,Aetna First Health,Commercial,,15.72,85,,,8.2,15.72,percent of total billed charges,
hydrOXYzine 10 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,62135075047,NDC,facility,both,5,ML,18.5,13.1,Aetna First Health,Commercial,,15.72,85,,,8.2,15.72,percent of total billed charges,
doxycycline calcium 50 MG/5ML Syrup 473 mL Bottle,63700001,CDM,,,250,RC,00069097195,NDC,facility,both,5,ML,18.87,13.36,Aetna First Health,Commercial,,16.04,85,,,8.36,16.04,percent of total billed charges,
diphenoxylate-atropine 2.5-0.025 MG/5ML Liquid 60 mL Bottle,63700001,CDM,,,250,RC,00054319446,NDC,facility,both,5,ML,20.42,14.46,Aetna First Health,Commercial,,17.36,85,,,9.05,17.36,percent of total billed charges,
escitalopram 5 MG/5ML Solution 240 mL Bottle,63700001,CDM,,,250,RC,00456210108,NDC,facility,both,5,ML,23.38,16.55,Aetna First Health,Commercial,,19.87,85,,,10.36,19.87,percent of total billed charges,
PARoxetine 10 MG/5ML Suspension 250 mL Bottle,63700001,CDM,,,250,RC,70954031910,NDC,facility,both,5,ML,25.71,18.2,Aetna First Health,Commercial,,21.85,85,,,11.39,21.85,percent of total billed charges,
PARoxetine 10 MG/5ML Suspension 250 mL Bottle,63700001,CDM,,,250,RC,60505040205,NDC,facility,both,5,ML,31.05,21.98,Aetna First Health,Commercial,,26.39,85,,,13.76,26.39,percent of total billed charges,
lacosamide 10 MG/ML Solution 200 mL Bottle,63700001,CDM,,,250,RC,00131541071,NDC,facility,both,5,ML,32.24,22.83,Aetna First Health,Commercial,,27.4,85,,,14.29,27.4,percent of total billed charges,
lacosamide 10 MG/ML Solution 200 mL Bottle,63700001,CDM,,,250,RC,00131541072,NDC,facility,both,5,ML,39.99,28.31,Aetna First Health,Commercial,,33.99,85,,,17.72,33.99,percent of total billed charges,
loperamide 1 mg/7.5 mL Solution 120 mL Bottle,63700001,CDM,,,250,RC,00904683620,NDC,facility,both,7.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loperamide 1 mg/7.5 mL Solution 120 mL Bottle,63700001,CDM,,,250,RC,46122054426,NDC,facility,both,7.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loperamide 1 mg/7.5 mL Solution 120 mL Bottle,63700001,CDM,,,250,RC,70677005401,NDC,facility,both,7.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loperamide 1 mg/7.5 mL Solution 120 mL Bottle,63700001,CDM,,,250,RC,50580013404,NDC,facility,both,7.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loperamide 1 mg/7.5 mL Solution 120 mL Bottle,63700001,CDM,,,250,RC,00045013404,NDC,facility,both,7.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
loperamide 1 mg/7.5 mL Solution 120 mL Bottle,63700001,CDM,,,250,RC,00045013444,NDC,facility,both,7.5,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
PHENobarbital 20 MG/5ML Elixir 473 mL Bottle,63700001,CDM,,,250,RC,16571067516,NDC,facility,both,7.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 20 MG/5ML Elixir 473 mL Bottle,63700001,CDM,,,250,RC,00121094216,NDC,facility,both,7.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 20 MG/5ML Elixir 473 mL Bottle,63700001,CDM,,,250,RC,64380016601,NDC,facility,both,7.5,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
PHENobarbital 20 MG/5ML Elixir 473 mL Bottle,63700001,CDM,,,250,RC,13517010716,NDC,facility,both,7.5,ML,3.83,2.71,Aetna First Health,Commercial,,3.26,85,,,1.7,3.26,percent of total billed charges,
PHENobarbital 20 MG/5ML Elixir 473 mL Bottle,63700001,CDM,,,250,RC,00603150858,NDC,facility,both,7.5,ML,3.96,2.8,Aetna First Health,Commercial,,3.37,85,,,1.76,3.37,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,00904000414,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,00904572114,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,57896062912,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,00536194583,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,00536129383,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,46122043340,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,46122043440,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,49348015339,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
aluminum & magnesium hydroxide-simethicone 200-200-20 MG/5ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,00904676414,NDC,facility,both,10,ML,0.5,0.35,Aetna First Health,Commercial,,0.42,85,,,0.22,0.42,percent of total billed charges,
sulfamethoxazole-trimethoprim 200-40 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,00121085416,NDC,facility,both,10,ML,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
sulfamethoxazole-trimethoprim 200-40 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,65862049647,NDC,facility,both,10,ML,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
sulfamethoxazole-trimethoprim 200-40 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,70954025810,NDC,facility,both,10,ML,3.19,2.26,Aetna First Health,Commercial,,2.71,85,,,1.41,2.71,percent of total billed charges,
carBAMazepine 100 MG/5ML Suspension 450 mL Bottle,63700001,CDM,,,250,RC,60432012916,NDC,facility,both,10,ML,4.66,3.3,Aetna First Health,Commercial,,3.96,85,,,2.07,3.96,percent of total billed charges,
carBAMazepine 100 MG/5ML Suspension 450 mL Bottle,63700001,CDM,,,250,RC,70954024010,NDC,facility,both,10,ML,5.5,3.89,Aetna First Health,Commercial,,4.68,85,,,2.44,4.68,percent of total billed charges,
sulfamethoxazole-trimethoprim 200-40 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,50383082316,NDC,facility,both,10,ML,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
sulfamethoxazole-trimethoprim 200-40 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,50383082416,NDC,facility,both,10,ML,6.62,4.69,Aetna First Health,Commercial,,5.63,85,,,2.93,5.63,percent of total billed charges,
sulfamethoxazole-trimethoprim 200-40 MG/5ML Suspension 473 mL Bottle,63700001,CDM,,,250,RC,54879000716,NDC,facility,both,10,ML,6.97,4.93,Aetna First Health,Commercial,,5.92,85,,,3.09,5.92,percent of total billed charges,
carBAMazepine 100 MG/5ML Suspension 450 mL Bottle,63700001,CDM,,,250,RC,51672404709,NDC,facility,both,10,ML,10,7.08,Aetna First Health,Commercial,,8.5,85,,,4.43,8.5,percent of total billed charges,
carBAMazepine 100 MG/5ML Suspension 450 mL Bottle,63700001,CDM,,,250,RC,00078050883,NDC,facility,both,10,ML,15.09,10.68,Aetna First Health,Commercial,,12.83,85,,,6.69,12.83,percent of total billed charges,
OXcarbazepine 300 MG/5ML Suspension 250 mL Bottle,63700001,CDM,,,250,RC,42806060022,NDC,facility,both,10,ML,15.4,10.9,Aetna First Health,Commercial,,13.09,85,,,6.83,13.09,percent of total billed charges,
OXcarbazepine 300 MG/5ML Suspension 250 mL Bottle,63700001,CDM,,,250,RC,00781627043,NDC,facility,both,10,ML,23.17,16.4,Aetna First Health,Commercial,,19.69,85,,,10.27,19.69,percent of total billed charges,
OXcarbazepine 300 MG/5ML Suspension 250 mL Bottle,63700001,CDM,,,250,RC,65162064978,NDC,facility,both,10,ML,23.17,16.4,Aetna First Health,Commercial,,19.69,85,,,10.27,19.69,percent of total billed charges,
OXcarbazepine 300 MG/5ML Suspension 250 mL Bottle,63700001,CDM,,,250,RC,00054019959,NDC,facility,both,10,ML,23.17,16.4,Aetna First Health,Commercial,,19.69,85,,,10.27,19.69,percent of total billed charges,
OXcarbazepine 300 MG/5ML Suspension 250 mL Bottle,63700001,CDM,,,250,RC,00078035752,NDC,facility,both,10,ML,40.71,28.82,Aetna First Health,Commercial,,34.6,85,,,18.04,34.6,percent of total billed charges,
sorbitol 70 % Solution 473 mL Bottle,63700001,CDM,,,250,RC,00603090058,NDC,facility,both,15,ML,1.19,0.84,Aetna First Health,Commercial,,1.01,85,,,0.53,1.01,percent of total billed charges,
HYDROcodone-chlorpheniramine ER 10-8 MG/5ML Suspension Extended Release 118 mL Bottle,63700001,CDM,,,250,RC,62542030104,NDC,facility,both,118,ML,201.96,142.99,Aetna First Health,Commercial,,171.67,85,,,89.51,171.67,percent of total billed charges,
Alum & Mag Hydroxide-Simeth 1200-1200-120 MG/30ML Suspension 355 mL Bottle,63700001,CDM,,,250,RC,00536131783,NDC,facility,both,355,ML,12.43,8.8,Aetna First Health,Commercial,,10.57,85,,,5.51,10.57,percent of total billed charges,
Valproic Acid 250 MG/5ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121067585,NDC,facility,both,473,ML,66.22,46.88,Aetna First Health,Commercial,,56.29,85,,,29.35,56.29,percent of total billed charges,
metoclopramide 10 MG/10ML Solution 473 mL Bottle,63700001,CDM,,,250,RC,00121057616,NDC,facility,both,473,ML,102.64,72.67,Aetna First Health,Commercial,,87.24,85,,,45.49,87.24,percent of total billed charges,
TRAUMA ACTIVATION LEVEL 1,68200000,CDM,G0390,CPT,684,RC,,,facility,both,,,2934,2077.27,Aetna First Health,Commercial,,2493.9,85,,,1300.35,2493.9,percent of total billed charges,
TRAUMA ACTIVATION LEVEL 2,68200001,CDM,G0390,CPT,684,RC,,,facility,both,,,1696,1200.77,Aetna First Health,Commercial,,1441.6,85,,,751.67,1441.6,percent of total billed charges,
TRAUMA ACTIVATION,68200010,CDM,G0390,CPT,684,RC,,,facility,both,,,2841,2011.43,Aetna First Health,Commercial,,2414.85,85,,,1259.13,2414.85,percent of total billed charges,
TRAUMA ACTIVATION LEVEL 2,68200011,CDM,G0390,CPT,684,RC,,,facility,both,,,1696,1200.77,Aetna First Health,Commercial,,1441.6,85,,,751.67,1441.6,percent of total billed charges,
POST ANESTHESIA RECOVERY,71000019,CDM,,,710,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,,22.1,85,,,11.52,22.1,percent of total billed charges,
PHASE II RECOVERY,71000037,CDM,,,710,RC,,,facility,both,,,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
PHASE II RECOVERY PER MINUTE - SMMC 3N,71000041,CDM,,,710,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
PHASE II RECOVERY,71000047,CDM,,,710,RC,,,facility,both,,,21,14.87,Aetna First Health,Commercial,,17.85,85,,,9.31,17.85,percent of total billed charges,
AMNIOTOMY,72200000,CDM,,,722,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
LABOR - LEVEL I,72299001,CDM,,,721,RC,,,facility,both,,,680,481.44,Aetna First Health,Commercial,,578,85,,,301.38,578,percent of total billed charges,
LABOR - LEVEL II,72299002,CDM,,,721,RC,,,facility,both,,,849,601.09,Aetna First Health,Commercial,,721.65,85,,,376.28,721.65,percent of total billed charges,
LABOR - LEVEL III,72299003,CDM,,,721,RC,,,facility,both,,,1273,901.28,Aetna First Health,Commercial,,1082.05,85,,,564.19,1082.05,percent of total billed charges,
NON-VIABLE BIRTH,72299006,CDM,,,720,RC,,,facility,both,,,650,460.2,Aetna First Health,Commercial,,552.5,85,,,288.08,552.5,percent of total billed charges,
DELIVERY - LEVEL I,72299008,CDM,,,722,RC,,,facility,both,,,5889,4169.41,Aetna First Health,Commercial,,5005.65,85,,,2610,5005.65,percent of total billed charges,
DELIVERY - LEVEL II,72299009,CDM,,,722,RC,,,facility,both,,,6875,4867.5,Aetna First Health,Commercial,,5843.75,85,,,3047,5843.75,percent of total billed charges,
ASSIST WITH EPIDURAL,76000018,CDM,,,722,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
NITROUS OXIDE CIRCUIT W/MASK,76300073,CDM,,,272,RC,,,facility,both,,,112,79.3,Aetna First Health,Commercial,,95.2,85,,,49.64,95.2,percent of total billed charges,
NITROUS OXIDE CIRCUIT W/MASK,76300073,CDM,,,272,RC,,,facility,inpatient,,,109,77.17,Aetna First Health,Commercial,,92.65,85,,,48.31,92.65,percent of total billed charges,
CHEMICAL DEPEND EVAL/CONSULT,94599000,CDM,90791,CPT,945,RC,,,facility,both,,,376,266.21,Aetna First Health,Commercial,U5,319.6,85,,,166.64,319.6,percent of total billed charges,
EXTENDED GROUP 1 HR,94599002,CDM,90853,CPT,945,RC,,,facility,both,,,176,124.61,Aetna First Health,Commercial,U5,149.6,85,,,78,149.6,percent of total billed charges,
FOLLOWUP CSLR VISIT,94599011,CDM,90791,CPT,945,RC,,,facility,both,,,224,158.59,Aetna First Health,Commercial,U5,190.4,85,,,99.28,190.4,percent of total billed charges,
OUTPATIENT INDIVID 1 HR,94599012,CDM,90837,CPT,945,RC,,,facility,both,,,292,206.74,Aetna First Health,Commercial,U5,248.2,85,,,129.41,248.2,percent of total billed charges,
OUTPATIENT INDIVID 30 MIN,94599013,CDM,90832,CPT,945,RC,,,facility,both,,,173,122.48,Aetna First Health,Commercial,U5,147.05,85,,,76.67,147.05,percent of total billed charges,
PRIMARY GROUP 1 HR,94599014,CDM,90853,CPT,945,RC,,,facility,both,,,218,154.34,Aetna First Health,Commercial,U5,185.3,85,,,96.62,185.3,percent of total billed charges,
PRIMARY GROUP 2 HR,94599016,CDM,90853,CPT,945,RC,,,facility,both,,,286,202.49,Aetna First Health,Commercial,U5,243.1,85,,,126.76,243.1,percent of total billed charges,
PRIMARY GROUP 3 HR,94599018,CDM,90853,CPT,945,RC,,,facility,both,,,356,252.05,Aetna First Health,Commercial,U5,302.6,85,,,157.78,302.6,percent of total billed charges,
OUTPATIENT INDIVID 1 HR,94599031,CDM,H2035,CPT,945,RC,,,facility,both,,,268,189.74,Aetna First Health,Commercial,,227.8,85,,,118.78,227.8,percent of total billed charges,
OUTPATIENT INDIVID 30 MIN,94599032,CDM,H2035,CPT,945,RC,,,facility,both,,,149,105.49,Aetna First Health,Commercial,,126.65,85,,,66.04,126.65,percent of total billed charges,
SET FILTERLINE H ADULT/PEDIATRIC,272250141,CDM,,,272,RC,,,facility,both,,,53,37.52,Aetna First Health,Commercial,,45.05,85,,,23.49,45.05,percent of total billed charges,
CAPNOLINE PLUS ADULT NASAL CANNULA,272250142,CDM,,,272,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,,50.15,85,,,26.15,50.15,percent of total billed charges,
CAPNOLINE PLUS ADULT NASAL CANNULA,272250142,CDM,,,272,RC,,,facility,inpatient,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
AEROGEN NEBULIZER (AERONEB),272250143,CDM,,,272,RC,,,facility,both,,,182,128.86,Aetna First Health,Commercial,,154.7,85,,,80.66,154.7,percent of total billed charges,
AEROGEN NEBULIZER (AERONEB),272250143,CDM,,,272,RC,,,facility,inpatient,,,177,125.32,Aetna First Health,Commercial,,150.45,85,,,78.45,150.45,percent of total billed charges,
CPT DISPOSABLE WRAP VEST,763000031,CDM,,,272,RC,,,facility,inpatient,,,258,182.66,Aetna First Health,Commercial,,219.3,85,,,114.35,219.3,percent of total billed charges,
CPT DISPOSABLE WRAP VEST,763000031,CDM,,,272,RC,,,facility,both,,,258,182.66,Aetna First Health,Commercial,,219.3,85,,,114.35,219.3,percent of total billed charges,
FLUTTER VALVE,797001155,CDM,,,272,RC,,,facility,both,,,210,148.68,Aetna First Health,Commercial,,178.5,85,,,93.07,178.5,percent of total billed charges,
FLUTTER VALVE,797001155,CDM,,,272,RC,,,facility,inpatient,,,204,144.43,Aetna First Health,Commercial,,173.4,85,,,90.41,173.4,percent of total billed charges,
NITROUS OXIDE (PER HOUR),797001544,CDM,,,271,RC,,,facility,both,,,25,17.7,Aetna First Health,Commercial,,21.25,85,,,11.08,21.25,percent of total billed charges,
NEEDLE SPINAL 22GA X 3.5 IN (QUINKE),797001545,CDM,,,272,RC,,,facility,inpatient,,,20,14.16,Aetna First Health,Commercial,,17,85,,,8.86,17,percent of total billed charges,
ACAPELLA DEVICE,797003234,CDM,,,272,RC,,,facility,both,,,151,106.91,Aetna First Health,Commercial,,128.35,85,,,66.92,128.35,percent of total billed charges,
ACAPELLA DEVICE,797003234,CDM,,,272,RC,,,facility,inpatient,,,147,104.08,Aetna First Health,Commercial,,124.95,85,,,65.15,124.95,percent of total billed charges,
MODIFIED KOPANS NEEDLE/WIRE FOR LOCALIZATION,999007017,CDM,C1819,CPT,278,RC,,,facility,both,,,93,65.84,Aetna First Health,Commercial,,79.05,85,,,41.22,79.05,percent of total billed charges,
"PIFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, 1ST DOSE",0001A,CDM,0001A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, 2ND DOSE",0002A,CDM,0002A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, 3RD DOSE",0003A,CDM,0003A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, ADMINISTRATION, BOOSTER",0004A,CDM,0004A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"MODERNA COVID-19 VACCINE, 100MCG/0.5ML, ADMINISTRATION - 1ST DOSE",0011A,CDM,0011A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"MODERNA COVID-19 VACCINE, 100MCG/0.5ML, ADMINISTRATION - 2ND DOSE",0012A,CDM,0012A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"MODERNA COVID-19 VACCINE, 100MCG/0.5ML, ADMINISTRATION - 3RD DOSE",0013A,CDM,0013A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
JAK2 GENE TRGT PKU - REF,0027U90,CDM,0027U,CPT,310,RC,,,facility,both,,,451,319.31,Aetna First Health,Commercial,90,383.35,85,,,199.88,383.35,percent of total billed charges,
"DRUG METABOLISM, TARGETED SEQUENCE ANALYSIS - REF",0029U90,CDM,0029U,CPT,300,RC,,,facility,both,,,600,424.8,Aetna First Health,Commercial,90,510,85,,,265.92,510,percent of total billed charges,
"JANSSEN COVID-19 VACCINE, ADMINISTRATION",0031A,CDM,0031A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"JANSSEN COVID-19 VACCINE, ADMINISTRATION, BOOSTER DOSE",0034A,CDM,0034A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
TPMT AND NUDT15 GENOTYPE - REF,0034U90,CDM,0034U,CPT,300,RC,,,facility,both,,,528,373.82,Aetna First Health,Commercial,90,448.8,85,,,234.01,448.8,percent of total billed charges,
XOME TUM & NML SPEC SEQ ALYS,0035U90,CDM,0035U,CPT,300,RC,,,facility,both,,,758,536.66,Aetna First Health,Commercial,90,644.3,85,,,335.95,644.3,percent of total billed charges,
NOVAVAX COVID-19 VACCINE ADMINISTRATION 1ST DOSE,0041A,CDM,0041A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
NOVAVAX COVID-19 VACCINE ADMINISTRATION 2ND DOSE,0042A,CDM,0042A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
NOVAVAX COVID-19 VACCINE ADMINISTRATION BOOSTER,0044A,CDM,0044A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG, TRS-SUCR, ADMINISTRATION, 1ST DOSE",0051A,CDM,0051A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG, TRS-SUCR, ADMINISTRATION, 2ND DOSE",0052A,CDM,0052A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG, TRS-SUCR, ADMINISTRATION, 3RD DOSE",0053A,CDM,0053A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG, TRS-SUCR, ADMINISTRATION, BOOSTER",0054A,CDM,0054A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"MODERNA COVID-19 VACCINE, 50MCG/0.25ML, ADMINISTRATION ?Çô BOOSTER DOSE",0064A,CDM,0064A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 10MCG, TRS-SUCR, ADMINISTRATION, 1ST DOSE",0071A,CDM,0071A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 10MCG, TRS-SUCR, ADMINISTRATION, 2ND DOSE",0072A,CDM,0072A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 10MCG, TRS-SUCR, ADMINISTRATION, 3RD DOSE",0073A,CDM,0073A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 10MCG, TRS-SUCR, ADMINISTRATION, BOOSTER DOSE",0074A,CDM,0074A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
IG PARAPROTEIN QUAL BLD/UR,0077U90,CDM,0077U,CPT,300,RC,,,facility,both,,,262,185.5,Aetna First Health,Commercial,90,222.7,85,,,116.12,222.7,percent of total billed charges,
PFIZER-BIONTECH COVID-19 ADM PF 3MCG/0.2ML 1ST DOSE AGE 6MO-4YRS,0081A,CDM,0081A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
PFIZER-BIONTECH COVID-19 ADM PF 3MCG/0.2ML 2ND DOSE AGE 6MO-4YRS,0082A,CDM,0082A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
PFIZER-BIONTECH COVID-19 ADM PF 3MCG/0.2ML 3RD DOSE AGE 6MO-4YRS,0083A,CDM,0083A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
CRD CERAMIDES LIQ CHROMPLSM,0119U90,CDM,0119U,CPT,300,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,90,96.9,85,,,50.52,96.9,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 30MCG/0.3ML, BIVALENT, ADMIN ADDL DOSE",0124A,CDM,0124A,CPT,771,RC,,,facility,both,,,44,31.15,Aetna First Health,Commercial,,37.4,85,,,19.5,37.4,percent of total billed charges,
"PFIZER-BIONTECH COVID-19 VACCINE, 10MCG/0.2ML, BIVALENT, ADMIN ADDL DOSE",0154A,CDM,0154A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
"COVID BIVALENT VACCINE ADMIN 3RD DOSE,6MO-4YRS",0173A,CDM,0173A,CPT,771,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2,0202U,CDM,0202U,CPT,300,RC,,,facility,both,,,700,495.6,Aetna First Health,Commercial,,595,85,,,310.24,595,percent of total billed charges,
NFCT AGENT HIV TRGT VIRAL NEXT-GNRJ SEQ ALYS ALG,0219U90,CDM,0219U,CPT,300,RC,,,facility,both,,,540,382.32,Aetna First Health,Commercial,90,459,85,,,239.33,459,percent of total billed charges,
"INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION), ",0240U,CDM,0240U,CPT,300,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,,187.85,85,,,97.95,187.85,percent of total billed charges,
INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION),0240UQW,CDM,0240U,CPT,300,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,QW,187.85,85,,,97.95,187.85,percent of total billed charges,
"INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION), ",0241U,CDM,0241U,CPT,300,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,,187.85,85,,,97.95,187.85,percent of total billed charges,
"INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION), 0241U",0241UQW,CDM,0241U,CPT,300,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,QW,187.85,85,,,97.95,187.85,percent of total billed charges,
EPHEIDARINFECTIOUS DISEASE (BACTERIAL VAGINOSIS AND VAGINITIS),0352U,CDM,0352U,CPT,300,RC,,,facility,both,,,255,180.54,Aetna First Health,Commercial,,216.75,85,,,113.02,216.75,percent of total billed charges,
EPHEIDARINFECTIOUS DISEASE (BACTERIAL VAGINOSIS AND VAGINITIS),0352UQW,CDM,0352U,CPT,300,RC,,,facility,both,,,255,180.54,Aetna First Health,Commercial,QW,216.75,85,,,113.02,216.75,percent of total billed charges,
"NEUROFILAMENT LIGHT CHAIN, DIGITAL.",0361U90,CDM,0361U,CPT,300,RC,,,facility,both,,,959,678.97,Aetna First Health,Commercial,90,815.15,85,,,425.03,815.15,percent of total billed charges,
QUANT US TISSUE CHARACT WO DX US TC,0689T01,CDM,0689T,CPT,761,RC,,,facility,both,,,955,676.14,Aetna First Health,Commercial,TC,811.75,85,,,423.26,811.75,percent of total billed charges,
QUANT US TISSUE CHARACT W DX US TC,0690T01,CDM,0690T,CPT,761,RC,,,facility,both,,,955,676.14,Aetna First Health,Commercial,TC,811.75,85,,,423.26,811.75,percent of total billed charges,
PERC TRANSLUMINAL CORNONARY LITHOTRIPSY,0715TF,CDM,0715T,CPT,481,RC,,,facility,both,,,6657,4713.16,Aetna First Health,Commercial,,5658.45,85,,,2950.38,5658.45,percent of total billed charges,
REMOVAL OF SKIN TAGS,11200F,CDM,11200,CPT,510,RC,,,facility,both,,,210,148.68,Aetna First Health,Commercial,,178.5,85,,,93.07,178.5,percent of total billed charges,
"SHAV SKIN LES 1.1-2.0CM TRUNK,ARM,LEG",11302F,CDM,11302,CPT,510,RC,,,facility,both,,,269,190.45,Aetna First Health,Commercial,,228.65,85,,,119.22,228.65,percent of total billed charges,
"SHAV SKIN LES 0.6-1.0CM FACE,FACIAL",11311F,CDM,11311,CPT,510,RC,,,facility,both,,,269,190.45,Aetna First Health,Commercial,,228.65,85,,,119.22,228.65,percent of total billed charges,
"EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LEG",11402F,CDM,11402,CPT,510,RC,,,facility,both,,,800,566.4,Aetna First Health,Commercial,,680,85,,,354.56,680,percent of total billed charges,
TRIM NON-DYSTROPHIC NAIL(S),11719F,CDM,11719,CPT,510,RC,,,facility,both,,,102,72.22,Aetna First Health,Commercial,,86.7,85,,,45.21,86.7,percent of total billed charges,
REMOVAL OF NAIL PLATE,11730F,CDM,11730,CPT,510,RC,,,facility,both,,,386,273.29,Aetna First Health,Commercial,,328.1,85,,,171.08,328.1,percent of total billed charges,
DRAIN BLOOD FROM UNDER NAIL,11740F,CDM,11740,CPT,510,RC,,,facility,both,,,198,140.18,Aetna First Health,Commercial,,168.3,85,,,87.75,168.3,percent of total billed charges,
REMOVAL OF NAIL BED,11750F,CDM,11750,CPT,510,RC,,,facility,both,,,729,516.13,Aetna First Health,Commercial,,619.65,85,,,323.09,619.65,percent of total billed charges,
RECONSTRUC OF NAIL BED,11760F,CDM,11760,CPT,510,RC,,,facility,both,,,1116,790.13,Aetna First Health,Commercial,,948.6,85,,,494.61,948.6,percent of total billed charges,
"EXCISION OF NAIL FOLD, TOE",11765F,CDM,11765,CPT,510,RC,,,facility,both,,,290,205.32,Aetna First Health,Commercial,,246.5,85,,,128.53,246.5,percent of total billed charges,
REPR SUPERF WND BODY <2.5CM,12001F,CDM,12001,CPT,510,RC,,,facility,both,,,409,289.57,Aetna First Health,Commercial,,347.65,85,,,181.27,347.65,percent of total billed charges,
REPR SUP NPTERF WND BODY 2.6-7.5,12002F,CDM,12002,CPT,510,RC,,,facility,both,,,475,336.3,Aetna First Health,Commercial,,403.75,85,,,210.52,403.75,percent of total billed charges,
REPR SUPERF WND BODY 7.6-12.5,12004F,CDM,12004,CPT,510,RC,,,facility,both,,,525,371.7,Aetna First Health,Commercial,,446.25,85,,,232.68,446.25,percent of total billed charges,
REPR SUPERF WND BODY 12.6-20,12005F,CDM,12005,CPT,510,RC,,,facility,both,,,743,526.04,Aetna First Health,Commercial,,631.55,85,,,329.3,631.55,percent of total billed charges,
REPR SUPERF WND BODY 20.1-30,12006F,CDM,12006,CPT,510,RC,,,facility,both,,,488,345.5,Aetna First Health,Commercial,,414.8,85,,,216.28,414.8,percent of total billed charges,
REPR SUPERF WND BODY >30CM,12007F,CDM,12007,CPT,510,RC,,,facility,both,,,270,191.16,Aetna First Health,Commercial,,229.5,85,,,119.66,229.5,percent of total billed charges,
REPR SUPERF WND FACE <2.5CM,12011F,CDM,12011,CPT,510,RC,,,facility,both,,,442,312.94,Aetna First Health,Commercial,,375.7,85,,,195.89,375.7,percent of total billed charges,
REPR SUPERF WND FACE 2.6-5,12013F,CDM,12013,CPT,510,RC,,,facility,both,,,477,337.72,Aetna First Health,Commercial,,405.45,85,,,211.41,405.45,percent of total billed charges,
REPR SUPERF WND FACE 5.1-7.5,12014F,CDM,12014,CPT,510,RC,,,facility,both,,,651,460.91,Aetna First Health,Commercial,,553.35,85,,,288.52,553.35,percent of total billed charges,
REPR SUPERF WND FACE 7.6-12.5,12015F,CDM,12015,CPT,510,RC,,,facility,both,,,720,509.76,Aetna First Health,Commercial,,612,85,,,319.1,612,percent of total billed charges,
REPR SUPERF WND FACE 12.6-20,12016F,CDM,12016,CPT,510,RC,,,facility,both,,,323,228.68,Aetna First Health,Commercial,,274.55,85,,,143.15,274.55,percent of total billed charges,
CLOSURE SUPERF WND DEHIS SIMPLE,12020F,CDM,12020,CPT,510,RC,,,facility,both,,,824,583.39,Aetna First Health,Commercial,,700.4,85,,,365.2,700.4,percent of total billed charges,
"LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",12031F,CDM,12031,CPT,510,RC,,,facility,both,,,869,615.25,Aetna First Health,Commercial,,738.65,85,,,385.14,738.65,percent of total billed charges,
"LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5",12032F,CDM,12032,CPT,510,RC,,,facility,both,,,992,702.34,Aetna First Health,Commercial,,843.2,85,,,439.65,843.2,percent of total billed charges,
"LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5",12034F,CDM,12034,CPT,510,RC,,,facility,both,,,1152,815.62,Aetna First Health,Commercial,,979.2,85,,,510.57,979.2,percent of total billed charges,
"LAYR CLOS WND TRUNK,ARM,LEG 12.6-20",12035F,CDM,12035,CPT,510,RC,,,facility,both,,,700,495.6,Aetna First Health,Commercial,,595,85,,,310.24,595,percent of total billed charges,
"LAYR CLOS WND TRUNK,ARM,LEG 20.1-30",12036F,CDM,12036,CPT,510,RC,,,facility,both,,,749,530.29,Aetna First Health,Commercial,,636.65,85,,,331.96,636.65,percent of total billed charges,
"LAYR CLOS WND TRUNK,ARM,LEG >30CM",12037F,CDM,12037,CPT,510,RC,,,facility,both,,,2393,1694.24,Aetna First Health,Commercial,,2034.05,85,,,1060.58,2034.05,percent of total billed charges,
LAYR CLOS WND REST BODY <2.5CM,12041F,CDM,12041,CPT,510,RC,,,facility,both,,,791,560.03,Aetna First Health,Commercial,,672.35,85,,,350.57,672.35,percent of total billed charges,
LAYR CLOS WND REST BODY 2.6-7.5,12042F,CDM,12042,CPT,510,RC,,,facility,both,,,980,693.84,Aetna First Health,Commercial,,833,85,,,434.34,833,percent of total billed charges,
LAYR CLOS WND REST BODY 7.6-12.5,12044F,CDM,12044,CPT,510,RC,,,facility,both,,,846,598.97,Aetna First Health,Commercial,,719.1,85,,,374.95,719.1,percent of total billed charges,
LAYR CLOS WND REST BODY 12.6-20,12045F,CDM,12045,CPT,510,RC,,,facility,both,,,909,643.57,Aetna First Health,Commercial,,772.65,85,,,402.87,772.65,percent of total billed charges,
LAYR CLOS WND REST BODY 20.1-30,12046F,CDM,12046,CPT,510,RC,,,facility,both,,,488,345.5,Aetna First Health,Commercial,,414.8,85,,,216.28,414.8,percent of total billed charges,
"LAYR CLOS WND FACE,FACIAL <2.5CM",12051F,CDM,12051,CPT,510,RC,,,facility,both,,,838,593.3,Aetna First Health,Commercial,,712.3,85,,,371.4,712.3,percent of total billed charges,
"LAYR CLOS WND FACE,FACIAL 2.5-5",12052F,CDM,12052,CPT,510,RC,,,facility,both,,,863,611,Aetna First Health,Commercial,,733.55,85,,,382.48,733.55,percent of total billed charges,
"LAYR CLOS WND FACE,FACIAL 5.1-7.5",12053F,CDM,12053,CPT,510,RC,,,facility,both,,,920,651.36,Aetna First Health,Commercial,,782,85,,,407.74,782,percent of total billed charges,
"LAYR CLOS WND FACE,FACIAL 7.6-12.5",12054F,CDM,12054,CPT,510,RC,,,facility,both,,,996,705.17,Aetna First Health,Commercial,,846.6,85,,,441.43,846.6,percent of total billed charges,
"LAYR CLOS WND FACE,FACIAL 12.6-20",12055F,CDM,12055,CPT,510,RC,,,facility,both,,,488,345.5,Aetna First Health,Commercial,,414.8,85,,,216.28,414.8,percent of total billed charges,
REPR CMPL WND TRUNK 2.6-7.5CM,13101F,CDM,13101,CPT,510,RC,,,facility,both,,,769,544.45,Aetna First Health,Commercial,,653.65,85,,,340.82,653.65,percent of total billed charges,
"REP,SKIN,TRUNK,CMPLX,+5CM/<",13102F,CDM,13102,CPT,510,RC,,,facility,both,,,385,272.58,Aetna First Health,Commercial,,327.25,85,,,170.63,327.25,percent of total billed charges,
"REPR CMPL WND SCALP,EXTR 1.1-2.5",13120F,CDM,13120,CPT,510,RC,,,facility,both,,,769,544.45,Aetna First Health,Commercial,,653.65,85,,,340.82,653.65,percent of total billed charges,
"REPR CMPL WND SCALP,EXTR 2.6-7.5",13121F,CDM,13121,CPT,510,RC,,,facility,both,,,1530,1083.24,Aetna First Health,Commercial,,1300.5,85,,,678.1,1300.5,percent of total billed charges,
"REP,SKIN,SCALP/EXTREM+5CM/<",13122F,CDM,13122,CPT,510,RC,,,facility,both,,,190,134.52,Aetna First Health,Commercial,,161.5,85,,,84.21,161.5,percent of total billed charges,
"REPR CMPL WND HEAD,FAC,HAND 1.1-2.5",13131F,CDM,13131,CPT,510,RC,,,facility,both,,,721,510.47,Aetna First Health,Commercial,,612.85,85,,,319.55,612.85,percent of total billed charges,
"REPR CMPL WND HEAD,FAC,HAND 2.6-7.5",13132F,CDM,13132,CPT,510,RC,,,facility,both,,,850,601.8,Aetna First Health,Commercial,,722.5,85,,,376.72,722.5,percent of total billed charges,
"REP,FACE,GENITAL,HAND,FT+5CM/<",13133F,CDM,13133,CPT,510,RC,,,facility,both,,,803,568.52,Aetna First Health,Commercial,,682.55,85,,,355.89,682.55,percent of total billed charges,
"REPR CMPL WND LID,NOS,EAR 1.1-2.5",13151F,CDM,13151,CPT,510,RC,,,facility,both,,,833,589.76,Aetna First Health,Commercial,,708.05,85,,,369.19,708.05,percent of total billed charges,
"REPR CMPL WND LID,NOS,EAR 2.5-7.5",13152F,CDM,13152,CPT,510,RC,,,facility,both,,,2107,1491.76,Aetna First Health,Commercial,,1790.95,85,,,933.82,1790.95,percent of total billed charges,
"REP,EYELID,NOSE,EAR,LIP+5CM",13153F,CDM,13153,CPT,510,RC,,,facility,both,,,740,523.92,Aetna First Health,Commercial,,629,85,,,327.97,629,percent of total billed charges,
TRIMMING DYSTROPHIC NAILS,1352F,CDM,G0127,CPT,510,RC,,,facility,both,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
"ADJ TISS XFER HEAD,FAC,HAND <10SQCM",14040F,CDM,14040,CPT,510,RC,,,facility,both,,,3008,2129.66,Aetna First Health,Commercial,,2556.8,85,,,1333.15,2556.8,percent of total billed charges,
"FULL THICK GRFT NOS,EAR,LID<2",15260F,CDM,15260,CPT,510,RC,,,facility,both,,,2512,1778.5,Aetna First Health,Commercial,,2135.2,85,,,1113.32,2135.2,percent of total billed charges,
SKIN SUB GRAFT TRNK/ARM/LEG,15271F,CDM,15271,CPT,510,RC,,,facility,both,,,2380,1685.04,Aetna First Health,Commercial,,2023,85,,,1054.82,2023,percent of total billed charges,
SKIN SUB GRAFT FACE/NK/HF/G,15275F,CDM,15275,CPT,510,RC,,,facility,both,,,2380,1685.04,Aetna First Health,Commercial,,2023,85,,,1054.82,2023,percent of total billed charges,
INITIAL RX BURN(S) 1ST DEGREE,16000F,CDM,16000,CPT,510,RC,,,facility,both,,,290,205.32,Aetna First Health,Commercial,,246.5,85,,,128.53,246.5,percent of total billed charges,
DRESS/DEBRID SMALL BURN NO ANES,16020F,CDM,16020,CPT,510,RC,,,facility,both,,,363,257,Aetna First Health,Commercial,,308.55,85,,,160.88,308.55,percent of total billed charges,
DRESS/DEBRID MED BURN NO ANESTH,16025F,CDM,16025,CPT,510,RC,,,facility,both,,,337,238.6,Aetna First Health,Commercial,,286.45,85,,,149.36,286.45,percent of total billed charges,
DRESS/DEBRID LARGE BURN NO ANESTH,16030F,CDM,16030,CPT,510,RC,,,facility,both,,,449,317.89,Aetna First Health,Commercial,,381.65,85,,,199,381.65,percent of total billed charges,
"DESTRUCT BENIGN LESION, 1-14",17110F,CDM,17110,CPT,510,RC,,,facility,both,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
"DESTRUCT BENIGN LESION, 15+",17111F,CDM,17111,CPT,510,RC,,,facility,both,,,254,179.83,Aetna First Health,Commercial,,215.9,85,,,112.57,215.9,percent of total billed charges,
CHEM CAUTERY GRANULATN TISSUE,17250F,CDM,17250,CPT,510,RC,,,facility,both,,,303,214.52,Aetna First Health,Commercial,,257.55,85,,,134.29,257.55,percent of total billed charges,
PUNC/ASPIR BREAST CYST(T),19000F,CDM,19000,CPT,510,RC,,,facility,both,,,686,485.69,Aetna First Health,Commercial,,583.1,85,,,304.04,583.1,percent of total billed charges,
PUCT/ASPIR BRST CYST EAADDL(T),19001F,CDM,19001,CPT,510,RC,,,facility,both,,,350,247.8,Aetna First Health,Commercial,,297.5,85,,,155.12,297.5,percent of total billed charges,
INJECT DUCTOGRAM/GALACTOGRM(T),19030F,CDM,19030,CPT,510,RC,,,facility,both,,,142,100.54,Aetna First Health,Commercial,,120.7,85,,,62.93,120.7,percent of total billed charges,
BX BREAST 1ST LESION STRTCTC,19081F,CDM,19081,CPT,510,RC,,,facility,both,,,2781,1968.95,Aetna First Health,Commercial,,2363.85,85,,,1232.54,2363.85,percent of total billed charges,
BX BREAST ADD LESION STRTCTC,19082F,CDM,19082,CPT,510,RC,,,facility,both,,,1579,1117.93,Aetna First Health,Commercial,,1342.15,85,,,699.81,1342.15,percent of total billed charges,
BX BREAST 1ST LESION US IMAG,19083F,CDM,19083,CPT,510,RC,,,facility,both,,,2716,1922.93,Aetna First Health,Commercial,,2308.6,85,,,1203.73,2308.6,percent of total billed charges,
BX BREAST ADD LESION US IMAG,19084F,CDM,19084,CPT,510,RC,,,facility,both,,,1476,1045.01,Aetna First Health,Commercial,,1254.6,85,,,654.16,1254.6,percent of total billed charges,
BX BREAST 1ST LESION MR IMAG,19085F,CDM,19085,CPT,510,RC,,,facility,both,,,3552,2514.82,Aetna First Health,Commercial,,3019.2,85,,,1574.25,3019.2,percent of total billed charges,
PERQ DEVICE BREAST 1ST IMAG,19281F,CDM,19281,CPT,510,RC,,,facility,both,,,1671,1183.07,Aetna First Health,Commercial,,1420.35,85,,,740.59,1420.35,percent of total billed charges,
PERQ DEVICE BREAST EA IMAG,19282F,CDM,19282,CPT,510,RC,,,facility,both,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
PERQ DEV BREAST 1ST STRTCTC,19283F,CDM,19283,CPT,510,RC,,,facility,both,,,856,606.05,Aetna First Health,Commercial,,727.6,85,,,379.38,727.6,percent of total billed charges,
PERQ DEV BREAST ADD STRTCTC,19284F,CDM,19284,CPT,510,RC,,,facility,both,,,373,264.08,Aetna First Health,Commercial,,317.05,85,,,165.31,317.05,percent of total billed charges,
PERQ DEV BREAST 1ST US IMAG,19285F,CDM,19285,CPT,510,RC,,,facility,both,,,626,443.21,Aetna First Health,Commercial,,532.1,85,,,277.44,532.1,percent of total billed charges,
PERQ DEV BREAST ADD US IMAG,19286F,CDM,19286,CPT,510,RC,,,facility,both,,,197,139.48,Aetna First Health,Commercial,,167.45,85,,,87.31,167.45,percent of total billed charges,
"SIGMOIDOSCOPY,SCREEN PREV",2001F,CDM,45330,CPT,750,RC,,,facility,both,,,1715,1214.22,Aetna First Health,Commercial,,1457.75,85,,,760.09,1457.75,percent of total billed charges,
"COLONOSCOPY,FLEX,SCREEN",2002F,CDM,G0105,CPT,750,RC,,,facility,both,,,2731,1933.55,Aetna First Health,Commercial,,2321.35,85,,,1210.38,2321.35,percent of total billed charges,
"COLONOSCOPY,SCREEN PREV",2004F,CDM,G0121,CPT,750,RC,,,facility,both,,,2704,1914.43,Aetna First Health,Commercial,,2298.4,85,,,1198.41,2298.4,percent of total billed charges,
"EXPLORE WOUND,EXTREMITY",20103F,CDM,20103,CPT,510,RC,,,facility,both,,,911,644.99,Aetna First Health,Commercial,,774.35,85,,,403.76,774.35,percent of total billed charges,
DEEP MUSCLE BIOPSY,20205F,CDM,20205,CPT,510,RC,,,facility,both,,,2419,1712.65,Aetna First Health,Commercial,,2056.15,85,,,1072.1,2056.15,percent of total billed charges,
"NEEDLE BIOPSY,MUSCLE(T)",20206F,CDM,20206,CPT,510,RC,,,facility,both,,,1603,1134.92,Aetna First Health,Commercial,,1362.55,85,,,710.45,1362.55,percent of total billed charges,
"BONE BX,TROCAR/NDLE SUPERF(T)",20220F,CDM,20220,CPT,510,RC,,,facility,both,,,1748,1237.58,Aetna First Health,Commercial,,1485.8,85,,,774.71,1485.8,percent of total billed charges,
"BONE BX,TROCAR/NDLE DEEP(T)",20225F,CDM,20225,CPT,510,RC,,,facility,both,,,2593,1835.84,Aetna First Health,Commercial,,2204.05,85,,,1149.22,2204.05,percent of total billed charges,
INJ SINUS TRACT DX W XRAY(T),20501F,CDM,20501,CPT,510,RC,,,facility,both,,,387,274,Aetna First Health,Commercial,,328.95,85,,,171.52,328.95,percent of total billed charges,
INJ TENDON/LIGAMENT/CYST,20550F,CDM,20550,CPT,510,RC,,,facility,both,,,429,303.73,Aetna First Health,Commercial,,364.65,85,,,190.13,364.65,percent of total billed charges,
"INJ TRIGGER POINT, 1 OR 2(T)",20552F,CDM,20552,CPT,510,RC,,,facility,both,,,388,274.7,Aetna First Health,Commercial,,329.8,85,,,171.96,329.8,percent of total billed charges,
"INJECT TRIGGER POINTS,>3(T)",20553F,CDM,20553,CPT,510,RC,,,facility,both,,,356,252.05,Aetna First Health,Commercial,,302.6,85,,,157.78,302.6,percent of total billed charges,
NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES,20560F,CDM,20560,CPT,420,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,,28.05,85,,,14.63,28.05,percent of total billed charges,
NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES,20561F,CDM,20561,CPT,420,RC,,,facility,both,,,33,23.36,Aetna First Health,Commercial,,28.05,85,,,14.63,28.05,percent of total billed charges,
DRAIN/INJ SMALL JOINT/BURSA(T),20600F,CDM,20600,CPT,510,RC,,,facility,both,,,454,321.43,Aetna First Health,Commercial,,385.9,85,,,201.21,385.9,percent of total billed charges,
DRAIN/INJECT SM JOINT/BURSA W/ US GUIDE,20604F,CDM,20604,CPT,510,RC,,,facility,both,,,930,658.44,Aetna First Health,Commercial,,790.5,85,,,412.18,790.5,percent of total billed charges,
DRAIN/IN MEDIUM JOINT/BURSA(T),20605F,CDM,20605,CPT,510,RC,,,facility,both,,,401,283.91,Aetna First Health,Commercial,,340.85,85,,,177.72,340.85,percent of total billed charges,
DRAIN/INJECT MED JOINT/BRUSA W/US GUIDE,20606F,CDM,20606,CPT,510,RC,,,facility,both,,,930,658.44,Aetna First Health,Commercial,,790.5,85,,,412.18,790.5,percent of total billed charges,
DRAIN/INJ LARGE JOINT/BURSA(T),20610F,CDM,20610,CPT,510,RC,,,facility,both,,,408,288.86,Aetna First Health,Commercial,,346.8,85,,,180.83,346.8,percent of total billed charges,
DRAIN/INJECT LG JOINT/BRUSA W/US GUIDE,20611F,CDM,20611,CPT,510,RC,,,facility,both,,,1010,715.08,Aetna First Health,Commercial,,858.5,85,,,447.63,858.5,percent of total billed charges,
ASPIRATE/INJ GANGLION CYST,20612F,CDM,20612,CPT,510,RC,,,facility,both,,,380,269.04,Aetna First Health,Commercial,,323,85,,,168.42,323,percent of total billed charges,
"RECORD FLUID PRESSURE,MUSCLE",20950F,CDM,20950,CPT,510,RC,,,facility,both,,,899,636.49,Aetna First Health,Commercial,,764.15,85,,,398.44,764.15,percent of total billed charges,
REDUCE TEMPOROMANDIBL DISLOC,21480F,CDM,21480,CPT,510,RC,,,facility,both,,,273,193.28,Aetna First Health,Commercial,,232.05,85,,,120.99,232.05,percent of total billed charges,
BX SOFT TISSUE NECK/CHEST(T),21550F,CDM,21550,CPT,510,RC,,,facility,both,,,2313,1637.6,Aetna First Health,Commercial,,1966.05,85,,,1025.12,1966.05,percent of total billed charges,
CLOSED TREAT VERT BODY FRACT,22310F,CDM,22310,CPT,510,RC,,,facility,both,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC,22510F,CDM,22510,CPT,510,RC,,,facility,both,,,4385,3104.58,Aetna First Health,Commercial,,3727.25,85,,,1943.43,3727.25,percent of total billed charges,
PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL,22511F,CDM,22511,CPT,510,RC,,,facility,both,,,4385,3104.58,Aetna First Health,Commercial,,3727.25,85,,,1943.43,3727.25,percent of total billed charges,
VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL,22512F,CDM,22512,CPT,510,RC,,,facility,both,,,3688,2611.1,Aetna First Health,Commercial,,3134.8,85,,,1634.52,3134.8,percent of total billed charges,
INJ FOR SHOULDER ARTHROGRAM(T),23350F,CDM,23350,CPT,510,RC,,,facility,both,,,605,428.34,Aetna First Health,Commercial,,514.25,85,,,268.14,514.25,percent of total billed charges,
CLOSED RX CLAVICLE FRACTURE,23500F,CDM,23500,CPT,510,RC,,,facility,both,,,221,156.47,Aetna First Health,Commercial,,187.85,85,,,97.95,187.85,percent of total billed charges,
"CLOSED RX SCAPULA FX,MANIPULATN",23575F,CDM,23575,CPT,510,RC,,,facility,both,,,2113,1496,Aetna First Health,Commercial,,1796.05,85,,,936.48,1796.05,percent of total billed charges,
CLOSED RX PROX HUMERUS FRACTURE,23600F,CDM,23600,CPT,510,RC,,,facility,both,,,522,369.58,Aetna First Health,Commercial,,443.7,85,,,231.35,443.7,percent of total billed charges,
"CLOSED RX PROX HUMERUS FX,MANIP",23605F,CDM,23605,CPT,510,RC,,,facility,both,,,2636,1866.29,Aetna First Health,Commercial,,2240.6,85,,,1168.28,2240.6,percent of total billed charges,
"CLOSED RX GR TUBER HUM FX,MANIP",23625F,CDM,23625,CPT,510,RC,,,facility,both,,,2068,1464.14,Aetna First Health,Commercial,,1757.8,85,,,916.54,1757.8,percent of total billed charges,
CLOSED RX SHLDR DISLOCATION,23650F,CDM,23650,CPT,510,RC,,,facility,both,,,885,626.58,Aetna First Health,Commercial,,752.25,85,,,392.23,752.25,percent of total billed charges,
"CLOSED RX SHLDR DISLOC,ANESTHESIA",23655F,CDM,23655,CPT,510,RC,,,facility,both,,,1911,1352.99,Aetna First Health,Commercial,,1624.35,85,,,846.96,1624.35,percent of total billed charges,
"CLOSED RX SHLDR DISLOC,GR TUB FX",23665F,CDM,23665,CPT,510,RC,,,facility,both,,,479,339.13,Aetna First Health,Commercial,,407.15,85,,,212.29,407.15,percent of total billed charges,
INJ FOR ELBOW ARTHROGRAM(T),24220F,CDM,24220,CPT,510,RC,,,facility,both,,,394,278.95,Aetna First Health,Commercial,,334.9,85,,,174.62,334.9,percent of total billed charges,
CLOSED RX MID HUMERUS FRACTURE,24500F,CDM,24500,CPT,510,RC,,,facility,both,,,318,225.14,Aetna First Health,Commercial,,270.3,85,,,140.94,270.3,percent of total billed charges,
"CLOSED RX MID HUMERUS FX,MANIPULATN",24505F,CDM,24505,CPT,510,RC,,,facility,both,,,1820,1288.56,Aetna First Health,Commercial,,1547,85,,,806.62,1547,percent of total billed charges,
CLOSED RX HUMERAL SUPRACONDYLAR FX,24530F,CDM,24530,CPT,510,RC,,,facility,both,,,353,249.92,Aetna First Health,Commercial,,300.05,85,,,156.45,300.05,percent of total billed charges,
"CLOSED RX HUM SUPRACONDYLR FX,MANIPU",24535F,CDM,24535,CPT,510,RC,,,facility,both,,,1851,1310.51,Aetna First Health,Commercial,,1573.35,85,,,820.36,1573.35,percent of total billed charges,
PERCUT FIX HUM SUPRACONDYLAR FX,24538F,CDM,24538,CPT,510,RC,,,facility,both,,,8237,5831.8,Aetna First Health,Commercial,,7001.45,85,,,3650.64,7001.45,percent of total billed charges,
"CLOSED RX HUMER EPICONDYLR FX,MANIP",24565F,CDM,24565,CPT,510,RC,,,facility,both,,,1859,1316.17,Aetna First Health,Commercial,,1580.15,85,,,823.91,1580.15,percent of total billed charges,
CLOSED RX ELBOW DISLOCATION,24600F,CDM,24600,CPT,510,RC,,,facility,both,,,717,507.64,Aetna First Health,Commercial,,609.45,85,,,317.77,609.45,percent of total billed charges,
"CLOSED RX ELBOW DISLOCATN,ANESTHESIA",24605F,CDM,24605,CPT,510,RC,,,facility,both,,,1910,1352.28,Aetna First Health,Commercial,,1623.5,85,,,846.51,1623.5,percent of total billed charges,
CLOSED RX MONTEGGIA FX/DISLOC ELBOW,24620F,CDM,24620,CPT,510,RC,,,facility,both,,,2622,1856.38,Aetna First Health,Commercial,,2228.7,85,,,1162.07,2228.7,percent of total billed charges,
"CLOSED RX RADIAL HEAD DISLOC,CHILD",24640F,CDM,24640,CPT,510,RC,,,facility,both,,,417,295.24,Aetna First Health,Commercial,,354.45,85,,,184.81,354.45,percent of total billed charges,
"CLOSED RX RADIAL HEAD/NECK FX,MANIP",24655F,CDM,24655,CPT,510,RC,,,facility,both,,,2127,1505.92,Aetna First Health,Commercial,,1807.95,85,,,942.69,1807.95,percent of total billed charges,
CLOSED RX PROX ULNA FRACTURE,24670F,CDM,24670,CPT,510,RC,,,facility,both,,,206,145.85,Aetna First Health,Commercial,,175.1,85,,,91.3,175.1,percent of total billed charges,
"CLOSED RX PROX ULNA FX,MANIPULATN",24675F,CDM,24675,CPT,510,RC,,,facility,both,,,2209,1563.97,Aetna First Health,Commercial,,1877.65,85,,,979.03,1877.65,percent of total billed charges,
INJ FOR WRIST ARTHROGRAM(T),25246F,CDM,25246,CPT,510,RC,,,facility,both,,,456,322.85,Aetna First Health,Commercial,,387.6,85,,,202.1,387.6,percent of total billed charges,
CLOSED RX RADIAL SHAFT FX,25500F,CDM,25500,CPT,510,RC,,,facility,both,,,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
"CLOSED RX RADIAL SHAFT FX,MANIPULATN",25505F,CDM,25505,CPT,510,RC,,,facility,both,,,2116,1498.13,Aetna First Health,Commercial,,1798.6,85,,,937.81,1798.6,percent of total billed charges,
"CLOSED RX ULNA SHAFT FX,MANIPULATN",25535F,CDM,25535,CPT,510,RC,,,facility,both,,,344,243.55,Aetna First Health,Commercial,,292.4,85,,,152.46,292.4,percent of total billed charges,
CLOSED RX RAD/ULNA SHAFT FX,25560F,CDM,25560,CPT,510,RC,,,facility,both,,,188,133.1,Aetna First Health,Commercial,,159.8,85,,,83.32,159.8,percent of total billed charges,
"CLOSED RX RAD/ULNA SHAFT FX,MANIP",25565F,CDM,25565,CPT,510,RC,,,facility,both,,,2113,1496,Aetna First Health,Commercial,,1796.05,85,,,936.48,1796.05,percent of total billed charges,
CLOSED RX DIST RAD/ULNA FX,25600F,CDM,25600,CPT,510,RC,,,facility,both,,,468,331.34,Aetna First Health,Commercial,,397.8,85,,,207.42,397.8,percent of total billed charges,
"CLOSED RX DIST RAD/ULNA FX,MANIPUL",25605F,CDM,25605,CPT,510,RC,,,facility,both,,,1625,1150.5,Aetna First Health,Commercial,,1381.25,85,,,720.2,1381.25,percent of total billed charges,
CLOSED RX ULNA STYLOID FX,25650F,CDM,25650,CPT,510,RC,,,facility,both,,,329,232.93,Aetna First Health,Commercial,,279.65,85,,,145.81,279.65,percent of total billed charges,
"DRAIN FINGER ABSCESS,SIMPLE",26010F,CDM,26010,CPT,510,RC,,,facility,both,,,333,235.76,Aetna First Health,Commercial,,283.05,85,,,147.59,283.05,percent of total billed charges,
"DRAIN FINGER ABSCESS,COMPLICATED",26011F,CDM,26011,CPT,510,RC,,,facility,both,,,2124,1503.79,Aetna First Health,Commercial,,1805.4,85,,,941.36,1805.4,percent of total billed charges,
"FIX EXTEN TENDON,DORSUM HAND,EA",26410F,CDM,26410,CPT,510,RC,,,facility,both,,,1447,1024.48,Aetna First Health,Commercial,,1229.95,85,,,641.31,1229.95,percent of total billed charges,
"FIX EXTEN TENDON,DORSUM FINGR,EA",26418F,CDM,26418,CPT,510,RC,,,facility,both,,,1733,1226.96,Aetna First Health,Commercial,,1473.05,85,,,768.07,1473.05,percent of total billed charges,
CLOSED RX METACARPAL FX,26600F,CDM,26600,CPT,510,RC,,,facility,both,,,334,236.47,Aetna First Health,Commercial,,283.9,85,,,148.03,283.9,percent of total billed charges,
"CLOSED RX METACARPAL FX,MANIP",26605F,CDM,26605,CPT,510,RC,,,facility,both,,,623,441.08,Aetna First Health,Commercial,,529.55,85,,,276.11,529.55,percent of total billed charges,
"TREAT THUMB DISLOC,MANIPULATN",26641F,CDM,26641,CPT,510,RC,,,facility,both,,,333,235.76,Aetna First Health,Commercial,,283.05,85,,,147.59,283.05,percent of total billed charges,
CLOSED RX MC-P DISLOC,26700F,CDM,26700,CPT,510,RC,,,facility,both,,,522,369.58,Aetna First Health,Commercial,,443.7,85,,,231.35,443.7,percent of total billed charges,
CLOSE RX PROX/MID FING SHFT FX,26720F,CDM,26720,CPT,510,RC,,,facility,both,,,201,142.31,Aetna First Health,Commercial,,170.85,85,,,89.08,170.85,percent of total billed charges,
"CLOSE RX PROX/MID FING SHFT FX,MANIP",26725F,CDM,26725,CPT,510,RC,,,facility,both,,,572,404.98,Aetna First Health,Commercial,,486.2,85,,,253.51,486.2,percent of total billed charges,
CLOSE RX FINGR ARTICULAR FX,26740F,CDM,26740,CPT,510,RC,,,facility,both,,,341,241.43,Aetna First Health,Commercial,,289.85,85,,,151.13,289.85,percent of total billed charges,
"CLOSE RX FINGR ARTICULAR FX,MANIP",26742F,CDM,26742,CPT,510,RC,,,facility,both,,,2113,1496,Aetna First Health,Commercial,,1796.05,85,,,936.48,1796.05,percent of total billed charges,
CLOSE RX DIST FINGR FX,26750F,CDM,26750,CPT,510,RC,,,facility,both,,,324,229.39,Aetna First Health,Commercial,,275.4,85,,,143.6,275.4,percent of total billed charges,
"CLOSE RX DIST FINGR FX,MANIPULATN",26755F,CDM,26755,CPT,510,RC,,,facility,both,,,428,303.02,Aetna First Health,Commercial,,363.8,85,,,189.69,363.8,percent of total billed charges,
CLOSED RX IP JT DISLOCATION,26770F,CDM,26770,CPT,510,RC,,,facility,both,,,519,367.45,Aetna First Health,Commercial,,441.15,85,,,230.02,441.15,percent of total billed charges,
"CLOSED RX IP JT DISLOCATION,ANESTH",26775F,CDM,26775,CPT,510,RC,,,facility,both,,,534,378.07,Aetna First Health,Commercial,,453.9,85,,,236.67,453.9,percent of total billed charges,
AMPUTATION FINGER/THUMB,26951F,CDM,26951,CPT,510,RC,,,facility,both,,,2244,1588.75,Aetna First Health,Commercial,,1907.4,85,,,994.54,1907.4,percent of total billed charges,
AMPUTATION FINGER/THUMB+FLAPS,26952F,CDM,26952,CPT,510,RC,,,facility,both,,,4510,3193.08,Aetna First Health,Commercial,,3833.5,85,,,1998.83,3833.5,percent of total billed charges,
INJECTION HIP ARTHROGRAM(T),27093F,CDM,27093,CPT,510,RC,,,facility,both,,,235,166.38,Aetna First Health,Commercial,,199.75,85,,,104.15,199.75,percent of total billed charges,
"INJECTION,SACROILIAC JOINT(T)",27096F,CDM,27096,CPT,510,RC,,,facility,both,,,1544,1093.15,Aetna First Health,Commercial,,1312.4,85,,,684.3,1312.4,percent of total billed charges,
CLOSED RX TRAUMATIC HIP DISLOCATN,27250F,CDM,27250,CPT,510,RC,,,facility,both,,,482,341.26,Aetna First Health,Commercial,,409.7,85,,,213.62,409.7,percent of total billed charges,
"CLOSED RX SPONT HIP DISLOC,ANESTH",27257F,CDM,27257,CPT,510,RC,,,facility,both,,,1850,1309.8,Aetna First Health,Commercial,,1572.5,85,,,819.92,1572.5,percent of total billed charges,
CLOSED RX POST HIP ARTHRPLAS DISLOC,27265F,CDM,27265,CPT,510,RC,,,facility,both,,,622,440.38,Aetna First Health,Commercial,,528.7,85,,,275.67,528.7,percent of total billed charges,
"CLOSED RX POST HIP FIX DISLOC,ANESTH",27266F,CDM,27266,CPT,510,RC,,,facility,both,,,1685,1192.98,Aetna First Health,Commercial,,1432.25,85,,,746.79,1432.25,percent of total billed charges,
INJ FOR CONTRAST KNEE ARTHRO OR CONTRAST ENHANCE CT/MRI KNEE ARTHRO,27369F,CDM,27369,CPT,510,RC,,,facility,both,,,378,267.62,Aetna First Health,Commercial,,321.3,85,,,167.53,321.3,percent of total billed charges,
"FIX INFRAPATELLA TENDON,PRIMARY",27380F,CDM,27380,CPT,510,RC,,,facility,both,,,9500,6726,Aetna First Health,Commercial,,8075,85,,,4210.4,8075,percent of total billed charges,
"CLOSED RX FEMUR,DISTAL+MANIP",27510F,CDM,27510,CPT,510,RC,,,facility,both,,,2147,1520.08,Aetna First Health,Commercial,,1824.95,85,,,951.55,1824.95,percent of total billed charges,
CLOSED RX PATELLA FX,27520F,CDM,27520,CPT,510,RC,,,facility,both,,,333,235.76,Aetna First Health,Commercial,,283.05,85,,,147.59,283.05,percent of total billed charges,
CLOSED RX TIBIAL PLATEAU FX,27530F,CDM,27530,CPT,510,RC,,,facility,both,,,333,235.76,Aetna First Health,Commercial,,283.05,85,,,147.59,283.05,percent of total billed charges,
CLOSED RX KNEE DISLOCATN,27550F,CDM,27550,CPT,510,RC,,,facility,both,,,310,219.48,Aetna First Health,Commercial,,263.5,85,,,137.39,263.5,percent of total billed charges,
CLOSED RX KNEECAP DISLOCATN,27560F,CDM,27560,CPT,510,RC,,,facility,both,,,701,496.31,Aetna First Health,Commercial,,595.85,85,,,310.68,595.85,percent of total billed charges,
INCIS ACHILLES TENDON+LOCAL ANESTH,27605F,CDM,27605,CPT,510,RC,,,facility,both,,,2939,2080.81,Aetna First Health,Commercial,,2498.15,85,,,1302.56,2498.15,percent of total billed charges,
CLOSED RX TIBIA SHAFT FX,27750F,CDM,27750,CPT,510,RC,,,facility,both,,,336,237.89,Aetna First Health,Commercial,,285.6,85,,,148.92,285.6,percent of total billed charges,
"CLOSED RX TIBIA SHAFT FX,MANIPULATN",27752F,CDM,27752,CPT,510,RC,,,facility,both,,,2539,1797.61,Aetna First Health,Commercial,,2158.15,85,,,1125.28,2158.15,percent of total billed charges,
"CLOSED RX MED MALLEOLUS FX,MANIP",27762F,CDM,27762,CPT,510,RC,,,facility,both,,,2550,1805.4,Aetna First Health,Commercial,,2167.5,85,,,1130.16,2167.5,percent of total billed charges,
"CLOSED RX PROX/SHAFT FIB FX,MANIP",27781F,CDM,27781,CPT,510,RC,,,facility,both,,,2434,1723.27,Aetna First Health,Commercial,,2068.9,85,,,1078.75,2068.9,percent of total billed charges,
CLOSED RX DIST FIBULA FX,27786F,CDM,27786,CPT,510,RC,,,facility,both,,,225,159.3,Aetna First Health,Commercial,,191.25,85,,,99.72,191.25,percent of total billed charges,
"CLOSED RX DIST FIBULA FX,MANIP",27788F,CDM,27788,CPT,510,RC,,,facility,both,,,279,197.53,Aetna First Health,Commercial,,237.15,85,,,123.65,237.15,percent of total billed charges,
"CLOSED RX BIMALLEOLAR FX,MANIP",27810F,CDM,27810,CPT,510,RC,,,facility,both,,,1518,1074.74,Aetna First Health,Commercial,,1290.3,85,,,672.78,1290.3,percent of total billed charges,
OPEN RX BIMALLEOLAR FX,27814F,CDM,27814,CPT,510,RC,,,facility,both,,,8225,5823.3,Aetna First Health,Commercial,,6991.25,85,,,3645.32,6991.25,percent of total billed charges,
"CLOSED RX TRIMALLEOLAR FX,MANIP",27818F,CDM,27818,CPT,510,RC,,,facility,both,,,1742,1233.34,Aetna First Health,Commercial,,1480.7,85,,,772.05,1480.7,percent of total billed charges,
CLOSED RX WEIGHT BEAR DIST TIBIA,27824F,CDM,27824,CPT,510,RC,,,facility,both,,,305,215.94,Aetna First Health,Commercial,,259.25,85,,,135.18,259.25,percent of total billed charges,
"CLOSED RX WEIGHT BEAR DIST TIB,MANIP",27825F,CDM,27825,CPT,510,RC,,,facility,both,,,2147,1520.08,Aetna First Health,Commercial,,1824.95,85,,,951.55,1824.95,percent of total billed charges,
CLOSED RX ANKLE DISLOCATN,27840F,CDM,27840,CPT,510,RC,,,facility,both,,,543,384.44,Aetna First Health,Commercial,,461.55,85,,,240.66,461.55,percent of total billed charges,
"RESEC TOE AT I-P JT,SINGLE,EA",28160F,CDM,28160,CPT,510,RC,,,facility,both,,,4273,3025.28,Aetna First Health,Commercial,,3632.05,85,,,1893.79,3632.05,percent of total billed charges,
"REMV FOOT FOREIGN BODY,SUBCUTANEOUS",28190F,CDM,28190,CPT,510,RC,,,facility,both,,,1609,1139.17,Aetna First Health,Commercial,,1367.65,85,,,713.11,1367.65,percent of total billed charges,
"REMV FOOT FOREIGN BODY,DEEP",28192F,CDM,28192,CPT,510,RC,,,facility,both,,,2398,1697.78,Aetna First Health,Commercial,,2038.3,85,,,1062.79,2038.3,percent of total billed charges,
"REMV FOOT FOREIGN BODY,COMPLEX",28193F,CDM,28193,CPT,510,RC,,,facility,both,,,2398,1697.78,Aetna First Health,Commercial,,2038.3,85,,,1062.79,2038.3,percent of total billed charges,
"CLOSED RX TALUS FX,MANIPULATN",28435F,CDM,28435,CPT,510,RC,,,facility,both,,,947,670.48,Aetna First Health,Commercial,,804.95,85,,,419.71,804.95,percent of total billed charges,
"CLOSED RX METATARSAL FX,MANIP",28475F,CDM,28475,CPT,510,RC,,,facility,both,,,354,250.63,Aetna First Health,Commercial,,300.9,85,,,156.89,300.9,percent of total billed charges,
CLOSED RX BIG TOE FRACTURE,28490F,CDM,28490,CPT,510,RC,,,facility,both,,,241,170.63,Aetna First Health,Commercial,,204.85,85,,,106.81,204.85,percent of total billed charges,
"CLOSED RX BIG TOE FX,MANIP",28495F,CDM,28495,CPT,510,RC,,,facility,both,,,235,166.38,Aetna First Health,Commercial,,199.75,85,,,104.15,199.75,percent of total billed charges,
CLOSED RX TOE FX,28510F,CDM,28510,CPT,510,RC,,,facility,both,,,230,162.84,Aetna First Health,Commercial,,195.5,85,,,101.94,195.5,percent of total billed charges,
"CLOSED RX TOE FX,MANIPULATN",28515F,CDM,28515,CPT,510,RC,,,facility,both,,,351,248.51,Aetna First Health,Commercial,,298.35,85,,,155.56,298.35,percent of total billed charges,
CLOSED RX MT-PHAL TOE DISLOCATION,28630F,CDM,28630,CPT,510,RC,,,facility,both,,,342,242.14,Aetna First Health,Commercial,,290.7,85,,,151.57,290.7,percent of total billed charges,
"CLOSED RX I-P JT,TOE DISLOCATION",28660F,CDM,28660,CPT,510,RC,,,facility,both,,,446,315.77,Aetna First Health,Commercial,,379.1,85,,,197.67,379.1,percent of total billed charges,
APPLY LONG ARM CAST,29065F,CDM,29065,CPT,510,RC,,,facility,both,,,259,183.37,Aetna First Health,Commercial,,220.15,85,,,114.79,220.15,percent of total billed charges,
APPLY FOREARM CAST,29075F,CDM,29075,CPT,510,RC,,,facility,both,,,259,183.37,Aetna First Health,Commercial,,220.15,85,,,114.79,220.15,percent of total billed charges,
APPLY LONG ARM SPLINT,29105F,CDM,29105,CPT,510,RC,,,facility,both,,,348,246.38,Aetna First Health,Commercial,,295.8,85,,,154.23,295.8,percent of total billed charges,
"APPLY FOREARM SPLINT,STATIC",29125F,CDM,29125,CPT,510,RC,,,facility,both,,,298,210.98,Aetna First Health,Commercial,,253.3,85,,,132.07,253.3,percent of total billed charges,
"APPLY FOREARM SPLINT, DYNAMIC",29126F,CDM,29126,CPT,420,RC,,,facility,both,,,155,109.74,Aetna First Health,Commercial,,131.75,85,,,68.7,131.75,percent of total billed charges,
"APPLY FINGER SPLINT,STATIC",29130F,CDM,29130,CPT,420,RC,,,facility,both,,,297,210.28,Aetna First Health,Commercial,,252.45,85,,,131.63,252.45,percent of total billed charges,
"APPLY FINGER SPLINT,DYNAMIC",29131F,CDM,29131,CPT,420,RC,,,facility,both,,,92,65.14,Aetna First Health,Commercial,,78.2,85,,,40.77,78.2,percent of total billed charges,
STRAPPING OF HAND OR FINGER,29280F,CDM,29280,CPT,420,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
APPLY LONG LEG CAST,29345F,CDM,29345,CPT,510,RC,,,facility,both,,,404,286.03,Aetna First Health,Commercial,,343.4,85,,,179.05,343.4,percent of total billed charges,
APPLY SHORT LEG CAST,29405F,CDM,29405,CPT,510,RC,,,facility,both,,,203,143.72,Aetna First Health,Commercial,,172.55,85,,,89.97,172.55,percent of total billed charges,
APPLY LONG LEG SPLINT,29505F,CDM,29505,CPT,510,RC,,,facility,both,,,427,302.32,Aetna First Health,Commercial,,362.95,85,,,189.25,362.95,percent of total billed charges,
APPLY LOWER LEG SPLINT,29515F,CDM,29515,CPT,510,RC,,,facility,both,,,320,226.56,Aetna First Health,Commercial,,272,85,,,141.82,272,percent of total billed charges,
APPLY OF PASTE BOOT,29580F,CDM,29580,CPT,510,RC,,,facility,both,,,191,135.23,Aetna First Health,Commercial,,162.35,85,,,84.65,162.35,percent of total billed charges,
APPLY MULTLAY COMPRS LWR LEG,29581F,CDM,29581,CPT,510,RC,,,facility,both,,,242,171.34,Aetna First Health,Commercial,,205.7,85,,,107.25,205.7,percent of total billed charges,
REMV/REVISN BOOT/BODY CAST,29700F,CDM,29700,CPT,510,RC,,,facility,both,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
REMV/REVISN FULL ARM/LEG CAST,29705F,CDM,29705,CPT,510,RC,,,facility,both,,,330,233.64,Aetna First Health,Commercial,,280.5,85,,,146.26,280.5,percent of total billed charges,
REMOVE NASAL FOREIGN BODY,30300F,CDM,30300,CPT,510,RC,,,facility,both,,,151,106.91,Aetna First Health,Commercial,,128.35,85,,,66.92,128.35,percent of total billed charges,
"REMV NASAL FOR BODY,LAT RHINOTOMY",30320F,CDM,30320,CPT,510,RC,,,facility,both,,,1726,1222.01,Aetna First Health,Commercial,,1467.1,85,,,764.96,1467.1,percent of total billed charges,
"CTRL NOSEBLEED,ANTER,SIMPLE",30901F,CDM,30901,CPT,510,RC,,,facility,both,,,373,264.08,Aetna First Health,Commercial,,317.05,85,,,165.31,317.05,percent of total billed charges,
"CTRL NOSEBLEED,ANTER,COMPLEX",30903F,CDM,30903,CPT,510,RC,,,facility,both,,,422,298.78,Aetna First Health,Commercial,,358.7,85,,,187.03,358.7,percent of total billed charges,
"CTRL NOSEBLEED,POSTER,INITIAL",30905F,CDM,30905,CPT,510,RC,,,facility,both,,,575,407.1,Aetna First Health,Commercial,,488.75,85,,,254.84,488.75,percent of total billed charges,
REPEAT CONTROL OF NOSEBLEED,30906F,CDM,30906,CPT,510,RC,,,facility,both,,,498,352.58,Aetna First Health,Commercial,,423.3,85,,,220.71,423.3,percent of total billed charges,
"NASAL ENDOSCOPY,DX",31231F,CDM,31231,CPT,510,RC,,,facility,both,,,214,151.51,Aetna First Health,Commercial,,181.9,85,,,94.84,181.9,percent of total billed charges,
"NASAL/SINUS SCOPY,CTRL BLEED",31238F,CDM,31238,CPT,510,RC,,,facility,both,,,2957,2093.56,Aetna First Health,Commercial,,2513.45,85,,,1310.54,2513.45,percent of total billed charges,
INSERT EMERGENCY ENDOTRACH AIRWAY,31500F,CDM,31500,CPT,510,RC,,,facility,both,,,794,562.15,Aetna First Health,Commercial,,674.9,85,,,351.9,674.9,percent of total billed charges,
TRACH TUBE CHANGE,31502F,CDM,31502,CPT,510,RC,,,facility,both,,,313,221.6,Aetna First Health,Commercial,,266.05,85,,,138.72,266.05,percent of total billed charges,
"LARYNGOSCOPY,INDIRECT,DX",31505F,CDM,31505,CPT,510,RC,,,facility,both,,,218,154.34,Aetna First Health,Commercial,,185.3,85,,,96.62,185.3,percent of total billed charges,
"LARYNGOSCOPY,DIRECT,DIAGNOSTIC",31525F,CDM,31525,CPT,510,RC,,,facility,both,,,2275,1610.7,Aetna First Health,Commercial,,1933.75,85,,,1008.28,1933.75,percent of total billed charges,
"LARYNGOSCOPY,DIRECT,DX,OP MICROSCOP",31526F,CDM,31526,CPT,510,RC,,,facility,both,,,5903,4179.32,Aetna First Health,Commercial,,5017.55,85,,,2616.21,5017.55,percent of total billed charges,
"LARYNGOSCOPY,FLEXIBLE,DIAGNOSTIC",31575F,CDM,31575,CPT,510,RC,,,facility,both,,,387,274,Aetna First Health,Commercial,,328.95,85,,,171.52,328.95,percent of total billed charges,
"LARYNGOSCOPY,FLEXIBLE W/REMV OF F.B.",31577F,CDM,31577,CPT,510,RC,,,facility,both,,,761,538.79,Aetna First Health,Commercial,,646.85,85,,,337.28,646.85,percent of total billed charges,
"TRACHEOSTOMY, PLANNED",31600F,CDM,31600,CPT,510,RC,,,facility,both,,,4357,3084.76,Aetna First Health,Commercial,,3703.45,85,,,1931.02,3703.45,percent of total billed charges,
SCOPE THRU TRACHEOSTOMY,31615F,CDM,31615,CPT,360,RC,,,facility,both,,,569,402.85,Aetna First Health,Commercial,,483.65,85,,,252.18,483.65,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC",31622F,CDM,31622,CPT,360,RC,,,facility,both,,,2886,2043.29,Aetna First Health,Commercial,,2453.1,85,,,1279.08,2453.1,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC W BRUSH",31623F,CDM,31623,CPT,360,RC,,,facility,both,,,3443,2437.64,Aetna First Health,Commercial,,2926.55,85,,,1525.94,2926.55,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC W LAVAGE",31624F,CDM,31624,CPT,761,RC,,,facility,both,,,3280,2322.24,Aetna First Health,Commercial,,2788,85,,,1453.7,2788,percent of total billed charges,
"BRONCHOSCOPY,BIOPSY",31625F,CDM,31625,CPT,360,RC,,,facility,both,,,3029,2144.53,Aetna First Health,Commercial,,2574.65,85,,,1342.45,2574.65,percent of total billed charges,
BRONCHOSCOPY W/MARKERS,31626F,CDM,31626,CPT,360,RC,,,facility,both,,,5594,3960.55,Aetna First Health,Commercial,,4754.9,85,,,2479.26,4754.9,percent of total billed charges,
NAVIGATIONAL BRONCHOSCOPY,31627F,CDM,31627,CPT,510,RC,,,facility,both,,,1866,1321.13,Aetna First Health,Commercial,,1586.1,85,,,827.01,1586.1,percent of total billed charges,
"BRONCHOSCOPY,TRANSBRONCH BIOPSY",31628F,CDM,31628,CPT,360,RC,,,facility,both,,,2741,1940.63,Aetna First Health,Commercial,,2329.85,85,,,1214.81,2329.85,percent of total billed charges,
"BRONCHOSCOPY,TRANSBRON ASPIR BX",31629F,CDM,31629,CPT,510,RC,,,facility,both,,,3762,2663.5,Aetna First Health,Commercial,,3197.7,85,,,1667.32,3197.7,percent of total billed charges,
"BRONCHOSCOPY TRANSBRONCHIAL LUNG BIOPSY, ADDITIONAL LOBE",31632F,CDM,31632,CPT,360,RC,,,facility,both,,,442,312.94,Aetna First Health,Commercial,,375.7,85,,,195.89,375.7,percent of total billed charges,
"BRONCHOSCOPY,REMV FOR. BODY",31635F,CDM,31635,CPT,360,RC,,,facility,both,,,2453,1736.72,Aetna First Health,Commercial,,2085.05,85,,,1087.17,2085.05,percent of total billed charges,
"BRONCHOSCOPY,RX ASPIR PULM TREE",31645F,CDM,31645,CPT,761,RC,,,facility,both,,,2558,1811.06,Aetna First Health,Commercial,,2174.3,85,,,1133.71,2174.3,percent of total billed charges,
BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX,31652F,CDM,31652,CPT,510,RC,,,facility,both,,,4582,3244.06,Aetna First Health,Commercial,,3894.7,85,,,2030.74,3894.7,percent of total billed charges,
BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES,31654F,CDM,31654,CPT,510,RC,,,facility,both,,,553,391.52,Aetna First Health,Commercial,,470.05,85,,,245.09,470.05,percent of total billed charges,
"CATHETER ASPIRATN,NASOTRACH",31720F,CDM,31720,CPT,510,RC,,,facility,both,,,263,186.2,Aetna First Health,Commercial,,223.55,85,,,116.56,223.55,percent of total billed charges,
NEEDLE BIOPSY PLEURA(T),32400F,CDM,32400,CPT,510,RC,,,facility,both,,,1082,766.06,Aetna First Health,Commercial,,919.7,85,,,479.54,919.7,percent of total billed charges,
"PERCUT BX, LUNG/MEDIASTINUM W GUIDE",32408F,CDM,32408,CPT,761,RC,,,facility,both,,,2298,1626.98,Aetna First Health,Commercial,,1953.3,85,,,1018.47,1953.3,percent of total billed charges,
TUBE THORACOSTOMY INC WTR SEAL,32551F,CDM,32551,CPT,510,RC,,,facility,both,,,1194,845.35,Aetna First Health,Commercial,,1014.9,85,,,529.18,1014.9,percent of total billed charges,
ASPIRATE PLEURA W/O IMAGING,32554F,CDM,32554,CPT,510,RC,,,facility,both,,,751,531.71,Aetna First Health,Commercial,,638.35,85,,,332.84,638.35,percent of total billed charges,
ASPIRATE PLEURA W/ IMAGING,32555F,CDM,32555,CPT,761,RC,,,facility,both,,,1190,842.52,Aetna First Health,Commercial,,1011.5,85,,,527.41,1011.5,percent of total billed charges,
INSERT CATH PLEURA W/O IMAGE,32556F,CDM,32556,CPT,510,RC,,,facility,both,,,2225,1575.3,Aetna First Health,Commercial,,1891.25,85,,,986.12,1891.25,percent of total billed charges,
INSERT CATH PLEURA W/ IMAGE,32557F,CDM,32557,CPT,510,RC,,,facility,both,,,819,579.85,Aetna First Health,Commercial,,696.15,85,,,362.98,696.15,percent of total billed charges,
CHEMICAL PLEURODESIS,32560F,CDM,32560,CPT,510,RC,,,facility,both,,,887,628,Aetna First Health,Commercial,,753.95,85,,,393.12,753.95,percent of total billed charges,
PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED,33016F,CDM,33016,CPT,481,RC,,,facility,both,,,2731,1933.55,Aetna First Health,Commercial,,2321.35,85,,,1210.38,2321.35,percent of total billed charges,
PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY,33017F,CDM,33017,CPT,481,RC,,,facility,both,,,3277,2320.12,Aetna First Health,Commercial,,2785.45,85,,,1452.37,2785.45,percent of total billed charges,
INSER HEART TEMP PACER ONE CHMBR,33210F,CDM,33210,CPT,480,RC,,,facility,both,,,9267,6561.04,Aetna First Health,Commercial,,7876.95,85,,,4107.13,7876.95,percent of total billed charges,
INSERT CARDIAC RHYTHM MONITOR,33285F,CDM,33285,CPT,480,RC,,,facility,both,,,9212,6522.1,Aetna First Health,Commercial,,7830.2,85,,,4082.76,7830.2,percent of total billed charges,
INSERT IA PERCUT DEVICE,33967F,CDM,33967,CPT,480,RC,,,facility,both,,,1589,1125.01,Aetna First Health,Commercial,,1350.65,85,,,704.24,1350.65,percent of total billed charges,
RMV AORTIC BALLOON DEVICE,33968F,CDM,33968,CPT,480,RC,,,facility,both,,,300,212.4,Aetna First Health,Commercial,,255,85,,,132.96,255,percent of total billed charges,
ENDOVASC REP AORTA/ILIAC NOT RUPT BIL,34705F,CDM,34705,CPT,360,RC,,,facility,both,,,10641,7533.83,Aetna First Health,Commercial,,9044.85,85,,,4716.09,9044.85,percent of total billed charges,
PERC ACCESS/CLSR FEM ART,34713F,CDM,34713,CPT,360,RC,,,facility,both,,,3008,2129.66,Aetna First Health,Commercial,,2556.8,85,,,1333.15,2556.8,percent of total billed charges,
PLACE NEEDLE IN VEIN(T),36000F,CDM,36000,CPT,510,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,,52.7,85,,,27.48,52.7,percent of total billed charges,
PSEUDOANEURYSM INJECTION TRT,36002F,CDM,36002,CPT,510,RC,,,facility,both,,,843,596.84,Aetna First Health,Commercial,,716.55,85,,,373.62,716.55,percent of total billed charges,
"INJECTION, VENOGRAPHY(T)",36005F,CDM,36005,CPT,510,RC,,,facility,both,,,403,285.32,Aetna First Health,Commercial,,342.55,85,,,178.61,342.55,percent of total billed charges,
"PLACE CATH IN VEIN,SVC,IVC(T)",36010F,CDM,36010,CPT,510,RC,,,facility,both,,,802,567.82,Aetna First Health,Commercial,,681.7,85,,,355.45,681.7,percent of total billed charges,
PLACE CATH EXTREM ARTERY(T),36140F,CDM,36140,CPT,510,RC,,,facility,both,,,585,414.18,Aetna First Health,Commercial,,497.25,85,,,259.27,497.25,percent of total billed charges,
PLACE CATH AORTA(T),36200F,CDM,36200,CPT,480,RC,,,facility,both,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
"PLC CATH SELECTIVE ART,NECK(T)",36215F,CDM,36215,CPT,510,RC,,,facility,both,,,1605,1136.34,Aetna First Health,Commercial,,1364.25,85,,,711.34,1364.25,percent of total billed charges,
"PLC CATH SUBSELECT ART,NECK(T)",36216F,CDM,36216,CPT,510,RC,,,facility,both,,,1484,1050.67,Aetna First Health,Commercial,,1261.4,85,,,657.71,1261.4,percent of total billed charges,
PLC CATH SUBSUBSLCT ARTNECK(T),36217F,CDM,36217,CPT,510,RC,,,facility,both,,,2102,1488.22,Aetna First Health,Commercial,,1786.7,85,,,931.61,1786.7,percent of total billed charges,
PLC CATH ADDLSUBSLC ARTNECK(T),36218F,CDM,36218,CPT,510,RC,,,facility,both,,,746,528.17,Aetna First Health,Commercial,,634.1,85,,,330.63,634.1,percent of total billed charges,
"PLC CATH SELECT ART,ABD/PEL(T)",36245F,CDM,36245,CPT,480,RC,,,facility,both,,,2033,1439.36,Aetna First Health,Commercial,,1728.05,85,,,901.03,1728.05,percent of total billed charges,
PLC CATH SUBSLCT ARTABD/PEL(T),36246F,CDM,36246,CPT,360,RC,,,facility,both,,,2232,1580.26,Aetna First Health,Commercial,,1897.2,85,,,989.22,1897.2,percent of total billed charges,
PLC CATH SUBSUBS ARTABD/PEL(T),36247F,CDM,36247,CPT,480,RC,,,facility,both,,,3723,2635.88,Aetna First Health,Commercial,,3164.55,85,,,1650.03,3164.55,percent of total billed charges,
PLC CATH ADDL SUBARTABD/PEL(T),36248F,CDM,36248,CPT,510,RC,,,facility,both,,,726,514.01,Aetna First Health,Commercial,,617.1,85,,,321.76,617.1,percent of total billed charges,
INS CATH REN ART 1ST UNILAT(T),36251F,CDM,36251,CPT,360,RC,,,facility,both,,,4908,3474.86,Aetna First Health,Commercial,,4171.8,85,,,2175.23,4171.8,percent of total billed charges,
INS CATH REN ART 1ST BILAT(T),36252F,CDM,36252,CPT,360,RC,,,facility,both,,,4908,3474.86,Aetna First Health,Commercial,,4171.8,85,,,2175.23,4171.8,percent of total billed charges,
INS CATH REN ART 2ND+ UNILAT(T),36253F,CDM,36253,CPT,360,RC,,,facility,both,,,4128,2922.62,Aetna First Health,Commercial,,3508.8,85,,,1829.53,3508.8,percent of total billed charges,
"VENIPUNCTURE BY PHYSICIAN, SCALP VEIN, UNDER AGE 3 YEARS",36405F,CDM,36405,CPT,510,RC,,,facility,both,,,67,47.44,Aetna First Health,Commercial,,56.95,85,,,29.69,56.95,percent of total billed charges,
"VENIPUNCTURE BY PHYSICIAN, OTHER VEIN, UNDER AGE 3 YEARS",36406F,CDM,36406,CPT,510,RC,,,facility,both,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
VENIPNC W PHYS SKILLDX/RX(T),36410F,CDM,36410,CPT,510,RC,,,facility,both,,,180,127.44,Aetna First Health,Commercial,,153,85,,,79.78,153,percent of total billed charges,
COMMUNITY PARAMEDIC VENIPUNCTURE,36415CP,CDM,36415,CPT,300,RC,,,facility,both,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
"CATH, VEIN UMBILICAL NEWBORN",36510F,CDM,36510,CPT,510,RC,,,facility,both,,,373,264.08,Aetna First Health,Commercial,,317.05,85,,,165.31,317.05,percent of total billed charges,
INSERT NON-TUNNEL CV CATHETER <5 YEARS,36555F,CDM,36555,CPT,510,RC,,,facility,both,,,1470,1040.76,Aetna First Health,Commercial,,1249.5,85,,,651.5,1249.5,percent of total billed charges,
INSERT NON-TUNNEL CV CATHETER >5 YEARS,36556F,CDM,36556,CPT,510,RC,,,facility,both,,,2460,1741.68,Aetna First Health,Commercial,,2091,85,,,1090.27,2091,percent of total billed charges,
INSERT TUNNEL CV CATHETER WITHOUT PUMP/PORT>5 YEARS,36558F,CDM,36558,CPT,510,RC,,,facility,both,,,3309,2342.77,Aetna First Health,Commercial,,2812.65,85,,,1466.55,2812.65,percent of total billed charges,
"PERI/INST CVCATH WO P/P, WO IMAGE GUIDE  <5YR(P)",36568F,CDM,36568,CPT,510,RC,,,facility,both,,,1836,1299.89,Aetna First Health,Commercial,,1560.6,85,,,813.72,1560.6,percent of total billed charges,
"PERI/INST CVCATH WO P/P, WO IMAGE GUIDE  >5YR(P)",36569F,CDM,36569,CPT,510,RC,,,facility,both,,,2299,1627.69,Aetna First Health,Commercial,,1954.15,85,,,1018.92,1954.15,percent of total billed charges,
INSERT PICC INCL IMAGE W/O SUBQ PORT/PUMP <5YRS,36572F,CDM,36572,CPT,761,RC,,,facility,both,,,818,579.14,Aetna First Health,Commercial,,695.3,85,,,362.54,695.3,percent of total billed charges,
INSERT PICC INCL IMAGE W/O SUBQ PORT/PUMP 5YRS/OLDER,36573F,CDM,36573,CPT,761,RC,,,facility,both,,,2297,1626.28,Aetna First Health,Commercial,,1952.45,85,,,1018.03,1952.45,percent of total billed charges,
REPAIR CV ACCESS CATHETER WITHOUT PORT/PUMP,36575F,CDM,36575,CPT,510,RC,,,facility,both,,,894,632.95,Aetna First Health,Commercial,,759.9,85,,,396.22,759.9,percent of total billed charges,
REPAIR CENTRAL VENOUS ACCESS DEVICE WITH PORT/PUMP,36576F,CDM,36576,CPT,510,RC,,,facility,both,,,1796,1271.57,Aetna First Health,Commercial,,1526.6,85,,,795.99,1526.6,percent of total billed charges,
"REMOVAL OF TUNNEL CV ACCESS DEVICE, WITH PORT/PUMP",36590F,CDM,36590,CPT,510,RC,,,facility,both,,,1024,724.99,Aetna First Health,Commercial,,870.4,85,,,453.84,870.4,percent of total billed charges,
DRAW BLOOD OFF VENOUS DEVICE,36591F,CDM,36591,CPT,510,RC,,,facility,both,,,143,101.24,Aetna First Health,Commercial,,121.55,85,,,63.38,121.55,percent of total billed charges,
COLLECT BLOOD FROM PICC,36592F,CDM,36592,CPT,510,RC,,,facility,both,,,133,94.16,Aetna First Health,Commercial,,113.05,85,,,58.95,113.05,percent of total billed charges,
DECLOT VASCULAR ACCESS DEVICE,36593F,CDM,36593,CPT,510,RC,,,facility,both,,,503,356.12,Aetna First Health,Commercial,,427.55,85,,,222.93,427.55,percent of total billed charges,
"EVAL CV DEVICE, INJ W/FLUO(T)",36598F,CDM,36598,CPT,761,RC,,,facility,both,,,752,532.42,Aetna First Health,Commercial,,639.2,85,,,333.29,639.2,percent of total billed charges,
WITHDRAWAL OF ARTERIAL BLOOD,36600F,CDM,36600,CPT,510,RC,,,facility,both,,,145,102.66,Aetna First Health,Commercial,,123.25,85,,,64.26,123.25,percent of total billed charges,
"INSERT CATH,ART,PERCUT,SHORTTERM",36620F,CDM,36620,CPT,510,RC,,,facility,both,,,220,155.76,Aetna First Health,Commercial,,187,85,,,97.5,187,percent of total billed charges,
"CATH, UMBILICAL ARTERY",36660F,CDM,36660,CPT,761,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
"INSERT NEEDLE,INTRAOSSEOUS INFUSN",36680F,CDM,36680,CPT,510,RC,,,facility,both,,,332,235.06,Aetna First Health,Commercial,,282.2,85,,,147.14,282.2,percent of total billed charges,
"PRIMARY ARTERIAL MECHANICAL THROMBECTOMY, INITIAL VESSEL",37184F,CDM,37184,CPT,510,RC,,,facility,both,,,4545,3217.86,Aetna First Health,Commercial,,3863.25,85,,,2014.34,3863.25,percent of total billed charges,
"PRIMARY ARTERIAL MECHANICAL THROMBECTOMY, 2ND + VESSEL",37185F,CDM,37185,CPT,510,RC,,,facility,both,,,5121,3625.67,Aetna First Health,Commercial,,4352.85,85,,,2269.63,4352.85,percent of total billed charges,
SECONDARY ARTERIAL MECHANICAL THROMBECTOMY ADD-ON,37186F,CDM,37186,CPT,510,RC,,,facility,both,,,4444,3146.35,Aetna First Health,Commercial,,3777.4,85,,,1969.58,3777.4,percent of total billed charges,
INS ENDOVAS VENA CAVA FILTR(T),37191F,CDM,37191,CPT,360,RC,,,facility,both,,,9746,6900.17,Aetna First Health,Commercial,,8284.1,85,,,4319.43,8284.1,percent of total billed charges,
REM ENDOVAS VENA CAVA FILTER(T),37193F,CDM,37193,CPT,360,RC,,,facility,both,,,6102,4320.22,Aetna First Health,Commercial,,5186.7,85,,,2704.41,5186.7,percent of total billed charges,
REMOVE INTRVAS FOREIGN BODY,37197F,CDM,37197,CPT,360,RC,,,facility,both,,,6285,4449.78,Aetna First Health,Commercial,,5342.25,85,,,2785.51,5342.25,percent of total billed charges,
REVAS ENDO ILIAC UNI INITIAL,37220F,CDM,37220,CPT,761,RC,,,facility,both,,,11997,8493.88,Aetna First Health,Commercial,,10197.45,85,,,5317.07,10197.45,percent of total billed charges,
ILIAC REVASC WITH STENT,37221F,CDM,37221,CPT,480,RC,,,facility,both,,,17239,12205.21,Aetna First Health,Commercial,,14653.15,85,,,7640.32,14653.15,percent of total billed charges,
ILIAC REVASC ADD ON,37222F,CDM,37222,CPT,761,RC,,,facility,both,,,5727,4054.72,Aetna First Health,Commercial,,4867.95,85,,,2538.21,4867.95,percent of total billed charges,
ILIAC REVASC WITH STENT ADD ON,37223F,CDM,37223,CPT,761,RC,,,facility,both,,,8040,5692.32,Aetna First Health,Commercial,,6834,85,,,3563.33,6834,percent of total billed charges,
FEM/POPL REVAS W/TLA,37224F,CDM,37224,CPT,480,RC,,,facility,both,,,6194,4385.35,Aetna First Health,Commercial,,5264.9,85,,,2745.18,5264.9,percent of total billed charges,
FEM/POPL REVAS W/ATHER,37225F,CDM,37225,CPT,761,RC,,,facility,both,,,11118,7871.54,Aetna First Health,Commercial,,9450.3,85,,,4927.5,9450.3,percent of total billed charges,
FEM/POPL REVAS W/STENT,37226F,CDM,37226,CPT,480,RC,,,facility,both,,,23038,16310.9,Aetna First Health,Commercial,,19582.3,85,,,10210.44,19582.3,percent of total billed charges,
FEM/POPL REVASC STNT & ATHER,37227F,CDM,37227,CPT,761,RC,,,facility,both,,,19063,13496.6,Aetna First Health,Commercial,,16203.55,85,,,8448.72,16203.55,percent of total billed charges,
TIB/PER REVASC W/TLA,37228F,CDM,37228,CPT,480,RC,,,facility,both,,,16476,11665.01,Aetna First Health,Commercial,,14004.6,85,,,7302.16,14004.6,percent of total billed charges,
TIB/PER REVASC W/ATHER,37229F,CDM,37229,CPT,761,RC,,,facility,both,,,11009,7794.37,Aetna First Health,Commercial,,9357.65,85,,,4879.19,9357.65,percent of total billed charges,
TIB/PER REVASC W/STENT,37230F,CDM,37230,CPT,761,RC,,,facility,both,,,18149,12849.49,Aetna First Health,Commercial,,15426.65,85,,,8043.64,15426.65,percent of total billed charges,
TIB/PER REVASC ADD-ON,37232F,CDM,37232,CPT,761,RC,,,facility,both,,,11490,8134.92,Aetna First Health,Commercial,,9766.5,85,,,5092.37,9766.5,percent of total billed charges,
OPEN/PERQ PLACE STENT 1ST,37236F,CDM,37236,CPT,360,RC,,,facility,both,,,16786,11884.49,Aetna First Health,Commercial,,14268.1,85,,,7439.56,14268.1,percent of total billed charges,
OPEN/PERQ PLACE STENT EA ADD ARTERY,37237F,CDM,37237,CPT,360,RC,,,facility,both,,,11847,8387.68,Aetna First Health,Commercial,,10069.95,85,,,5250.59,10069.95,percent of total billed charges,
REPLACE PICC W/O SUBQ PORT/PUMP SAME ACCESS SITE W/O IMAGING,37799.03F,CDM,37799,CPT,510,RC,,,facility,both,,,1858,1315.46,Aetna First Health,Commercial,,1579.3,85,,,823.47,1579.3,percent of total billed charges,
ARTERIAL DRAW,3779901F,CDM,37799,CPT,480,RC,,,facility,both,,,92,65.14,Aetna First Health,Commercial,,78.2,85,,,40.77,78.2,percent of total billed charges,
"BONE MARROW ASPIRATION(S),DIAG",38220F,CDM,38220,CPT,510,RC,,,facility,both,,,1205,853.14,Aetna First Health,Commercial,,1024.25,85,,,534.06,1024.25,percent of total billed charges,
BONE MARROW BIOPSY(IES),38221F,CDM,38221,CPT,510,RC,,,facility,both,,,1810,1281.48,Aetna First Health,Commercial,,1538.5,85,,,802.19,1538.5,percent of total billed charges,
"DIAGNOSTIC BONE MARROW, BIOPSY AND ASPIRATION",38222F,CDM,38222,CPT,761,RC,,,facility,both,,,2273,1609.28,Aetna First Health,Commercial,,1932.05,85,,,1007.39,1932.05,percent of total billed charges,
"BIOPSY/EXCISION, LYMPH NODE(S)",38500F,CDM,38500,CPT,510,RC,,,facility,both,,,4167,2950.24,Aetna First Health,Commercial,,3541.95,85,,,1846.81,3541.95,percent of total billed charges,
"NEEDLE BX, LYMPH NODE(S)(T)",38505F,CDM,38505,CPT,510,RC,,,facility,both,,,1483,1049.96,Aetna First Health,Commercial,,1260.55,85,,,657.27,1260.55,percent of total billed charges,
IDENTIFY SENTINEL NODE(T),38792F,CDM,38792,CPT,510,RC,,,facility,both,,,626,443.21,Aetna First Health,Commercial,,532.1,85,,,277.44,532.1,percent of total billed charges,
"REPAIR LIP,FULL THICK,VERMILION",40650F,CDM,40650,CPT,510,RC,,,facility,both,,,741,524.63,Aetna First Health,Commercial,,629.85,85,,,328.41,629.85,percent of total billed charges,
"REPAIR LIP,<1/2 VERT HEIGHT",40652F,CDM,40652,CPT,510,RC,,,facility,both,,,1089,771.01,Aetna First Health,Commercial,,925.65,85,,,482.64,925.65,percent of total billed charges,
"REPAIR LIP,>1/2 VERT HEIGHT",40654F,CDM,40654,CPT,510,RC,,,facility,both,,,1239,877.21,Aetna First Health,Commercial,,1053.15,85,,,549.12,1053.15,percent of total billed charges,
"DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL",40800F,CDM,40800,CPT,510,RC,,,facility,both,,,264,186.91,Aetna First Health,Commercial,,224.4,85,,,117,224.4,percent of total billed charges,
DESTRUC MOUTH LESION/SCAR,40820F,CDM,40820,CPT,510,RC,,,facility,both,,,3704,2622.43,Aetna First Health,Commercial,,3148.4,85,,,1641.61,3148.4,percent of total billed charges,
"REPAIR MOUTH LACERATION,<2.5CM",40830F,CDM,40830,CPT,510,RC,,,facility,both,,,325,230.1,Aetna First Health,Commercial,,276.25,85,,,144.04,276.25,percent of total billed charges,
"REPAIR MOUTH LACERATION,>2.5CM",40831F,CDM,40831,CPT,510,RC,,,facility,both,,,578,409.22,Aetna First Health,Commercial,,491.3,85,,,256.17,491.3,percent of total billed charges,
"I&D MOUTH/TONG INTRA,SUBMANDIBULAR",41008F,CDM,41008,CPT,510,RC,,,facility,both,,,3537,2504.2,Aetna First Health,Commercial,,3006.45,85,,,1567.6,3006.45,percent of total billed charges,
INCISION OF TONGUE FOLD,41010F,CDM,41010,CPT,510,RC,,,facility,both,,,2012,1424.5,Aetna First Health,Commercial,,1710.2,85,,,891.72,1710.2,percent of total billed charges,
"REPAIR TONGUE LACER,<2.6CM",41250F,CDM,41250,CPT,510,RC,,,facility,both,,,364,257.71,Aetna First Health,Commercial,,309.4,85,,,161.32,309.4,percent of total billed charges,
"REPAIR TONGUE LACER,2.6CM+/COMPLX",41252F,CDM,41252,CPT,510,RC,,,facility,both,,,1005,711.54,Aetna First Health,Commercial,,854.25,85,,,445.42,854.25,percent of total billed charges,
DRAINAGE OF GUM LESION,41800F,CDM,41800,CPT,510,RC,,,facility,both,,,505,357.54,Aetna First Health,Commercial,,429.25,85,,,223.82,429.25,percent of total billed charges,
DRAINAGE ABSCESS PALATE/UVULA,42000F,CDM,42000,CPT,510,RC,,,facility,both,,,428,303.02,Aetna First Health,Commercial,,363.8,85,,,189.69,363.8,percent of total billed charges,
"BX SALIVARY GLAND,NEEDLE(T)",42400F,CDM,42400,CPT,510,RC,,,facility,both,,,1427,1010.32,Aetna First Health,Commercial,,1212.95,85,,,632.45,1212.95,percent of total billed charges,
INC/DRAIN PERITONSIL ABSCESS,42700F,CDM,42700,CPT,510,RC,,,facility,both,,,529,374.53,Aetna First Health,Commercial,,449.65,85,,,234.45,449.65,percent of total billed charges,
REMOVE PHARYNX FOREIGN BODY,42809F,CDM,42809,CPT,510,RC,,,facility,both,,,159,112.57,Aetna First Health,Commercial,,135.15,85,,,70.47,135.15,percent of total billed charges,
"CONTROL THROAT BLEED,SIMPLE",42960F,CDM,42960,CPT,510,RC,,,facility,both,,,732,518.26,Aetna First Health,Commercial,,622.2,85,,,324.42,622.2,percent of total billed charges,
"ESOPHAGOSCOPY,DIAGNOSTIC",43200F,CDM,43200,CPT,750,RC,,,facility,both,,,1098,777.38,Aetna First Health,Commercial,,933.3,85,,,486.63,933.3,percent of total billed charges,
ESOPH SCOPE W/SUBMUCOUS INJ,43201F,CDM,43201,CPT,750,RC,,,facility,both,,,2166,1533.53,Aetna First Health,Commercial,,1841.1,85,,,959.97,1841.1,percent of total billed charges,
"ESOPHAGOSCOPY,BIOPSY",43202F,CDM,43202,CPT,750,RC,,,facility,both,,,1279,905.53,Aetna First Health,Commercial,,1087.15,85,,,566.85,1087.15,percent of total billed charges,
"ESOPHAGOSCOPY,LIGATN VARICES",43205F,CDM,43205,CPT,750,RC,,,facility,both,,,2410,1706.28,Aetna First Health,Commercial,,2048.5,85,,,1068.11,2048.5,percent of total billed charges,
ESOPHAGOSCOP STENT PLACEMENT,43212F,CDM,43212,CPT,750,RC,,,facility,both,,,7619,5394.25,Aetna First Health,Commercial,,6476.15,85,,,3376.74,6476.15,percent of total billed charges,
"ESOPHAGOSCOPY,REMOVE F.B.",43215F,CDM,43215,CPT,750,RC,,,facility,both,,,1886,1335.29,Aetna First Health,Commercial,,1603.1,85,,,835.88,1603.1,percent of total billed charges,
"ESOPHAGOSCOPY,DILATION,<30MM",43220F,CDM,43220,CPT,750,RC,,,facility,both,,,2363,1673,Aetna First Health,Commercial,,2008.55,85,,,1047.28,2008.55,percent of total billed charges,
"ESOPHAGOSCOPY,DILATION OVER GUIDE",43226F,CDM,43226,CPT,750,RC,,,facility,both,,,1687,1194.4,Aetna First Health,Commercial,,1433.95,85,,,747.68,1433.95,percent of total billed charges,
ESOPHAGOSCOPY LESION ABLATE,43229F,CDM,43229,CPT,750,RC,,,facility,both,,,3228,2285.42,Aetna First Health,Commercial,,2743.8,85,,,1430.65,2743.8,percent of total billed charges,
EGD BALLOON DIL ESOPH30 MM/>,43233F,CDM,43233,CPT,750,RC,,,facility,both,,,2224,1574.59,Aetna First Health,Commercial,,1890.4,85,,,985.68,1890.4,percent of total billed charges,
"UPPER GI ENDOSCOPY,DIAGNOSIS",43235F,CDM,43235,CPT,750,RC,,,facility,both,,,2561,1813.19,Aetna First Health,Commercial,,2176.85,85,,,1135.04,2176.85,percent of total billed charges,
UPPR GI SCOPE W/SUBMUC INJ,43236F,CDM,43236,CPT,750,RC,,,facility,both,,,2421,1714.07,Aetna First Health,Commercial,,2057.85,85,,,1072.99,2057.85,percent of total billed charges,
GI ENDOSCOPY WITH/WITHOUT SPECIMEN/BRUSH/WASH US GUIDE/NEEDLE ASPIRATION,43238F,CDM,43238,CPT,750,RC,,,facility,both,,,2383,1687.16,Aetna First Health,Commercial,,2025.55,85,,,1056.15,2025.55,percent of total billed charges,
"UPPER GI ENDOSCOPY,BIOPSY",43239F,CDM,43239,CPT,750,RC,,,facility,both,,,2949,2087.89,Aetna First Health,Commercial,,2506.65,85,,,1307,2506.65,percent of total billed charges,
"UPPER GI ENDOSCOPY,TUBE PLACE",43241F,CDM,43241,CPT,750,RC,,,facility,both,,,1749,1238.29,Aetna First Health,Commercial,,1486.65,85,,,775.16,1486.65,percent of total billed charges,
"UPPER GI ENDOSCOPY,LIGAT VARIX",43244F,CDM,43244,CPT,750,RC,,,facility,both,,,3110,2201.88,Aetna First Health,Commercial,,2643.5,85,,,1378.35,2643.5,percent of total billed charges,
"GASTSROSCOPY,DILATE OUTLET",43245F,CDM,43245,CPT,750,RC,,,facility,both,,,3010,2131.08,Aetna First Health,Commercial,,2558.5,85,,,1334.03,2558.5,percent of total billed charges,
PLACE PERCUT GASTROSTOMY TUBE,43246F,CDM,43246,CPT,510,RC,,,facility,both,,,3438,2434.1,Aetna First Health,Commercial,,2922.3,85,,,1523.72,2922.3,percent of total billed charges,
"UPPER GI ENDOSCOPY,REMOV F.B.",43247F,CDM,43247,CPT,750,RC,,,facility,both,,,2946,2085.77,Aetna First Health,Commercial,,2504.1,85,,,1305.67,2504.1,percent of total billed charges,
"UP GI ENDOSCOPY,DILATN W GUIDE",43248F,CDM,43248,CPT,750,RC,,,facility,both,,,2331,1650.35,Aetna First Health,Commercial,,1981.35,85,,,1033.1,1981.35,percent of total billed charges,
"UP GI ENDOSCOPY,BALL DIL,30MM",43249F,CDM,43249,CPT,750,RC,,,facility,both,,,2722,1927.18,Aetna First Health,Commercial,,2313.7,85,,,1206.39,2313.7,percent of total billed charges,
"UP GI ENDOSCOPY,REMV TUMOR,FORCEPS",43250F,CDM,43250,CPT,750,RC,,,facility,both,,,2620,1854.96,Aetna First Health,Commercial,,2227,85,,,1161.18,2227,percent of total billed charges,
"UP GI ENDOSCOPY,REMV TUMOR,SNARE",43251F,CDM,43251,CPT,750,RC,,,facility,both,,,3076,2177.81,Aetna First Health,Commercial,,2614.6,85,,,1363.28,2614.6,percent of total billed charges,
"UPPER GI ENDOSCOPY,CTRL BLEED",43255F,CDM,43255,CPT,750,RC,,,facility,both,,,2684,1900.27,Aetna First Health,Commercial,,2281.4,85,,,1189.55,2281.4,percent of total billed charges,
ENDOSCOPIC ULTRASOUND EXAM,43259F,CDM,43259,CPT,750,RC,,,facility,both,,,2190,1550.52,Aetna First Health,Commercial,,1861.5,85,,,970.61,1861.5,percent of total billed charges,
"ERCP,DIAGNOSTIC(T)",43260F,CDM,43260,CPT,750,RC,,,facility,both,,,2644,1871.95,Aetna First Health,Commercial,,2247.4,85,,,1171.82,2247.4,percent of total billed charges,
"ERCP,BIOPSY",43261F,CDM,43261,CPT,750,RC,,,facility,both,,,2271,1607.87,Aetna First Health,Commercial,,1930.35,85,,,1006.51,1930.35,percent of total billed charges,
"ERCP,SPHINCTEROTOMY",43262F,CDM,43262,CPT,750,RC,,,facility,both,,,2817,1994.44,Aetna First Health,Commercial,,2394.45,85,,,1248.49,2394.45,percent of total billed charges,
"ERCP,REMVAL STONES",43264F,CDM,43264,CPT,750,RC,,,facility,both,,,2338,1655.3,Aetna First Health,Commercial,,1987.3,85,,,1036.2,1987.3,percent of total billed charges,
"ERCP,DESTRUC STONES",43265F,CDM,43265,CPT,750,RC,,,facility,both,,,2460,1741.68,Aetna First Health,Commercial,,2091,85,,,1090.27,2091,percent of total billed charges,
EGD ENDOSCOPIC STENT PLACE,43266F,CDM,43266,CPT,750,RC,,,facility,both,,,5352,3789.22,Aetna First Health,Commercial,,4549.2,85,,,2372.01,4549.2,percent of total billed charges,
EGD LESION ABLATION,43270F,CDM,43270,CPT,750,RC,,,facility,both,,,2145,1518.66,Aetna First Health,Commercial,,1823.25,85,,,950.66,1823.25,percent of total billed charges,
ENDOSCOP CANNULATION PAPILLA,43273F,CDM,43273,CPT,510,RC,,,facility,both,,,2393,1694.24,Aetna First Health,Commercial,,2034.05,85,,,1060.58,2034.05,percent of total billed charges,
ERCP DUCT STENT PLACEMENT,43274F,CDM,43274,CPT,750,RC,,,facility,both,,,4489,3178.21,Aetna First Health,Commercial,,3815.65,85,,,1989.52,3815.65,percent of total billed charges,
ERCP REMOVE FORGN BODY DUCT,43275F,CDM,43275,CPT,750,RC,,,facility,both,,,3327,2355.52,Aetna First Health,Commercial,,2827.95,85,,,1474.53,2827.95,percent of total billed charges,
ERCP STENT EXCHANGE W/DILATE,43276F,CDM,43276,CPT,750,RC,,,facility,both,,,5352,3789.22,Aetna First Health,Commercial,,4549.2,85,,,2372.01,4549.2,percent of total billed charges,
ERCP EA DUCT/AMPULLA DILATE,43277F,CDM,43277,CPT,750,RC,,,facility,both,,,3327,2355.52,Aetna First Health,Commercial,,2827.95,85,,,1474.53,2827.95,percent of total billed charges,
ERCP LESION ABLATE W/DILATE,43278F,CDM,43278,CPT,750,RC,,,facility,both,,,4443,3145.64,Aetna First Health,Commercial,,3776.55,85,,,1969.14,3776.55,percent of total billed charges,
DILATE ESOPHAGUS,43450F,CDM,43450,CPT,750,RC,,,facility,both,,,2098,1485.38,Aetna First Health,Commercial,,1783.3,85,,,929.83,1783.3,percent of total billed charges,
NASO/OROGASTRIC TUBE(T),43752F,CDM,43752,CPT,510,RC,,,facility,both,,,404,286.03,Aetna First Health,Commercial,,343.4,85,,,179.05,343.4,percent of total billed charges,
GASTRIC INTUBATION TREATMENT,43753F,CDM,43753,CPT,510,RC,,,facility,both,,,274,193.99,Aetna First Health,Commercial,,232.9,85,,,121.44,232.9,percent of total billed charges,
REPOSITION GASTROSTOMY TUBE,43761F,CDM,43761,CPT,510,RC,,,facility,both,,,1098,777.38,Aetna First Health,Commercial,,933.3,85,,,486.63,933.3,percent of total billed charges,
REPLACE GASTRO TUBE PERC W/O IMAGE;WO REVISION,43762F,CDM,43762,CPT,510,RC,,,facility,both,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
"SMALL BOWEL ENDOSCOPY,PAST 2ND DUOD",44360F,CDM,44360,CPT,750,RC,,,facility,both,,,2525,1787.7,Aetna First Health,Commercial,,2146.25,85,,,1119.08,2146.25,percent of total billed charges,
"SMALL BOWEL ENDOSCOPY,BIOPSY",44361F,CDM,44361,CPT,750,RC,,,facility,both,,,1762,1247.5,Aetna First Health,Commercial,,1497.7,85,,,780.92,1497.7,percent of total billed charges,
"SMALL BOWEL ENDOSCOPY,CTRL BLEED",44366F,CDM,44366,CPT,750,RC,,,facility,both,,,2253,1595.12,Aetna First Health,Commercial,,1915.05,85,,,998.53,1915.05,percent of total billed charges,
"SB SCOPE,TO ILEUM,DIAGNOSTIC",44376F,CDM,44376,CPT,750,RC,,,facility,both,,,1479,1047.13,Aetna First Health,Commercial,,1257.15,85,,,655.49,1257.15,percent of total billed charges,
"ILEOSCOPY THRU STOMA,DIAGNOSTIC",44380F,CDM,44380,CPT,750,RC,,,facility,both,,,1803,1276.52,Aetna First Health,Commercial,,1532.55,85,,,799.09,1532.55,percent of total billed charges,
"ILEOSCOPY THRU STOMA,BIOPSY",44382F,CDM,44382,CPT,750,RC,,,facility,both,,,1155,817.74,Aetna First Health,Commercial,,981.75,85,,,511.9,981.75,percent of total billed charges,
ENDOSCOPY OF BOWEL POUCH,44385F,CDM,44385,CPT,750,RC,,,facility,both,,,1303,922.52,Aetna First Health,Commercial,,1107.55,85,,,577.49,1107.55,percent of total billed charges,
"ENDOSCOPY, BOWEL POUCH, BIOPSY",44386F,CDM,44386,CPT,750,RC,,,facility,both,,,1486,1052.09,Aetna First Health,Commercial,,1263.1,85,,,658.6,1263.1,percent of total billed charges,
COLONOSCOPY,44388F,CDM,44388,CPT,750,RC,,,facility,both,,,2198,1556.18,Aetna First Health,Commercial,,1868.3,85,,,974.15,1868.3,percent of total billed charges,
COLONOSCOPY WITH BIOPSY,44389F,CDM,44389,CPT,750,RC,,,facility,both,,,1812,1282.9,Aetna First Health,Commercial,,1540.2,85,,,803.08,1540.2,percent of total billed charges,
COLONOSCOPY W/SNARE,44394F,CDM,44394,CPT,750,RC,,,facility,both,,,2235,1582.38,Aetna First Health,Commercial,,1899.75,85,,,990.55,1899.75,percent of total billed charges,
INTRO LONG GI TUBE(T),44500F,CDM,44500,CPT,510,RC,,,facility,both,,,708,501.26,Aetna First Health,Commercial,,601.8,85,,,313.79,601.8,percent of total billed charges,
"PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS",45300F,CDM,45300,CPT,510,RC,,,facility,both,,,835,591.18,Aetna First Health,Commercial,,709.75,85,,,370.07,709.75,percent of total billed charges,
"PROCTOSIGMOIDOSCOPY,RIGID+DILATN",45303F,CDM,45303,CPT,750,RC,,,facility,both,,,1358,961.46,Aetna First Health,Commercial,,1154.3,85,,,601.87,1154.3,percent of total billed charges,
"PROCTOSIGMOIDOSCOPY,BIOPSY",45305F,CDM,45305,CPT,510,RC,,,facility,both,,,1345,952.26,Aetna First Health,Commercial,,1143.25,85,,,596.1,1143.25,percent of total billed charges,
"SIGMOIDOSCOPY,DIAGNOSTIC",45330F,CDM,45330,CPT,510,RC,,,facility,both,,,1617,1144.84,Aetna First Health,Commercial,,1374.45,85,,,716.65,1374.45,percent of total billed charges,
"SIGMOIDOSCOPY,BIOPSY",45331F,CDM,45331,CPT,750,RC,,,facility,both,,,2240,1585.92,Aetna First Health,Commercial,,1904,85,,,992.77,1904,percent of total billed charges,
"SIGMOIDOSCOPY,REMVL F.B.",45332F,CDM,45332,CPT,750,RC,,,facility,both,,,1887,1336,Aetna First Health,Commercial,,1603.95,85,,,836.32,1603.95,percent of total billed charges,
"SIGMOIDOSCOPY,REMV LESN,FORCEP/CAUT",45333F,CDM,45333,CPT,510,RC,,,facility,both,,,1527,1081.12,Aetna First Health,Commercial,,1297.95,85,,,676.77,1297.95,percent of total billed charges,
"SIGMOIDOSCOPY,CTRL BLEEDING",45334F,CDM,45334,CPT,750,RC,,,facility,both,,,1880,1331.04,Aetna First Health,Commercial,,1598,85,,,833.22,1598,percent of total billed charges,
SIGMOIDOSCOPE W/SUBMUC INJ,45335F,CDM,45335,CPT,750,RC,,,facility,both,,,1495,1058.46,Aetna First Health,Commercial,,1270.75,85,,,662.58,1270.75,percent of total billed charges,
"SIGMOIDOSCOPY,DECOMPRESS VOLVULUS",45337F,CDM,45337,CPT,750,RC,,,facility,both,,,1564,1107.31,Aetna First Health,Commercial,,1329.4,85,,,693.16,1329.4,percent of total billed charges,
"SIGMOIDOSCOPY,REMV LESN,SNARE",45338F,CDM,45338,CPT,510,RC,,,facility,both,,,2559,1811.77,Aetna First Health,Commercial,,2175.15,85,,,1134.15,2175.15,percent of total billed charges,
SIG W/BALLOON DILATION,45340F,CDM,45340,CPT,750,RC,,,facility,both,,,2116,1498.13,Aetna First Health,Commercial,,1798.6,85,,,937.81,1798.6,percent of total billed charges,
SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES,45346F,CDM,45346,CPT,750,RC,,,facility,both,,,1588,1124.3,Aetna First Health,Commercial,,1349.8,85,,,703.8,1349.8,percent of total billed charges,
SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT,45347F,CDM,45347,CPT,750,RC,,,facility,both,,,6568,4650.14,Aetna First Health,Commercial,,5582.8,85,,,2910.94,5582.8,percent of total billed charges,
"COLONOSCOPY,FLEX,DIAGNOSTIC",45378F,CDM,45378,CPT,750,RC,,,facility,both,,,2692,1905.94,Aetna First Health,Commercial,,2288.2,85,,,1193.09,2288.2,percent of total billed charges,
"COLONOSCOPY,REMV FOREIGN BODY",45379F,CDM,45379,CPT,750,RC,,,facility,both,,,1255,888.54,Aetna First Health,Commercial,,1066.75,85,,,556.22,1066.75,percent of total billed charges,
"COLONOSCOPY,BIOPSY",45380F,CDM,45380,CPT,750,RC,,,facility,both,,,3064,2169.31,Aetna First Health,Commercial,,2604.4,85,,,1357.96,2604.4,percent of total billed charges,
"COLONOSCOPE, SUBMUCOUS INJ",45381F,CDM,45381,CPT,750,RC,,,facility,both,,,2143,1517.24,Aetna First Health,Commercial,,1821.55,85,,,949.78,1821.55,percent of total billed charges,
"COLONOSCOPY,CONTROL BLEEDING",45382F,CDM,45382,CPT,750,RC,,,facility,both,,,2520,1784.16,Aetna First Health,Commercial,,2142,85,,,1116.86,2142,percent of total billed charges,
"COLONOSCOPY,REMV LESN,FORCEP/CAUTERY",45384F,CDM,45384,CPT,750,RC,,,facility,both,,,2508,1775.66,Aetna First Health,Commercial,,2131.8,85,,,1111.55,2131.8,percent of total billed charges,
"COLONOSCOPY,REMV LESN,SNARE",45385F,CDM,45385,CPT,750,RC,,,facility,both,,,3183,2253.56,Aetna First Health,Commercial,,2705.55,85,,,1410.71,2705.55,percent of total billed charges,
COLONOSCOPE DILATE STRICTURE,45386F,CDM,45386,CPT,750,RC,,,facility,both,,,2831,2004.35,Aetna First Health,Commercial,,2406.35,85,,,1254.7,2406.35,percent of total billed charges,
COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES,45388F,CDM,45388,CPT,750,RC,,,facility,both,,,1909,1351.57,Aetna First Health,Commercial,,1622.65,85,,,846.07,1622.65,percent of total billed charges,
COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION,45390F,CDM,45390,CPT,750,RC,,,facility,both,,,2474,1751.59,Aetna First Health,Commercial,,2102.9,85,,,1096.48,2102.9,percent of total billed charges,
COLONOSCOPY FLEXIBLE WITH DECOMPRESSION,45393F,CDM,45393,CPT,750,RC,,,facility,both,,,2300,1628.4,Aetna First Health,Commercial,,1955,85,,,1019.36,1955,percent of total billed charges,
COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S),45398F,CDM,45398,CPT,750,RC,,,facility,both,,,2369,1677.25,Aetna First Health,Commercial,,2013.65,85,,,1049.94,2013.65,percent of total billed charges,
DILATION ANAL SPHINCTER W ANESTH,45905F,CDM,45905,CPT,510,RC,,,facility,both,,,1565,1108.02,Aetna First Health,Commercial,,1330.25,85,,,693.61,1330.25,percent of total billed charges,
REMV RECTAL OBSTR:FECES/F.B. W ANEST,45915F,CDM,45915,CPT,510,RC,,,facility,both,,,2017,1428.04,Aetna First Health,Commercial,,1714.45,85,,,893.93,1714.45,percent of total billed charges,
I&D PERIRECTAL ABSCESS,46040F,CDM,46040,CPT,510,RC,,,facility,both,,,3916,2772.53,Aetna First Health,Commercial,,3328.6,85,,,1735.57,3328.6,percent of total billed charges,
"I&D PERIANAL ABSCESS,SUPERFICIAL",46050F,CDM,46050,CPT,510,RC,,,facility,both,,,1983,1403.96,Aetna First Health,Commercial,,1685.55,85,,,878.87,1685.55,percent of total billed charges,
INCISE EXTERNAL HEMORRHOID,46083F,CDM,46083,CPT,510,RC,,,facility,both,,,556,393.65,Aetna First Health,Commercial,,472.6,85,,,246.42,472.6,percent of total billed charges,
REMOVAL OF HEMORRHOID CLOT,46320F,CDM,46320,CPT,510,RC,,,facility,both,,,3176,2248.61,Aetna First Health,Commercial,,2699.6,85,,,1407.6,2699.6,percent of total billed charges,
DIAGNOSTIC ANOSCOPY,46600F,CDM,46600,CPT,510,RC,,,facility,both,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
ANOSCOPY AND DILATION,46604F,CDM,46604,CPT,750,RC,,,facility,both,,,1488,1053.5,Aetna First Health,Commercial,,1264.8,85,,,659.48,1264.8,percent of total billed charges,
NEEDLE BIOPSY LIVER(T),47000F,CDM,47000,CPT,510,RC,,,facility,both,,,2240,1585.92,Aetna First Health,Commercial,,1904,85,,,992.77,1904,percent of total billed charges,
"CHOLECYSTOSTOMY,PERCUT(T)",47490F,CDM,47490,CPT,510,RC,,,facility,both,,,4838,3425.3,Aetna First Health,Commercial,,4112.3,85,,,2144.2,4112.3,percent of total billed charges,
"INJECT CHOLANGIOGRAPHY,PERC W/IMG GUIDANCE,EXISTING",47531F,CDM,47531,CPT,510,RC,,,facility,both,,,615,435.42,Aetna First Health,Commercial,,522.75,85,,,272.57,522.75,percent of total billed charges,
PLCMT BILIARY DRAIN CATH;EXTERNAL,47533F,CDM,47533,CPT,510,RC,,,facility,both,,,5542,3923.74,Aetna First Health,Commercial,,4710.7,85,,,2456.21,4710.7,percent of total billed charges,
PLCMT BILIARY DRAIN CATH;INTERNAL-EXTERNAL,47534F,CDM,47534,CPT,510,RC,,,facility,both,,,3692,2613.94,Aetna First Health,Commercial,,3138.2,85,,,1636.29,3138.2,percent of total billed charges,
"EXCHANGE BILIARY DRNG CATH,PERC",47536F,CDM,47536,CPT,510,RC,,,facility,both,,,3178,2250.02,Aetna First Health,Commercial,,2701.3,85,,,1408.49,2701.3,percent of total billed charges,
ABD PARACENTESIS,49082F,CDM,49082,CPT,510,RC,,,facility,both,,,650,460.2,Aetna First Health,Commercial,,552.5,85,,,288.08,552.5,percent of total billed charges,
ABD PARACENTESIS W/IMAGING(T),49083F,CDM,49083,CPT,510,RC,,,facility,both,,,1542,1091.74,Aetna First Health,Commercial,,1310.7,85,,,683.41,1310.7,percent of total billed charges,
"PERCUT BX, ABDOMINAL MASS(T)",49180F,CDM,49180,CPT,510,RC,,,facility,both,,,1621,1147.67,Aetna First Health,Commercial,,1377.85,85,,,718.43,1377.85,percent of total billed charges,
IMAGE CATH FLUID COLXN VISC,49405F,CDM,49405,CPT,510,RC,,,facility,both,,,2211,1565.39,Aetna First Health,Commercial,,1879.35,85,,,979.92,1879.35,percent of total billed charges,
IMAGE CATH FLUID PERI/RETRO,49406F,CDM,49406,CPT,510,RC,,,facility,both,,,3682,2606.86,Aetna First Health,Commercial,,3129.7,85,,,1631.86,3129.7,percent of total billed charges,
DRAINAGE CATHETER EXCHANGE(T),49423F,CDM,49423,CPT,510,RC,,,facility,both,,,2751,1947.71,Aetna First Health,Commercial,,2338.35,85,,,1219.24,2338.35,percent of total billed charges,
CONTRAST INJ INPLACE CATH(T),49424F,CDM,49424,CPT,510,RC,,,facility,both,,,239,169.21,Aetna First Health,Commercial,,203.15,85,,,105.92,203.15,percent of total billed charges,
PLACE GASTROSTOMY TUBE PERC(T),49440F,CDM,49440,CPT,510,RC,,,facility,both,,,1795,1270.86,Aetna First Health,Commercial,,1525.75,85,,,795.54,1525.75,percent of total billed charges,
REPLACE G/C TUBE PERC(T),49450F,CDM,49450,CPT,510,RC,,,facility,both,,,1114,788.71,Aetna First Health,Commercial,,946.9,85,,,493.72,946.9,percent of total billed charges,
REPLACE DUOD/JEJ TUBE PERC(T),49451F,CDM,49451,CPT,510,RC,,,facility,both,,,881,623.75,Aetna First Health,Commercial,,748.85,85,,,390.46,748.85,percent of total billed charges,
REPLACE G-J TUBE PERC,49452F,CDM,49452,CPT,510,RC,,,facility,both,,,819,579.85,Aetna First Health,Commercial,,696.15,85,,,362.98,696.15,percent of total billed charges,
FLUORO EXAM OF G/COLON TUBE(T),49465F,CDM,49465,CPT,510,RC,,,facility,both,,,405,286.74,Aetna First Health,Commercial,,344.25,85,,,179.5,344.25,percent of total billed charges,
"BX OF KIDNEY,PERCUTANEOUS(T)",50200F,CDM,50200,CPT,510,RC,,,facility,both,,,1757,1243.96,Aetna First Health,Commercial,,1493.45,85,,,778.7,1493.45,percent of total billed charges,
CHANGE URETER STENT PERCUT,50382F,CDM,50382,CPT,510,RC,,,facility,both,,,3514,2487.91,Aetna First Health,Commercial,,2986.9,85,,,1557.4,2986.9,percent of total billed charges,
PERCUT DRN/INJ RENAL CYST(T),50390F,CDM,50390,CPT,510,RC,,,facility,both,,,1168,826.94,Aetna First Health,Commercial,,992.8,85,,,517.66,992.8,percent of total billed charges,
INJECT ANTEGRADE NEPHROSTOGRAM;EXIST ACCESS,50431F,CDM,50431,CPT,510,RC,,,facility,both,,,1343,950.84,Aetna First Health,Commercial,,1141.55,85,,,595.22,1141.55,percent of total billed charges,
"PLCMT NEPROSTOMY CATH,PERC",50432F,CDM,50432,CPT,510,RC,,,facility,both,,,3321,2351.27,Aetna First Health,Commercial,,2822.85,85,,,1471.87,2822.85,percent of total billed charges,
"PLCMT NEPHROURETERAL CATH,PERC;NEW ACCESS",50433F,CDM,50433,CPT,510,RC,,,facility,both,,,2554,1808.23,Aetna First Health,Commercial,,2170.9,85,,,1131.93,2170.9,percent of total billed charges,
"EXCHANGE NEPHROSTOMY CATH,PERC",50435F,CDM,50435,CPT,510,RC,,,facility,both,,,889,629.41,Aetna First Health,Commercial,,755.65,85,,,394,755.65,percent of total billed charges,
INJ RETROGRADE/CONDUIT XRAY(T),50690F,CDM,50690,CPT,510,RC,,,facility,both,,,138,97.7,Aetna First Health,Commercial,,117.3,85,,,61.16,117.3,percent of total billed charges,
"TROCAR ASPIR BLAD,INSRT CAT(T)",51102F,CDM,51102,CPT,510,RC,,,facility,both,,,3334,2360.47,Aetna First Health,Commercial,,2833.9,85,,,1477.63,2833.9,percent of total billed charges,
INJECTION FOR BLADDER X-RAY(T),51600F,CDM,51600,CPT,510,RC,,,facility,both,,,464,328.51,Aetna First Health,Commercial,,394.4,85,,,205.64,394.4,percent of total billed charges,
INJ RETROGRADE URETHOCYSTO(T),51610F,CDM,51610,CPT,510,RC,,,facility,both,,,239,169.21,Aetna First Health,Commercial,,203.15,85,,,105.92,203.15,percent of total billed charges,
IRRIGATION OF BLADDER,51700F,CDM,51700,CPT,510,RC,,,facility,both,,,392,277.54,Aetna First Health,Commercial,,333.2,85,,,173.73,333.2,percent of total billed charges,
INSERT STRAIGHT CATHETER,51701F,CDM,51701,CPT,510,RC,,,facility,both,,,206,145.85,Aetna First Health,Commercial,,175.1,85,,,91.3,175.1,percent of total billed charges,
INSERT SIMPLE CATH FOLEY,51702F,CDM,51702,CPT,510,RC,,,facility,both,,,240,169.92,Aetna First Health,Commercial,,204,85,,,106.37,204,percent of total billed charges,
"INSERT BLADDER CATH, COMPLEX",51703F,CDM,51703,CPT,510,RC,,,facility,both,,,201,142.31,Aetna First Health,Commercial,,170.85,85,,,89.08,170.85,percent of total billed charges,
"CHANGE OF BLADDER TUBE,SIMPLE",51705F,CDM,51705,CPT,510,RC,,,facility,both,,,511,361.79,Aetna First Health,Commercial,,434.35,85,,,226.48,434.35,percent of total billed charges,
"CHANGE OF BLADDER TUBE,COMPLICATED",51710F,CDM,51710,CPT,510,RC,,,facility,both,,,917,649.24,Aetna First Health,Commercial,,779.45,85,,,406.41,779.45,percent of total billed charges,
INSTILL ANTICANCER AGENT IN BLADDER,51720F,CDM,51720,CPT,510,RC,,,facility,both,,,616,436.13,Aetna First Health,Commercial,,523.6,85,,,273.01,523.6,percent of total billed charges,
US URINE CAPACITY MEASURE,51798F,CDM,51798,CPT,510,RC,,,facility,both,,,156,110.45,Aetna First Health,Commercial,,132.6,85,,,69.14,132.6,percent of total billed charges,
CYSTOURETHROSCOPY,52000F,CDM,52000,CPT,761,RC,,,facility,both,,,945,669.06,Aetna First Health,Commercial,,803.25,85,,,418.82,803.25,percent of total billed charges,
"CYSTOURETHROSCOPY,URETER CATHETER",52005F,CDM,52005,CPT,510,RC,,,facility,both,,,2937,2079.4,Aetna First Health,Commercial,,2496.45,85,,,1301.68,2496.45,percent of total billed charges,
"CYSTOURETHROSCOPY, BIOPSY(S)",52204F,CDM,52204,CPT,510,RC,,,facility,both,,,2307,1633.36,Aetna First Health,Commercial,,1960.95,85,,,1022.46,1960.95,percent of total billed charges,
"CYSTOSCOPY,DIL BLADDER,GEN ANESTH",52260F,CDM,52260,CPT,510,RC,,,facility,both,,,2937,2079.4,Aetna First Health,Commercial,,2496.45,85,,,1301.68,2496.45,percent of total billed charges,
"CYSTOSCOPY,DIL BLADDER,LOCAL ANESTH",52265F,CDM,52265,CPT,510,RC,,,facility,both,,,2851,2018.51,Aetna First Health,Commercial,,2423.35,85,,,1263.56,2423.35,percent of total billed charges,
"CYSTOSCOPY,DIL URETHRAL STRICTURE",52281F,CDM,52281,CPT,510,RC,,,facility,both,,,2307,1633.36,Aetna First Health,Commercial,,1960.95,85,,,1022.46,1960.95,percent of total billed charges,
"CYSTOURETHROSCOPY, WITH INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER",52287F,CDM,52287,CPT,360,RC,,,facility,both,,,2343,1658.84,Aetna First Health,Commercial,,1991.55,85,,,1038.42,1991.55,percent of total billed charges,
"CYSTOSCOPY,RESECT ECTOPIC URETEROCEL",52301F,CDM,52301,CPT,510,RC,,,facility,both,,,4010,2839.08,Aetna First Health,Commercial,,3408.5,85,,,1777.23,3408.5,percent of total billed charges,
"CYSTOSCOPY,REMV CALCULUS,SIMPLE",52310F,CDM,52310,CPT,510,RC,,,facility,both,,,2965,2099.22,Aetna First Health,Commercial,,2520.25,85,,,1314.09,2520.25,percent of total billed charges,
"REMOVE BLADDER STONE,<2.5CM",52317F,CDM,52317,CPT,510,RC,,,facility,both,,,4897,3467.08,Aetna First Health,Commercial,,4162.45,85,,,2170.35,4162.45,percent of total billed charges,
"REMOVE BLADDER STONE,>2.5CM",52318F,CDM,52318,CPT,510,RC,,,facility,both,,,4803,3400.52,Aetna First Health,Commercial,,4082.55,85,,,2128.69,4082.55,percent of total billed charges,
"CYSTOSCOPY,INSERT URETERAL STENT",52332F,CDM,52332,CPT,510,RC,,,facility,both,,,3986,2822.09,Aetna First Health,Commercial,,3388.1,85,,,1766.6,3388.1,percent of total billed charges,
CYSTO/URETERO W/LITHOTRIPSY,52356F,CDM,52356,CPT,510,RC,,,facility,both,,,8428,5967.02,Aetna First Health,Commercial,,7163.8,85,,,3735.29,7163.8,percent of total billed charges,
EXCIS URETHRAL CARUNCLE,53265F,CDM,53265,CPT,510,RC,,,facility,both,,,2307,1633.36,Aetna First Health,Commercial,,1960.95,85,,,1022.46,1960.95,percent of total billed charges,
"DIL URETHRA STRIC,MALE,INITIAL",53600F,CDM,53600,CPT,510,RC,,,facility,both,,,364,257.71,Aetna First Health,Commercial,,309.4,85,,,161.32,309.4,percent of total billed charges,
TRANSURETH DESTR PROSTATE;RADIOFREQ WATER VAPOR,53854F,CDM,53854,CPT,510,RC,,,facility,both,,,4010,2839.08,Aetna First Health,Commercial,,3408.5,85,,,1777.23,3408.5,percent of total billed charges,
REMV FOR.BODY DEEP PENILE TISS,54115F,CDM,54115,CPT,510,RC,,,facility,both,,,3578,2533.22,Aetna First Health,Commercial,,3041.3,85,,,1585.77,3041.3,percent of total billed charges,
"CIRCUMCISION,CLAMP,NEWBORN",54150F,CDM,54150,CPT,723,RC,,,facility,both,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
"CIRCUMCISION, OTHER THAN CLAMP < 28 DAYS AGE",54160F,CDM,54160,CPT,510,RC,,,facility,both,,,400,283.2,Aetna First Health,Commercial,,340,85,,,177.28,340,percent of total billed charges,
"IRRIGAT CORPUS CAVERN,PRIAPISM",54220F,CDM,54220,CPT,510,RC,,,facility,both,,,336,237.89,Aetna First Health,Commercial,,285.6,85,,,148.92,285.6,percent of total billed charges,
"INJECT CORPORA CAVERN,PHARM AGNT",54235F,CDM,54235,CPT,510,RC,,,facility,both,,,395,279.66,Aetna First Health,Commercial,,335.75,85,,,175.06,335.75,percent of total billed charges,
"REPAIR PENIS,EPISPADIUS+INCONTIN",54385F,CDM,54385,CPT,510,RC,,,facility,both,,,2240,1585.92,Aetna First Health,Commercial,,1904,85,,,992.77,1904,percent of total billed charges,
PREPUTIAL STRETCHING,54450F,CDM,54450,CPT,510,RC,,,facility,both,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
"INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM",54700F,CDM,54700,CPT,510,RC,,,facility,both,,,4051,2868.11,Aetna First Health,Commercial,,3443.35,85,,,1795.4,3443.35,percent of total billed charges,
"DRAINAGE OF HYDROCELE,TUNICA",55000F,CDM,55000,CPT,510,RC,,,facility,both,,,815,577.02,Aetna First Health,Commercial,,692.75,85,,,361.21,692.75,percent of total billed charges,
DRAINAGE SCROTAL WALL ABSCESS,55100F,CDM,55100,CPT,510,RC,,,facility,both,,,1477,1045.72,Aetna First Health,Commercial,,1255.45,85,,,654.61,1255.45,percent of total billed charges,
"BX OF PROSTATE,NEEDLE/PUNCH(T)",55700F,CDM,55700,CPT,510,RC,,,facility,both,,,1863,1319,Aetna First Health,Commercial,,1583.55,85,,,825.68,1583.55,percent of total billed charges,
I&D OF VULVA/PERINEUM ABSCESS,56405F,CDM,56405,CPT,510,RC,,,facility,both,,,588,416.3,Aetna First Health,Commercial,,499.8,85,,,260.6,499.8,percent of total billed charges,
I&D BARTHOLIN GLAND ABSCESS,56420F,CDM,56420,CPT,510,RC,,,facility,both,,,482,341.26,Aetna First Health,Commercial,,409.7,85,,,213.62,409.7,percent of total billed charges,
MARSUP BARTHOLIN GLAND CYST,56440F,CDM,56440,CPT,510,RC,,,facility,both,,,3415,2417.82,Aetna First Health,Commercial,,2902.75,85,,,1513.53,2902.75,percent of total billed charges,
"BIOPSY VULVA/PERINEUM,ONE LESN",56605F,CDM,56605,CPT,510,RC,,,facility,both,,,850,601.8,Aetna First Health,Commercial,,722.5,85,,,376.72,722.5,percent of total billed charges,
REPAIR OF VAGINA,57200F,CDM,57200,CPT,510,RC,,,facility,both,,,3516,2489.33,Aetna First Health,Commercial,,2988.6,85,,,1558.29,2988.6,percent of total billed charges,
CAUTERIZATION OF CERVIX,57510F,CDM,57510,CPT,510,RC,,,facility,both,,,3596,2545.97,Aetna First Health,Commercial,,3056.6,85,,,1593.75,3056.6,percent of total billed charges,
BIOPSY OF UTERUS LINING,58100F,CDM,58100,CPT,510,RC,,,facility,both,,,393,278.24,Aetna First Health,Commercial,,334.05,85,,,174.18,334.05,percent of total billed charges,
REMOVE INTRAUTERINE DEVICE,58301F,CDM,58301,CPT,510,RC,,,facility,both,,,371,262.67,Aetna First Health,Commercial,,315.35,85,,,164.43,315.35,percent of total billed charges,
CATH/INJ HYSTEROSALPINGOGRM(T),58340F,CDM,58340,CPT,510,RC,,,facility,both,,,630,446.04,Aetna First Health,Commercial,,535.5,85,,,279.22,535.5,percent of total billed charges,
AMNIOCENTESIS(T),59000F,CDM,59000,CPT,510,RC,,,facility,both,,,334,236.47,Aetna First Health,Commercial,,283.9,85,,,148.03,283.9,percent of total billed charges,
"TRANSABDOMINAL AMNIOINFUSION, ULTRASOUND GUIDANCE",59070F,CDM,59070,CPT,720,RC,,,facility,both,,,427,302.32,Aetna First Health,Commercial,,362.95,85,,,189.25,362.95,percent of total billed charges,
INSERT CERVICAL DILATOR,59200F,CDM,59200,CPT,761,RC,,,facility,both,,,870,615.96,Aetna First Health,Commercial,,739.5,85,,,385.58,739.5,percent of total billed charges,
EPISIOTOMY/VAGINAL REPR BY OTHR MD,59300F,CDM,59300,CPT,510,RC,,,facility,both,,,3865,2736.42,Aetna First Health,Commercial,,3285.25,85,,,1712.97,3285.25,percent of total billed charges,
ANTEPARTUM HEAD MANIPULATION,59412F,CDM,59412,CPT,720,RC,,,facility,both,,,2271,1607.87,Aetna First Health,Commercial,,1930.35,85,,,1006.51,1930.35,percent of total billed charges,
DELIVER PLACENTA,59414F,CDM,59414,CPT,720,RC,,,facility,both,,,2745,1943.46,Aetna First Health,Commercial,,2333.25,85,,,1216.58,2333.25,percent of total billed charges,
AMNIOINFUSION TRANSCERV FACILITY,59899.01F,CDM,59899,CPT,720,RC,,,facility,both,,,274,193.99,Aetna First Health,Commercial,,232.9,85,,,121.44,232.9,percent of total billed charges,
"BIOPSY OF THYROID,PERCUT(T)",60100F,CDM,60100,CPT,510,RC,,,facility,both,,,787,557.2,Aetna First Health,Commercial,,668.95,85,,,348.8,668.95,percent of total billed charges,
ASPIRAT&/OR INJTHYROID CYST(T),60300F,CDM,60300,CPT,510,RC,,,facility,both,,,468,331.34,Aetna First Health,Commercial,,397.8,85,,,207.42,397.8,percent of total billed charges,
"SPINAL PUNCTURE,LUMBAR,DX(T)",62270F,CDM,62270,CPT,510,RC,,,facility,both,,,963,681.8,Aetna First Health,Commercial,,818.55,85,,,426.8,818.55,percent of total billed charges,
"SPINAL PUNC,DRAIN,THERAPUTIC",62272F,CDM,62272,CPT,510,RC,,,facility,both,,,792,560.74,Aetna First Health,Commercial,,673.2,85,,,351.01,673.2,percent of total billed charges,
"INJ,LUMB EPIDUR,BLOOD/CLOT PATCH",62273F,CDM,62273,CPT,510,RC,,,facility,both,,,1304,923.23,Aetna First Health,Commercial,,1108.4,85,,,577.93,1108.4,percent of total billed charges,
"INJ FOR MYELOGRAM,CT-SPINAL(T)",62284F,CDM,62284,CPT,510,RC,,,facility,both,,,308,218.06,Aetna First Health,Commercial,,261.8,85,,,136.51,261.8,percent of total billed charges,
MYELO LUMBAR INJ W/S&I CERV,62302F,CDM,62302,CPT,510,RC,,,facility,both,,,1677,1187.32,Aetna First Health,Commercial,,1425.45,85,,,743.25,1425.45,percent of total billed charges,
MYELO LUMBAR INJ W/S&I THORA,62303F,CDM,62303,CPT,510,RC,,,facility,both,,,2791,1976.03,Aetna First Health,Commercial,,2372.35,85,,,1236.97,2372.35,percent of total billed charges,
MYELO LUMBAR INJ W/S&I LUMBO,62304F,CDM,62304,CPT,510,RC,,,facility,both,,,1987,1406.8,Aetna First Health,Commercial,,1688.95,85,,,880.64,1688.95,percent of total billed charges,
MYELO LUMBAR INJ W/S&I 2+REGION,62305F,CDM,62305,CPT,510,RC,,,facility,both,,,1355,959.34,Aetna First Health,Commercial,,1151.75,85,,,600.54,1151.75,percent of total billed charges,
INJ CERV/THORAC W/O IMAGE GUIDANCE,62320F,CDM,62320,CPT,510,RC,,,facility,both,,,1050,743.4,Aetna First Health,Commercial,,892.5,85,,,465.36,892.5,percent of total billed charges,
INJ CERV/THORAC WITH IMAGE GUIDANCE,62321F,CDM,62321,CPT,510,RC,,,facility,both,,,1473,1042.88,Aetna First Health,Commercial,,1252.05,85,,,652.83,1252.05,percent of total billed charges,
INJ LUMBAR/SACRAL W/O IMAGE GUIDANCE,62322F,CDM,62322,CPT,510,RC,,,facility,both,,,1382,978.46,Aetna First Health,Commercial,,1174.7,85,,,612.5,1174.7,percent of total billed charges,
INJ LUMBAR/SACRAL WITH IMAGE GUIDANCE,62323F,CDM,62323,CPT,510,RC,,,facility,both,,,1836,1299.89,Aetna First Health,Commercial,,1560.6,85,,,813.72,1560.6,percent of total billed charges,
"INJ/INFUS,CERV/THORAC,W/CATH,W/O IMAGE GUIDANCE",62324F,CDM,62324,CPT,510,RC,,,facility,both,,,1574,1114.39,Aetna First Health,Commercial,,1337.9,85,,,697.6,1337.9,percent of total billed charges,
"INJ/INFUS,CERV/THORAC,W/CATH,WITH IMAGE GUIDANCE",62325F,CDM,62325,CPT,510,RC,,,facility,both,,,1626,1151.21,Aetna First Health,Commercial,,1382.1,85,,,720.64,1382.1,percent of total billed charges,
"INJ/INFUS,LUMBAR/SACRAL W/O IMAGE GUIDANCE",62326F,CDM,62326,CPT,510,RC,,,facility,both,,,1213,858.8,Aetna First Health,Commercial,,1031.05,85,,,537.6,1031.05,percent of total billed charges,
"SPINAL PUNCTURE, LUMBAR, DIAG, W/FLUORO OR CT GUIDE",62328F,CDM,62328,CPT,510,RC,,,facility,both,,,1686,1193.69,Aetna First Health,Commercial,,1433.1,85,,,747.24,1433.1,percent of total billed charges,
"INJECT NERV BLCK,TRIGEMINAL",64400F,CDM,64400,CPT,510,RC,,,facility,both,,,547,387.28,Aetna First Health,Commercial,,464.95,85,,,242.43,464.95,percent of total billed charges,
"INJ NERV BLCK,GREAT OCCIPTL(T)",64405F,CDM,64405,CPT,510,RC,,,facility,both,,,407,288.16,Aetna First Health,Commercial,,345.95,85,,,180.38,345.95,percent of total billed charges,
"INJECT NERV BLCK,BRACH PLEXUS, INCL IMAGING",64415F,CDM,64415,CPT,510,RC,,,facility,both,,,1677,1187.32,Aetna First Health,Commercial,,1425.45,85,,,743.25,1425.45,percent of total billed charges,
"INJECT NERV BLCK,AXILLARY NERV, INCL IMAGING",64417F,CDM,64417,CPT,510,RC,,,facility,both,,,2040,1444.32,Aetna First Health,Commercial,,1734,85,,,904.13,1734,percent of total billed charges,
"INJECT NERV BLCK,ILIOINGU/ILIOHYP",64425F,CDM,64425,CPT,510,RC,,,facility,both,,,968,685.34,Aetna First Health,Commercial,,822.8,85,,,429.02,822.8,percent of total billed charges,
"INJECT NERV BLCK,SCIATIC NERVE, INCL IMAGING",64445F,CDM,64445,CPT,510,RC,,,facility,both,,,1226,868.01,Aetna First Health,Commercial,,1042.1,85,,,543.36,1042.1,percent of total billed charges,
"INJECT NERV BLCK, FEMORAL, INCL IMAGING",64447F,CDM,64447,CPT,510,RC,,,facility,both,,,880,623.04,Aetna First Health,Commercial,,748,85,,,390.02,748,percent of total billed charges,
"INJECT NERV BLCK, FEMORAL, CONT INFUSION, INCL IMAGING",64448F,CDM,64448,CPT,510,RC,,,facility,both,,,1249,884.29,Aetna First Health,Commercial,,1061.65,85,,,553.56,1061.65,percent of total billed charges,
INJ NERV BLCKOTHR PERIPHNRV(T),64450F,CDM,64450,CPT,510,RC,,,facility,both,,,679,480.73,Aetna First Health,Commercial,,577.15,85,,,300.93,577.15,percent of total billed charges,
"INJ,FORAMEN C/T,1 LEVEL(T)",64479F,CDM,64479,CPT,510,RC,,,facility,both,,,773,547.28,Aetna First Health,Commercial,,657.05,85,,,342.59,657.05,percent of total billed charges,
"INJ,FORAMEN C/T,ADDL LEVELS(T)",64480F,CDM,64480,CPT,510,RC,,,facility,both,,,750,531,Aetna First Health,Commercial,,637.5,85,,,332.4,637.5,percent of total billed charges,
"INJ,FORAMEN,L/S,1 LEVEL(T)",64483F,CDM,64483,CPT,510,RC,,,facility,both,,,1875,1327.5,Aetna First Health,Commercial,,1593.75,85,,,831,1593.75,percent of total billed charges,
"INJ,FORAMEN,L/S,ADDL LEVELS(T)",64484F,CDM,64484,CPT,510,RC,,,facility,both,,,923,653.48,Aetna First Health,Commercial,,784.55,85,,,409.07,784.55,percent of total billed charges,
TAP BLOCK BILATERAL BY INJECTION(S),64488F,CDM,64488,CPT,510,RC,,,facility,both,,,1036,733.49,Aetna First Health,Commercial,,880.6,85,,,459.16,880.6,percent of total billed charges,
INJ PARAVERT F JNT C/T1 LEV(T),64490F,CDM,64490,CPT,510,RC,,,facility,both,,,993,703.04,Aetna First Health,Commercial,,844.05,85,,,440.1,844.05,percent of total billed charges,
INJ PARAVERT F JNT C/T2 LEV(T),64491F,CDM,64491,CPT,510,RC,,,facility,both,,,609,431.17,Aetna First Health,Commercial,,517.65,85,,,269.91,517.65,percent of total billed charges,
INJ PARAVERT F JNT C/T3 LEV(T),64492F,CDM,64492,CPT,510,RC,,,facility,both,,,317,224.44,Aetna First Health,Commercial,,269.45,85,,,140.49,269.45,percent of total billed charges,
INJ PARAVERT F JNT L/S1 LEV(T),64493F,CDM,64493,CPT,510,RC,,,facility,both,,,1756,1243.25,Aetna First Health,Commercial,,1492.6,85,,,778.26,1492.6,percent of total billed charges,
INJ PARAVERT F JNT L/S2 LEV(T),64494F,CDM,64494,CPT,510,RC,,,facility,both,,,805,569.94,Aetna First Health,Commercial,,684.25,85,,,356.78,684.25,percent of total billed charges,
INJ PARAVERT F JNT L/S3 LEV(T),64495F,CDM,64495,CPT,510,RC,,,facility,both,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
"INJECT NERV BLCK,SPHENOPALAT GANGLN",64505F,CDM,64505,CPT,510,RC,,,facility,both,,,389,275.41,Aetna First Health,Commercial,,330.65,85,,,172.4,330.65,percent of total billed charges,
"INJECT NERV BLCK,PARAVERT SYMPATH",64520F,CDM,64520,CPT,510,RC,,,facility,both,,,1069,756.85,Aetna First Health,Commercial,,908.65,85,,,473.78,908.65,percent of total billed charges,
DESTROY CERV/THOR FACET JNT,64633F,CDM,64633,CPT,360,RC,,,facility,both,,,1382,978.46,Aetna First Health,Commercial,,1174.7,85,,,612.5,1174.7,percent of total billed charges,
DESTROY C/TH FACET JNT ADDL,64634F,CDM,64634,CPT,360,RC,,,facility,both,,,672,475.78,Aetna First Health,Commercial,,571.2,85,,,297.83,571.2,percent of total billed charges,
DESTROY LUMB/SAC FACET JNT,64635F,CDM,64635,CPT,360,RC,,,facility,both,,,1456,1030.85,Aetna First Health,Commercial,,1237.6,85,,,645.3,1237.6,percent of total billed charges,
DESTROY L/S FACET JNT ADDL,64636F,CDM,64636,CPT,360,RC,,,facility,both,,,699,494.89,Aetna First Health,Commercial,,594.15,85,,,309.8,594.15,percent of total billed charges,
"REMV F.B.,EYE,SUPERF CONJUNC",65205F,CDM,65205,CPT,510,RC,,,facility,both,,,426,301.61,Aetna First Health,Commercial,,362.1,85,,,188.8,362.1,percent of total billed charges,
"REMV F.B.,EYE,EMBED CONJUNC",65210F,CDM,65210,CPT,510,RC,,,facility,both,,,564,399.31,Aetna First Health,Commercial,,479.4,85,,,249.96,479.4,percent of total billed charges,
"REMV F.B.,EYE,CORNEA,NO SLIT",65220F,CDM,65220,CPT,510,RC,,,facility,both,,,487,344.8,Aetna First Health,Commercial,,413.95,85,,,215.84,413.95,percent of total billed charges,
"REMV F.B.,EYE,CORNEA,SLIT LAMP",65222F,CDM,65222,CPT,510,RC,,,facility,both,,,458,324.26,Aetna First Health,Commercial,,389.3,85,,,202.99,389.3,percent of total billed charges,
INJECT INTRAVITREAL PHARMCOLOGIC,67028F,CDM,67028,CPT,510,RC,,,facility,both,,,440,311.52,Aetna First Health,Commercial,,374,85,,,195.01,374,percent of total billed charges,
DRAINAGE OF EYELID ABSCESS,67700F,CDM,67700,CPT,510,RC,,,facility,both,,,424,300.19,Aetna First Health,Commercial,,360.4,85,,,187.92,360.4,percent of total billed charges,
"SUTURE EYELID WOUND,FULL THICK",67935F,CDM,67935,CPT,510,RC,,,facility,both,,,1903,1347.32,Aetna First Health,Commercial,,1617.55,85,,,843.41,1617.55,percent of total billed charges,
"REMOVE EYELID FOREIGN BODY,EMBEDDED",67938F,CDM,67938,CPT,510,RC,,,facility,both,,,474,335.59,Aetna First Health,Commercial,,402.9,85,,,210.08,402.9,percent of total billed charges,
"DRAIN EXT EAR ABSC/BLOOD,SIMPLE",69000F,CDM,69000,CPT,510,RC,,,facility,both,,,368,260.54,Aetna First Health,Commercial,,312.8,85,,,163.1,312.8,percent of total billed charges,
REMV EXT CANAL FOREIGN BODY,69200F,CDM,69200,CPT,510,RC,,,facility,both,,,262,185.5,Aetna First Health,Commercial,,222.7,85,,,116.12,222.7,percent of total billed charges,
REMOVE IMPACTED EAR WAX,69210F,CDM,69210,CPT,510,RC,,,facility,both,,,209,147.97,Aetna First Health,Commercial,,177.65,85,,,92.63,177.65,percent of total billed charges,
"US EXT NON-VASC LIMITED, REALTIME W/ IMG",76882F,CDM,76882,CPT,402,RC,,,facility,both,,,535,378.78,Aetna First Health,Commercial,,454.75,85,,,237.11,454.75,percent of total billed charges,
"US MUSCOSKELETAL LIMITED JOINT, TC",76882MSK01,CDM,76882,CPT,402,RC,,,facility,both,,,519,367.45,Aetna First Health,Commercial,TC,441.15,85,,,230.02,441.15,percent of total billed charges,
ALCOHOL,80307A,CDM,80307,CPT,300,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
URINE DRUG SCREEN,80307B,CDM,80307,CPT,300,RC,,,facility,both,,,408,288.86,Aetna First Health,Commercial,,346.8,85,,,180.83,346.8,percent of total billed charges,
OB URINE DRUG SCREEN,80307C,CDM,80307,CPT,300,RC,,,facility,both,,,364,257.71,Aetna First Health,Commercial,,309.4,85,,,161.32,309.4,percent of total billed charges,
SALICYLATE,80307D,CDM,80307,CPT,300,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
ACETAMINOPHEN,80307E,CDM,80307,CPT,300,RC,,,facility,both,,,155,109.74,Aetna First Health,Commercial,,131.75,85,,,68.7,131.75,percent of total billed charges,
"URINALYSIS, AUTO W/O SCOPE QW",81003QW,CDM,81003,CPT,300,RC,,,facility,both,,,72,50.98,Aetna First Health,Commercial,QW,61.2,85,,,31.91,61.2,percent of total billed charges,
REVEAL(R) POC PARAFFIN,81229A90,CDM,81229,CPT,310,RC,,,facility,both,,,1112,787.3,Aetna First Health,Commercial,90,945.2,85,,,492.84,945.2,percent of total billed charges,
HUNTINGTON DISEASE - REF,8140190C,CDM,81401,CPT,310,RC,,,facility,both,,,255,180.54,Aetna First Health,Commercial,90,216.75,85,,,113.02,216.75,percent of total billed charges,
DX OCCULT BLOOD IMMUNOASSAY,82274QW,CDM,82274,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,QW,96.05,85,,,50.08,96.05,percent of total billed charges,
PCB,82441A90,CDM,82441,CPT,300,RC,,,facility,both,,,140,99.12,Aetna First Health,Commercial,90,119,85,,,62.05,119,percent of total billed charges,
GLYCOSYLATED HEMOGLOBIN TEST QW,83036QW,CDM,83036,CPT,300,RC,,,facility,both,,,100,70.8,Aetna First Health,Commercial,QW,85,85,,,44.32,85,percent of total billed charges,
IMMUNOASSAY NOS - REF,8352090B,CDM,83520,CPT,300,RC,,,facility,both,,,160,113.28,Aetna First Health,Commercial,90,136,85,,,70.91,136,percent of total billed charges,
PYRROLES,8431190A,CDM,84311,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,90,96.05,85,,,50.08,96.05,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG), QUALITATIVE QW",84703QW,CDM,84703,CPT,300,RC,,,facility,both,,,146,103.37,Aetna First Health,Commercial,QW,124.1,85,,,64.71,124.1,percent of total billed charges,
HEMOGLOBIN,85018QW,CDM,85018,CPT,300,RC,,,facility,both,,,63,44.6,Aetna First Health,Commercial,QW,53.55,85,,,27.92,53.55,percent of total billed charges,
"ALLERGEN SPECIFIC IG PEANUT COMPONENTS, EACH ANTIBODY (PNTCO) - REF",8600890A,CDM,86008,CPT,300,RC,,,facility,both,,,317,224.44,Aetna First Health,Commercial,90,269.45,85,,,140.49,269.45,percent of total billed charges,
HETEROPHILE ANTIBODIES,86308QW,CDM,86308,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,QW,96.05,85,,,50.08,96.05,percent of total billed charges,
ORG ID AEROBIC-EACH,87077QW,CDM,87077,CPT,300,RC,,,facility,both,,,101,71.51,Aetna First Health,Commercial,QW,85.85,85,,,44.76,85.85,percent of total billed charges,
FLU DNA AMP PROBE 1ST 2 TYPES QW,87502QW,CDM,87502,CPT,300,RC,,,facility,both,,,384,271.87,Aetna First Health,Commercial,QW,326.4,85,,,170.19,326.4,percent of total billed charges,
RESP VIRUS 3-5 TARGETS,87631QW,CDM,87631,CPT,300,RC,,,facility,both,,,312,220.9,Aetna First Health,Commercial,QW,265.2,85,,,138.28,265.2,percent of total billed charges,
"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA);RESPIRATORY SYNCYTIAL VIRUS,AMPLIFIED PROBE",87634QW,CDM,87634,CPT,300,RC,,,facility,both,,,137,97,Aetna First Health,Commercial,QW,116.45,85,,,60.72,116.45,percent of total billed charges,
IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ QW,87635QW,CDM,87635,CPT,300,RC,,,facility,both,,,181,128.15,Aetna First Health,Commercial,QW,153.85,85,,,80.22,153.85,percent of total billed charges,
IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ QW,87651QW,CDM,87651,CPT,300,RC,,,facility,both,,,102,72.22,Aetna First Health,Commercial,QW,86.7,85,,,45.21,86.7,percent of total billed charges,
"FLOW CYTO, TECH, 1ST MRKR - REF (TEST ID CKNMM)",8818490A,CDM,88184,CPT,310,RC,,,facility,both,,,80,56.64,Aetna First Health,Commercial,90,68,85,,,35.46,68,percent of total billed charges,
FLOW CYTO EA ADDTL MARKER - REF (TEST ID CKNMN),8818590A,CDM,88185,CPT,310,RC,,,facility,both,,,118,83.54,Aetna First Health,Commercial,90,100.3,85,,,52.3,100.3,percent of total billed charges,
"13,21 POC ANEUPLOID",88271A90,CDM,88271,CPT,310,RC,,,facility,both,,,59,41.77,Aetna First Health,Commercial,90,50.15,85,,,26.15,50.15,percent of total billed charges,
"18,XY POC ANEUPLOID",88271B90,CDM,88271,CPT,310,RC,,,facility,both,,,58,41.06,Aetna First Health,Commercial,90,49.3,85,,,25.71,49.3,percent of total billed charges,
CEP16 POC ANEUPLOID,88271C90,CDM,88271,CPT,310,RC,,,facility,both,,,20,14.16,Aetna First Health,Commercial,90,17,85,,,8.86,17,percent of total billed charges,
EWS POC ANEUPLOID,88271D90,CDM,88271,CPT,310,RC,,,facility,both,,,20,14.16,Aetna First Health,Commercial,90,17,85,,,8.86,17,percent of total billed charges,
FISH INTER ANALYSIS 100-300,88275A90,CDM,88275,CPT,310,RC,,,facility,both,,,118,83.54,Aetna First Health,Commercial,90,100.3,85,,,52.3,100.3,percent of total billed charges,
"MORPHOMETRIC ANALYSIS, IN SITU HYBRID",8837790A,CDM,88377,CPT,310,RC,,,facility,both,,,504,356.83,Aetna First Health,Commercial,90,428.4,85,,,223.37,428.4,percent of total billed charges,
PSYCHIATRIC DIAGNOSTIC EVALUATION,90791F,CDM,90791,CPT,914,RC,,,facility,both,,,347,245.68,Aetna First Health,Commercial,,294.95,85,,,153.79,294.95,percent of total billed charges,
PSYCHIATRIC DIAGNOSTIC EVALUATION W/ MEDICAL SERVICES,90792F,CDM,90792,CPT,914,RC,,,facility,both,,,357,252.76,Aetna First Health,Commercial,,303.45,85,,,158.22,303.45,percent of total billed charges,
"PSYCHOTHERAPY, 30 MINUTES",90832F,CDM,90832,CPT,914,RC,,,facility,both,,,173,122.48,Aetna First Health,Commercial,,147.05,85,,,76.67,147.05,percent of total billed charges,
"PSYCHOTHERAPY, 45 MINUTES",90834F,CDM,90834,CPT,914,RC,,,facility,both,,,256,181.25,Aetna First Health,Commercial,,217.6,85,,,113.46,217.6,percent of total billed charges,
"PSYCHOTHERAPY, 60 MINUTES",90837F,CDM,90837,CPT,914,RC,,,facility,both,,,249,176.29,Aetna First Health,Commercial,,211.65,85,,,110.36,211.65,percent of total billed charges,
GROUP PSYCHOTHERAPY,90853F,CDM,90853,CPT,915,RC,,,facility,both,,,602,426.22,Aetna First Health,Commercial,,511.7,85,,,266.81,511.7,percent of total billed charges,
"BIOFEEDBACK TRAINING,ANY MODALITY",90901F,CDM,90901,CPT,420,RC,,,facility,both,,,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
NASOPHARYNGOSCOPY,92511F,CDM,92511,CPT,761,RC,,,facility,both,,,289,204.61,Aetna First Health,Commercial,,245.65,85,,,128.08,245.65,percent of total billed charges,
PRQ CARDIAC ANGIOPLAST 1 ART,92920F,CDM,92920,CPT,481,RC,,,facility,both,,,11817,8366.44,Aetna First Health,Commercial,,10044.45,85,,,5237.29,10044.45,percent of total billed charges,
PRQ CARDIAC ANGIO ADDL ART,92921F,CDM,92921,CPT,481,RC,,,facility,both,,,9245,6545.46,Aetna First Health,Commercial,,7858.25,85,,,4097.38,7858.25,percent of total billed charges,
PRQ CARD ANGIO/ATHRECT 1 ART,92924F,CDM,92924,CPT,481,RC,,,facility,both,,,12500,8850,Aetna First Health,Commercial,,10625,85,,,5540,10625,percent of total billed charges,
PRQ CARD STENT W/ANGIO 1 VSL,92928F,CDM,92928,CPT,481,RC,,,facility,both,,,17197,12175.48,Aetna First Health,Commercial,,14617.45,85,,,7621.71,14617.45,percent of total billed charges,
PRQ CARD STENT W/ANGIO ADDL,92929F,CDM,92929,CPT,481,RC,,,facility,both,,,8160,5777.28,Aetna First Health,Commercial,,6936,85,,,3616.51,6936,percent of total billed charges,
PRQ CARD STENT/ATH/ANGIO,92933F,CDM,92933,CPT,481,RC,,,facility,both,,,14619,10350.25,Aetna First Health,Commercial,,12426.15,85,,,6479.14,12426.15,percent of total billed charges,
PRQ REVASC BYP GRAFT 1 VSL,92937F,CDM,92937,CPT,481,RC,,,facility,both,,,16067,11375.44,Aetna First Health,Commercial,,13656.95,85,,,7120.89,13656.95,percent of total billed charges,
PRQ CARD REVASC MI 1 VSL,92941F,CDM,92941,CPT,481,RC,,,facility,both,,,25110,17777.88,Aetna First Health,Commercial,,21343.5,85,,,11128.75,21343.5,percent of total billed charges,
PRQ CARD REVASC CHRONIC 1VSL,92943F,CDM,92943,CPT,481,RC,,,facility,both,,,16081,11385.35,Aetna First Health,Commercial,,13668.85,85,,,7127.1,13668.85,percent of total billed charges,
PRQ CARD REVASC CHRONIC ADDL,92944F,CDM,92944,CPT,481,RC,,,facility,both,,,19632,13899.46,Aetna First Health,Commercial,,16687.2,85,,,8700.9,16687.2,percent of total billed charges,
HEART/LUNG RESUSCITATION (CPR),92950F,CDM,92950,CPT,480,RC,,,facility,both,,,831,588.35,Aetna First Health,Commercial,,706.35,85,,,368.3,706.35,percent of total billed charges,
TEMPORARY EXTERNAL PACING,92953F,CDM,92953,CPT,480,RC,,,facility,both,,,274,193.99,Aetna First Health,Commercial,,232.9,85,,,121.44,232.9,percent of total billed charges,
"CARDIOVERSION, ELECTIVE;EXTERN",92960F,CDM,92960,CPT,480,RC,,,facility,both,,,1652,1169.62,Aetna First Health,Commercial,,1404.2,85,,,732.17,1404.2,percent of total billed charges,
PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY,92972F,CDM,92972,CPT,481,RC,,,facility,both,,,6463,4575.8,Aetna First Health,Commercial,,5493.55,85,,,2864.4,5493.55,percent of total billed charges,
PERCUT CORONARY THROMBECTOMY,92973F,CDM,92973,CPT,480,RC,,,facility,both,,,5319,3765.85,Aetna First Health,Commercial,,4521.15,85,,,2357.38,4521.15,percent of total billed charges,
TTE CONGENITAL ANOM,93303C01,CDM,93303,CPT,483,RC,,,facility,both,,,1113,788,Aetna First Health,Commercial,TC,946.05,85,,,493.28,946.05,percent of total billed charges,
"TTE W/DOPPLER, COMPLETE",93306C01,CDM,93306,CPT,483,RC,,,facility,both,,,1995,1412.46,Aetna First Health,Commercial,TC,1695.75,85,,,884.18,1695.75,percent of total billed charges,
ECHO TT 2D COMPLETE,93307C01,CDM,93307,CPT,483,RC,,,facility,both,,,1034,732.07,Aetna First Health,Commercial,TC,878.9,85,,,458.27,878.9,percent of total billed charges,
"ECHO HEART XTHORACIC,LIMITED",93308C01,CDM,93308,CPT,483,RC,,,facility,both,,,895,633.66,Aetna First Health,Commercial,TC,760.75,85,,,396.66,760.75,percent of total billed charges,
"ECHO HEART,TRANSESOPH,PROBE PLACEMT",93313F,CDM,93313,CPT,480,RC,,,facility,both,,,774,547.99,Aetna First Health,Commercial,,657.9,85,,,343.04,657.9,percent of total billed charges,
TTE 2D STRESS,93350C01,CDM,93350,CPT,483,RC,,,facility,both,,,1590,1125.72,Aetna First Health,Commercial,TC,1351.5,85,,,704.69,1351.5,percent of total billed charges,
MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH,93356F,CDM,93356,CPT,480,RC,,,facility,both,,,392,277.54,Aetna First Health,Commercial,,333.2,85,,,173.73,333.2,percent of total billed charges,
DRUG ADMIN & HEMODYNMIC MEASR,93463F,CDM,93463,CPT,480,RC,,,facility,both,,,829,586.93,Aetna First Health,Commercial,,704.65,85,,,367.41,704.65,percent of total billed charges,
INSERT/PLACE FLOW DIRECT CATH,93503F,CDM,93503,CPT,481,RC,,,facility,both,,,1806,1278.65,Aetna First Health,Commercial,,1535.1,85,,,800.42,1535.1,percent of total billed charges,
INJECT SUPRVLV AORTOGRAPHY,93567F,CDM,93567,CPT,480,RC,,,facility,both,,,966,683.93,Aetna First Health,Commercial,,821.1,85,,,428.13,821.1,percent of total billed charges,
INJECT PULM ART HRT CATH,93568F,CDM,93568,CPT,480,RC,,,facility,both,,,893,632.24,Aetna First Health,Commercial,,759.05,85,,,395.78,759.05,percent of total billed charges,
CARDIAC REHAB/MONITOR,93798F,CDM,93798,CPT,943,RC,,,facility,both,,,277,196.12,Aetna First Health,Commercial,,235.45,85,,,122.77,235.45,percent of total billed charges,
INITIAL VENTILATOR MGMT.FIRST DAY,94002F,CDM,94002,CPT,410,RC,,,facility,both,,,891,630.83,Aetna First Health,Commercial,,757.35,85,,,394.89,757.35,percent of total billed charges,
VENTILATOR MGMT.SUBSEQ DAYS,94003F,CDM,94003,CPT,410,RC,,,facility,both,,,499,353.29,Aetna First Health,Commercial,,424.15,85,,,221.16,424.15,percent of total billed charges,
AIRWAY INHALATION TREATMENT,94640F,CDM,94640,CPT,410,RC,,,facility,both,,,199,140.89,Aetna First Health,Commercial,,169.15,85,,,88.2,169.15,percent of total billed charges,
AEROSOL INHALATION TREATMENT,94642F,CDM,94642,CPT,410,RC,,,facility,both,,,411,290.99,Aetna First Health,Commercial,,349.35,85,,,182.16,349.35,percent of total billed charges,
"INHALATION TREATMENT, CONTINUOUS, 1ST HR",94644F,CDM,94644,CPT,410,RC,,,facility,both,,,249,176.29,Aetna First Health,Commercial,,211.65,85,,,110.36,211.65,percent of total billed charges,
"INHALATION TREATMENT, CONTINUOUS, ADDL HR",94645F,CDM,94645,CPT,410,RC,,,facility,both,,,98,69.38,Aetna First Health,Commercial,,83.3,85,,,43.43,83.3,percent of total billed charges,
"POS AIRWAY PRESSURE, BIPAP",94660.01F,CDM,94660,CPT,410,RC,,,facility,both,,,1009,714.37,Aetna First Health,Commercial,,857.65,85,,,447.19,857.65,percent of total billed charges,
CPAP/BIPAP MGMNT-PT OWN EQUIPMENT,94660.02F,CDM,94660,CPT,410,RC,,,facility,both,,,108,76.46,Aetna First Health,Commercial,,91.8,85,,,47.87,91.8,percent of total billed charges,
"POS AIRWAY PRESSURE, CPAP",94660F,CDM,94660,CPT,410,RC,,,facility,both,,,677,479.32,Aetna First Health,Commercial,,575.45,85,,,300.05,575.45,percent of total billed charges,
AEROSOL OR VAPOR INHALATIONS,94664F,CDM,94664,CPT,410,RC,,,facility,both,,,184,130.27,Aetna First Health,Commercial,,156.4,85,,,81.55,156.4,percent of total billed charges,
"CHEST WALL MANIPULATION,INITIAL",94667F,CDM,94667,CPT,410,RC,,,facility,both,,,203,143.72,Aetna First Health,Commercial,,172.55,85,,,89.97,172.55,percent of total billed charges,
"CHEST WALL MANIPULATION,SUBSEQUENT",94668F,CDM,94668,CPT,410,RC,,,facility,both,,,171,121.07,Aetna First Health,Commercial,,145.35,85,,,75.79,145.35,percent of total billed charges,
ASSESSMENT OF APHASIA,96105F,CDM,96105,CPT,918,RC,,,facility,both,,,270,191.16,Aetna First Health,Commercial,,229.5,85,,,119.66,229.5,percent of total billed charges,
"DEVELOPMENTAL TEST W/ INTERP & REPORT; PHYSICIAN/QHP, FIRST HOUR",96112F,CDM,96112,CPT,918,RC,,,facility,both,,,423,299.48,Aetna First Health,Commercial,,359.55,85,,,187.47,359.55,percent of total billed charges,
STND COG PERFORMNCE TEST 1 HR,96125F,CDM,96125,CPT,918,RC,,,facility,both,,,329,232.93,Aetna First Health,Commercial,,279.65,85,,,145.81,279.65,percent of total billed charges,
"CHEMOTHER, INTO CNS",96450F,CDM,96450,CPT,335,RC,,,facility,both,,,637,451,Aetna First Health,Commercial,,541.45,85,,,282.32,541.45,percent of total billed charges,
"CHEMOTHER INJECT,SUBARACH/INTRAVENT",96542F,CDM,96542,CPT,335,RC,,,facility,both,,,258,182.66,Aetna First Health,Commercial,,219.3,85,,,114.35,219.3,percent of total billed charges,
"SELECTIVE DEBRIDEMENT, W/O ANESTHESIA, SURFACE AREA 20 SQ CM OR LESS",97597F,CDM,97597,CPT,510,RC,,,facility,both,,,299,211.69,Aetna First Health,Commercial,,254.15,85,,,132.52,254.15,percent of total billed charges,
"SELECTIVE DEBRIDEMENT, W/O ANESTHESIA, SURFACE AREA >20 SQ CM",97598F,CDM,97598,CPT,510,RC,,,facility,both,,,254,179.83,Aetna First Health,Commercial,,215.9,85,,,112.57,215.9,percent of total billed charges,
NEG PRESSURE WOUND THERAPY DME </=50 SQ CM,97605F,CDM,97605,CPT,510,RC,,,facility,both,,,399,282.49,Aetna First Health,Commercial,,339.15,85,,,176.84,339.15,percent of total billed charges,
NEG PRESSURE WOUND THERAPY DME >50 SQ CM,97606F,CDM,97606,CPT,761,RC,,,facility,both,,,416,294.53,Aetna First Health,Commercial,,353.6,85,,,184.37,353.6,percent of total billed charges,
MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS,99151F,CDM,99151,CPT,370,RC,,,facility,both,,,592,419.14,Aetna First Health,Commercial,,503.2,85,,,262.37,503.2,percent of total billed charges,
MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS,99152F,CDM,99152,CPT,370,RC,,,facility,both,,,470,332.76,Aetna First Health,Commercial,,399.5,85,,,208.3,399.5,percent of total billed charges,
MOD SED SAME PHYS/QHP EACH ADDL 15 MINS,99153F,CDM,99153,CPT,370,RC,,,facility,both,,,352,249.22,Aetna First Health,Commercial,,299.2,85,,,156.01,299.2,percent of total billed charges,
MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS,99155F,CDM,99155,CPT,370,RC,,,facility,both,,,118,83.54,Aetna First Health,Commercial,,100.3,85,,,52.3,100.3,percent of total billed charges,
MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS,99156F,CDM,99156,CPT,370,RC,,,facility,both,,,128,90.62,Aetna First Health,Commercial,,108.8,85,,,56.73,108.8,percent of total billed charges,
MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS,99157F,CDM,99157,CPT,370,RC,,,facility,both,,,202,143.02,Aetna First Health,Commercial,,171.7,85,,,89.53,171.7,percent of total billed charges,
"OFFICE/OUTPT VISIT,NEW,LEVL II",99202F,CDM,99202,CPT,510,RC,,,facility,both,,,91,64.43,Aetna First Health,Commercial,,77.35,85,,,40.33,77.35,percent of total billed charges,
"OFFICE/OUTPT VISIT,NEW,LEVL III",99203F,CDM,99203,CPT,510,RC,,,facility,both,,,131,92.75,Aetna First Health,Commercial,,111.35,85,,,58.06,111.35,percent of total billed charges,
"OFFICE/OUTPT VISIT,NEW,LEVL IV",99204F,CDM,99204,CPT,510,RC,,,facility,both,,,200,141.6,Aetna First Health,Commercial,,170,85,,,88.64,170,percent of total billed charges,
"OFFICE/OUTPT VISIT,NEW,LEVL V",99205F,CDM,99205,CPT,510,RC,,,facility,both,,,254,179.83,Aetna First Health,Commercial,,215.9,85,,,112.57,215.9,percent of total billed charges,
"ET THERAPY, 1-15 MINUTES",99211.01F,CDM,99211,CPT,761,RC,,,facility,both,,,165,116.82,Aetna First Health,Commercial,,140.25,85,,,73.13,140.25,percent of total billed charges,
AMS - E/M,99211.03F,CDM,99211,CPT,510,RC,,,facility,both,,,62,43.9,Aetna First Health,Commercial,,52.7,85,,,27.48,52.7,percent of total billed charges,
OFFICE/OUTPT VISIT EST LEVEL I,99211F,CDM,99211,CPT,510,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,,57.8,85,,,30.14,57.8,percent of total billed charges,
"ET THERAPY, 16-30 MINUTES",99212.01F,CDM,99212,CPT,761,RC,,,facility,both,,,268,189.74,Aetna First Health,Commercial,,227.8,85,,,118.78,227.8,percent of total billed charges,
"OFFICE/OUTPT VISIT,EST,LEVL II",99212F,CDM,99212,CPT,510,RC,,,facility,both,,,65,46.02,Aetna First Health,Commercial,,55.25,85,,,28.81,55.25,percent of total billed charges,
"ET THERAPY, 31-45 MINUTES",99213.01F,CDM,99213,CPT,761,RC,,,facility,both,,,371,262.67,Aetna First Health,Commercial,,315.35,85,,,164.43,315.35,percent of total billed charges,
"OFFICE/OUTPT VISIT,EST,LEVL III",99213F,CDM,99213,CPT,510,RC,,,facility,both,,,105,74.34,Aetna First Health,Commercial,,89.25,85,,,46.54,89.25,percent of total billed charges,
"ET THERAPY, 46-90 MINUTES",99214.01F,CDM,99214,CPT,761,RC,,,facility,both,,,478,338.42,Aetna First Health,Commercial,,406.3,85,,,211.85,406.3,percent of total billed charges,
"OFFICE/OUTPT VISIT,EST,LEVL IV",99214F,CDM,99214,CPT,510,RC,,,facility,both,,,147,104.08,Aetna First Health,Commercial,,124.95,85,,,65.15,124.95,percent of total billed charges,
"OFFICE/OUTPT VISIT,EST,LEVL V",99215F,CDM,99215,CPT,510,RC,,,facility,both,,,206,145.85,Aetna First Health,Commercial,,175.1,85,,,91.3,175.1,percent of total billed charges,
FACILITY EMERGENCY LEVEL 1 VISIT,99281F,CDM,99281,CPT,450,RC,,,facility,both,,,310,219.48,Aetna First Health,Commercial,,263.5,85,,,137.39,263.5,percent of total billed charges,
FACILITY EMERGENCY LEVEL II VISIT,99282F,CDM,99282,CPT,450,RC,,,facility,both,,,525,371.7,Aetna First Health,Commercial,,446.25,85,,,232.68,446.25,percent of total billed charges,
FACILITY EMERGENCY LEVEL III VISIT,99283F,CDM,99283,CPT,450,RC,,,facility,both,,,820,580.56,Aetna First Health,Commercial,,697,85,,,363.42,697,percent of total billed charges,
FACILITY EMERGENCY LEVEL IV VISIT,99284F,CDM,99284,CPT,450,RC,,,facility,both,,,1270,899.16,Aetna First Health,Commercial,,1079.5,85,,,562.86,1079.5,percent of total billed charges,
FACILITY EMERGENCY LEVEL V VISIT,99285F,CDM,99285,CPT,450,RC,,,facility,both,,,1675,1185.9,Aetna First Health,Commercial,,1423.75,85,,,742.36,1423.75,percent of total billed charges,
"FACILITY CRITICAL CARE, E/M 30-74 MINUTES",99291F,CDM,99291,CPT,510,RC,,,facility,both,,,2980,2109.84,Aetna First Health,Commercial,,2533,85,,,1320.74,2533,percent of total billed charges,
"FACILITY CRITICAL CARE, ADDL 30 MIN",99292F,CDM,99292,CPT,510,RC,,,facility,both,,,862,610.3,Aetna First Health,Commercial,,732.7,85,,,382.04,732.7,percent of total billed charges,
ATTENDANCE AT DELIVERY,99464F,CDM,99464,CPT,720,RC,,,facility,both,,,567,401.44,Aetna First Health,Commercial,,481.95,85,,,251.29,481.95,percent of total billed charges,
NB RESUSCITATION,99465F,CDM,99465,CPT,720,RC,,,facility,both,,,1218,862.34,Aetna First Health,Commercial,,1035.3,85,,,539.82,1035.3,percent of total billed charges,
SLINGS,A4565,CDM,A4565,CPT,274,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
"SLING, ARM SMALL",A4565.06,CDM,A4565,CPT,274,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
"SLING, ARM XLARGE",A4565.07,CDM,A4565,CPT,274,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
"SLING, ARM LARGE",A4565.12,CDM,A4565,CPT,274,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
"SLING, ARM MEDIUM",A4565.13,CDM,A4565,CPT,274,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
ARM SLING,A4565.17,CDM,A4565,CPT,274,RC,,,facility,both,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
SLING,A4565.90,CDM,A4565,CPT,274,RC,,,facility,inpatient,,,15,10.62,Aetna First Health,Commercial,,12.75,85,,,6.65,12.75,percent of total billed charges,
SPACER BAG/RESERVOIR,A4627,CDM,A4627,CPT,290,RC,,,facility,both,,,26,18.41,Aetna First Health,Commercial,,22.1,85,,,11.52,22.1,percent of total billed charges,
"HYDROMARK, PER MARKER",A4648.02,CDM,A4648,CPT,278,RC,,,facility,both,,,122,86.38,Aetna First Health,Commercial,,103.7,85,,,54.07,103.7,percent of total billed charges,
POUCH FECAL K 2.75IN   18174,A5061,CDM,A5061,CPT,272,RC,,,facility,inpatient,,,25,17.7,Aetna First Health,Commercial,,21.25,85,,,11.08,21.25,percent of total billed charges,
"SUPPLY TECHNICIUM SESTAMIBI,PER DOSE",A9500,CDM,A9500,CPT,343,RC,,,facility,both,,,389,275.41,Aetna First Health,Commercial,,330.65,85,,,172.4,330.65,percent of total billed charges,
SUPPLY TECHNICIUM TETROFOSMIN / DOSE,A9502,CDM,A9502,CPT,343,RC,,,facility,both,,,157,111.16,Aetna First Health,Commercial,,133.45,85,,,69.58,133.45,percent of total billed charges,
"SUPPLY TECHNETIUM MEDRONATE,TO 30 MC",A9503,CDM,A9503,CPT,343,RC,,,facility,both,,,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
"SUPPLY THALLIUM CH TL201,PER MCI",A9505,CDM,A9505,CPT,343,RC,,,facility,both,,,49,34.69,Aetna First Health,Commercial,,41.65,85,,,21.72,41.65,percent of total billed charges,
"IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER MILLICURIE",A9509.01,CDM,A9509,CPT,343,RC,,,facility,both,,,735,520.38,Aetna First Health,Commercial,,624.75,85,,,325.75,624.75,percent of total billed charges,
"PERTECHNETATE, DIA, PER MCI",A9512,CDM,A9512,CPT,343,RC,,,facility,both,,,22,15.58,Aetna First Health,Commercial,,18.7,85,,,9.75,18.7,percent of total billed charges,
IODINE I-123 100 MICROCURIES,A9516,CDM,A9516,CPT,343,RC,,,facility,both,,,116,82.13,Aetna First Health,Commercial,,98.6,85,,,51.41,98.6,percent of total billed charges,
SODIU IODI CAP THER PER MCI,A9517,CDM,A9517,CPT,344,RC,,,facility,both,,,48,33.98,Aetna First Health,Commercial,,40.8,85,,,21.27,40.8,percent of total billed charges,
TCHNETIUM TC99 TILMANOCEPT,A9520.01,CDM,A9520,CPT,343,RC,,,facility,both,,,700,495.6,Aetna First Health,Commercial,,595,85,,,310.24,595,percent of total billed charges,
TC99 MEBROFENIN TO 15 MCI,A9537,CDM,A9537,CPT,343,RC,,,facility,both,,,133,94.16,Aetna First Health,Commercial,,113.05,85,,,58.95,113.05,percent of total billed charges,
TC99M PENTETATE TO 25 MCI,A9539,CDM,A9539,CPT,343,RC,,,facility,both,,,255,180.54,Aetna First Health,Commercial,,216.75,85,,,113.02,216.75,percent of total billed charges,
TC99M ALBUMIN AGGR 1 MCI,A9540,CDM,A9540,CPT,343,RC,,,facility,both,,,758,536.66,Aetna First Health,Commercial,,644.3,85,,,335.95,644.3,percent of total billed charges,
SULFUR COLLOID PER DOSE,A9541,CDM,A9541,CPT,343,RC,,,facility,both,,,217,153.64,Aetna First Health,Commercial,,184.45,85,,,96.17,184.45,percent of total billed charges,
F-18 FDG PER DOSE TO 45MCI,A9552,CDM,A9552,CPT,343,RC,,,facility,both,,,1211,857.39,Aetna First Health,Commercial,,1029.35,85,,,536.72,1029.35,percent of total billed charges,
GALLIUM GA-67 SUPPLY PER MCI,A9556,CDM,A9556,CPT,343,RC,,,facility,both,,,69,48.85,Aetna First Health,Commercial,,58.65,85,,,30.58,58.65,percent of total billed charges,
TC99 LABELED RBC TO 30 MCI,A9560,CDM,A9560,CPT,343,RC,,,facility,both,,,250,177,Aetna First Health,Commercial,,212.5,85,,,110.8,212.5,percent of total billed charges,
TC99 MERTIATIDE TO 15 MCI,A9562,CDM,A9562,CPT,343,RC,,,facility,both,,,622,440.38,Aetna First Health,Commercial,,528.7,85,,,275.67,528.7,percent of total billed charges,
"TC99 PENTETATE AERO, DOSE-75MC",A9567,CDM,A9567,CPT,343,RC,,,facility,both,,,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
INDIUM IN-111 PENTETREOTIDE,A9572,CDM,A9572,CPT,343,RC,,,facility,both,,,5993,4243.04,Aetna First Health,Commercial,,5094.05,85,,,2656.1,5094.05,percent of total billed charges,
gadoteridol 279.3 MG/ML Solution 20 mL Vial,A9576,CDM,A9576,CPT,636,RC,00270111103,NDC,facility,both,0.5,ML,118.24,83.71,Aetna First Health,Commercial,,100.5,85,,,52.4,100.5,percent of total billed charges,
gadoteridol 279.3 MG/ML Solution 15 mL Vial,A9576,CDM,A9576,CPT,636,RC,00270111102,NDC,facility,both,0.66667,ML,127.67,90.39,Aetna First Health,Commercial,,108.52,85,,,56.58,108.52,percent of total billed charges,
gadoteridol 279.3 MG/ML Solution 10 mL Vial,A9576,CDM,A9576,CPT,636,RC,00270111101,NDC,facility,both,1,ML,130.86,92.65,Aetna First Health,Commercial,,111.23,85,,,58,111.23,percent of total billed charges,
gadoteridol 279.3 MG/ML Solution 10 mL Syringe,A9576,CDM,A9576,CPT,636,RC,00270111116,NDC,facility,both,1,ML,136.71,96.79,Aetna First Health,Commercial,,116.2,85,,,60.59,116.2,percent of total billed charges,
gadobenate dimeglumine 529 MG/ML Solution 20 mL Vial,A9577,CDM,A9577,CPT,636,RC,00270516415,NDC,facility,both,0.75,ML,177.36,125.57,Aetna First Health,Commercial,,150.76,85,,,78.61,150.76,percent of total billed charges,
gadobenate in sodium chloride 0.9% 5.29-0.9 MG/ML-% Solution 10 mL Bottle,A9577,CDM,A9577,CPT,636,RC,88887800065,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
gadobenate dimeglumine 529 MG/ML Solution 15 mL Vial,A9577,CDM,A9577,CPT,636,RC,00270516414,NDC,facility,both,1,ML,191.5,135.58,Aetna First Health,Commercial,,162.78,85,,,84.87,162.78,percent of total billed charges,
gadodiamide 287 MG/ML Solution 20 mL Vial,A9579,CDM,A9579,CPT,636,RC,00407069020,NDC,facility,both,0.5,ML,115.81,81.99,Aetna First Health,Commercial,,98.44,85,,,51.33,98.44,percent of total billed charges,
gadodiamide 287 MG/ML Solution 20 mL Vial,A9579,CDM,A9579,CPT,636,RC,00407069050,NDC,facility,both,0.5,ML,115.81,81.99,Aetna First Health,Commercial,,98.44,85,,,51.33,98.44,percent of total billed charges,
gadodiamide 287 MG/ML Solution 15 mL Vial,A9579,CDM,A9579,CPT,636,RC,00407069015,NDC,facility,both,0.66667,ML,124.99,88.49,Aetna First Health,Commercial,,106.24,85,,,55.4,106.24,percent of total billed charges,
gadodiamide 287 MG/ML Solution 10 mL Vial,A9579,CDM,A9579,CPT,636,RC,00407069030,NDC,facility,both,1,ML,127.94,90.58,Aetna First Health,Commercial,,108.75,85,,,56.7,108.75,percent of total billed charges,
gadodiamide 287 MG/ML Solution 10 mL Syringe,A9579,CDM,A9579,CPT,636,RC,00407069012,NDC,facility,both,1,ML,132.68,93.94,Aetna First Health,Commercial,,112.78,85,,,58.8,112.78,percent of total billed charges,
gadodiamide 287 MG/ML Solution 15 mL Vial,A9579,CDM,A9579,CPT,636,RC,00407069040,NDC,facility,both,1,ML,187.48,132.74,Aetna First Health,Commercial,,159.36,85,,,83.09,159.36,percent of total billed charges,
gadodiamide 287 MG/ML Solution 5 mL Vial,A9579,CDM,A9579,CPT,636,RC,00407069005,NDC,facility,both,2,ML,130.88,92.66,Aetna First Health,Commercial,,111.25,85,,,58.01,111.25,percent of total billed charges,
gadoxetate disodium 0.25 MOL/L Solution 15 mL Vial,A9581,CDM,A9581,CPT,636,RC,50419032015,NDC,facility,both,0.66667,ML,380.25,269.22,Aetna First Health,Commercial,,323.21,85,,,168.53,323.21,percent of total billed charges,
gadoxetate disodium 0.25 MOL/L Solution 10 mL Vial,A9581,CDM,A9581,CPT,636,RC,50419032001,NDC,facility,both,1,ML,307.13,217.45,Aetna First Health,Commercial,,261.06,85,,,136.12,261.06,percent of total billed charges,
gadoxetate disodium 0.25 MOL/L Solution 10 mL Vial,A9581,CDM,A9581,CPT,636,RC,50419032005,NDC,facility,both,1,ML,319.41,226.14,Aetna First Health,Commercial,,271.5,85,,,141.56,271.5,percent of total billed charges,
gadobutrol 1 mmol/mL Solution 2 mL Vial,A9585,CDM,A9585,CPT,636,RC,50419032537,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
gadobutrol 1 mmol/mL Solution 7.5 mL Vial,A9585,CDM,A9585,CPT,636,RC,50419032501,NDC,facility,both,1,ML,140.06,99.16,Aetna First Health,Commercial,,119.05,85,,,62.07,119.05,percent of total billed charges,
gadobutrol 1 mmol/mL Solution 7.5 mL Vial,A9585,CDM,A9585,CPT,636,RC,50419032511,NDC,facility,both,1,ML,140.06,99.16,Aetna First Health,Commercial,,119.05,85,,,62.07,119.05,percent of total billed charges,
gadobutrol 1 mmol/mL Solution 10 mL Vial,A9585,CDM,A9585,CPT,636,RC,50419032512,NDC,facility,both,1,ML,186.75,132.22,Aetna First Health,Commercial,,158.74,85,,,82.77,158.74,percent of total billed charges,
gadobutrol 1 mmol/mL Solution 15 mL Vial,A9585,CDM,A9585,CPT,636,RC,50419032503,NDC,facility,both,1,ML,280.13,198.33,Aetna First Health,Commercial,,238.11,85,,,124.15,238.11,percent of total billed charges,
gadobutrol 1 mmol/mL Solution 15 mL Vial,A9585,CDM,A9585,CPT,636,RC,50419032513,NDC,facility,both,1,ML,280.13,198.33,Aetna First Health,Commercial,,238.11,85,,,124.15,238.11,percent of total billed charges,
gozetotide Ga-68 PSMA-11 25 MCG Kit 1 Each Box,A9596,CDM,A9596,CPT,343,RC,74725010064,NDC,facility,both,0.0597,EA,660.9,467.92,Aetna First Health,Commercial,,561.76,85,,,292.91,561.76,percent of total billed charges,
Fludeoxyglucose F 18 20-500 MCI/ML Solution 1 Each Kit,A9609,CDM,A9609,CPT,343,RC,65857010103,NDC,facility,both,1,EA,684.7,484.77,Aetna First Health,Commercial,,582,85,,,303.46,582,percent of total billed charges,
Fludeoxyglucose F 18 20-500 MCI/ML Solution 1 Each Vial,A9609,CDM,A9609,CPT,343,RC,65857015030,NDC,facility,both,1,EA,684.7,484.77,Aetna First Health,Commercial,,582,85,,,303.46,582,percent of total billed charges,
HEMOSTAT ENDOSCOPIC 7FR HEMOSPRAY  G56572,C1052,CDM,C1052,CPT,278,RC,,,facility,inpatient,,,3443,2437.64,Aetna First Health,Commercial,,2926.55,85,,,1525.94,2926.55,percent of total billed charges,
PIN STEINMAN TROCAR PT 3/32IN   KM168-19-33,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,12,8.5,Aetna First Health,Commercial,,10.2,85,,,5.32,10.2,percent of total billed charges,
PIN FIXATION SMOOTH STEINMAN 9IN 5/32IN DIAMOND SINGLE  KM168-39-53,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
PIN STEINMAN TROCAR PT 3/16IN   KM168-19-31,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
WIRE K-WIRE 1.6X150MM SS   390164,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,23,16.28,Aetna First Health,Commercial,,19.55,85,,,10.19,19.55,percent of total billed charges,
PIN STEINMAN TROCAR PT FULLY THREADED 3/16IN  KM169-19-31,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,26,18.41,Aetna First Health,Commercial,,22.1,85,,,11.52,22.1,percent of total billed charges,
WIRE K-WIRE SYNT 1.25MM W/TROCAR POINT 150MM  292.12,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
SCREW SYNT CANC FT 4 X 12MM   206.012,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,66,46.73,Aetna First Health,Commercial,,56.1,85,,,29.25,56.1,percent of total billed charges,
SCREW SYNT CANC FT 4 X 14MM   206.014,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,66,46.73,Aetna First Health,Commercial,,56.1,85,,,29.25,56.1,percent of total billed charges,
WIRE K-WIRE SYNT 1.6MM W/TROCAR POINT 150MM  292.16,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 10MM  204.810,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 14MM  204.814,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 18MM  204.818,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 20MM  204.820,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 26MM  204.826,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 32MM  204.832,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 40MM  204.840,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 50MM  204.850,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 32MM  214.832,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 36MM  214.836,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 40MM  214.840,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 42MM  214.842,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 44MM  214.844,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 46MM  214.846,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
WIRE K-WIRE .045IN X4IN DOUBLE POINT 172-24-45  KM172-24-45,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,17,12.04,Aetna First Health,Commercial,,14.45,85,,,7.53,14.45,percent of total billed charges,
PIN ADAPTER PACING ACCESSORY   DINAPT,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
SCREW SYNT CORT LOW PROF T15 STRDRV 3.5X45MM  02.206.245,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,103,72.92,Aetna First Health,Commercial,,87.55,85,,,45.65,87.55,percent of total billed charges,
SCREW SYNT CORT LOW PROF T15 STRDRV 3.5 X 28MM  02.206.228,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
SCREW SYNT CORT LOW PROF T15 STRDRV 3.5 X 36MM  02.206.236,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
SCREW SYNT CORT LOW PROF T15 STRDRV 3.5 X 38MM  02.206.238,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,111,78.59,Aetna First Health,Commercial,,94.35,85,,,49.2,94.35,percent of total billed charges,
SCREW SYNT CORT S-TAP 2.7 X 18MM  202.818,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
SCREW SYNT CORT S-TAP 2.7 X 20MM  202.820,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
SCREW SYNT CORT S-TAP 2.7 X 22MM  202.822,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
SCREW SYNT CANC PT 4 X 40MM   207.040,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,63,44.6,Aetna First Health,Commercial,,53.55,85,,,27.92,53.55,percent of total billed charges,
SCREW SYNT CANC FT 4 X 16MM   206.016,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,66,46.73,Aetna First Health,Commercial,,56.1,85,,,29.25,56.1,percent of total billed charges,
WIRE FIXATION KIRSCHNER SS 2.0MM  29020280,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,135,95.58,Aetna First Health,Commercial,,114.75,85,,,59.83,114.75,percent of total billed charges,
SCREW ACET G7 6.5MM X 25MM LOW PROFILE DOME  010000998,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
SCREW ACET G7 6.5MM X 25MM LOW PROFILE DOME 010000998,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
SCREW ACET G7 6.5MM X 35MM LOW PROFILE DOME 010001000,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 12MM  204.812,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT CORT S-TAP FT 3.5 X 16MM  204.816,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,80,56.64,Aetna First Health,Commercial,,68,85,,,35.46,68,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 16MM  02.118.516,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,162,114.7,Aetna First Health,Commercial,,137.7,85,,,71.8,137.7,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 10MM  02.118.510,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 14MM  02.118.514,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 20MM  02.118.520,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 22MM  02.118.522,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 40MM  02.118.540,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 50MM  02.118.550,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
SCREW SYNT METAPHYSEAL S-TAP T8 STRDRV 2.7 X 60MM  02.118.560,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
CEMENT BONE BIO R 1 X 40   110035368,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,179,126.73,Aetna First Health,Commercial,,152.15,85,,,79.33,152.15,percent of total billed charges,
WASHER SYNT 7.0MM   219.98,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,92.5,65.49,Aetna First Health,Commercial,,78.62,85,,,41,78.62,percent of total billed charges,
SCREW SYNT CORT LOW PROF T15 STRDRV 3.5 X 46MM  02.206.246,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,106,75.05,Aetna First Health,Commercial,,90.1,85,,,46.98,90.1,percent of total billed charges,
SCREW BONE T10 3.5X20MM   40-35020,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,218,154.34,Aetna First Health,Commercial,,185.3,85,,,96.62,185.3,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 34MM  214.834,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
SCREW SYNT CORT S-TAP 4.5 X 70MM  214.870,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,81,57.35,Aetna First Health,Commercial,,68.85,85,,,35.9,68.85,percent of total billed charges,
SCREW BONE T10 3.5X14MM   40-35014,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,257,181.96,Aetna First Health,Commercial,,218.45,85,,,113.9,218.45,percent of total billed charges,
SLEEVE NAIL INSERTION T2 TIBIA 08-11 1806-1406S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,262,185.5,Aetna First Health,Commercial,,222.7,85,,,116.12,222.7,percent of total billed charges,
WIRE K-WIRE 3.2 X 450MM   1210-6450S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,262,185.5,Aetna First Health,Commercial,,222.7,85,,,116.12,222.7,percent of total billed charges,
CEMENT BONE 40G FULL DOSE RADIOPAQUE SIMPLEX P  6191-1-001,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,284,201.07,Aetna First Health,Commercial,,241.4,85,,,125.87,241.4,percent of total billed charges,
SCREW BONE 3.5MM/L24MM FL THRD T10  657424,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW BONE T10 2.7X18MM   657118,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW BONE T10 3.5X10MM   40-35010,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
SCREW NONLCK 2.7 X 14MM VARIAX 2  657114,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW NONLCK 2.7 X 20MM VARIAX 2  657120,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW STRY 3.5 X 32MM NON-LCK   657432,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW STRYKER VARIAX 2 NONLCK 3.5 X 12MM  657412,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW STRYKER VARIAX 2 NONLCK 3.5 X 14MM  657414,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW STRYKER VARIAX 2 NONLCK 3.5 X 50MM  657450,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW STRY VARIAX NONLCK 3.5MM X L16MM  657416,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW ACET G7 6.5MM X 30MM LOW PROFILE DOME 010000999,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
WIRE K-WIRE 3X285MM STRL   2351-3028S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,348,246.38,Aetna First Health,Commercial,,295.8,85,,,154.23,295.8,percent of total billed charges,
SCREW BIO COMP REVERSE SHOULDER 6.5MM X 30MM  115396,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,351,248.51,Aetna First Health,Commercial,,298.35,85,,,155.56,298.35,percent of total billed charges,
SCREW BIO COMP REVERSE SHOULDER HEX 6.5MM X 25MM  115395,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,351,248.51,Aetna First Health,Commercial,,298.35,85,,,155.56,298.35,percent of total billed charges,
PIN SYNT STEINMANN W/CENTRAL THREAD 4.5 X 225MM  293.78,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,362,256.3,Aetna First Health,Commercial,,307.7,85,,,160.44,307.7,percent of total billed charges,
CEMENT BONE 40G SPEEDSET RADIOPAQUE SIMPLEX P  6192-1-001,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,187,132.4,Aetna First Health,Commercial,,158.95,85,,,82.88,158.95,percent of total billed charges,
SCREW BIO FIXED LCK 4.75MM X 30MM  180553,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,381,269.75,Aetna First Health,Commercial,,323.85,85,,,168.86,323.85,percent of total billed charges,
SCREW STRY ASNIS 4.0 X 26MM NON STRL  604626,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,381,269.75,Aetna First Health,Commercial,,323.85,85,,,168.86,323.85,percent of total billed charges,
SCREW STRY CANN TI 4X24MM   604624,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,381,269.75,Aetna First Health,Commercial,,323.85,85,,,168.86,323.85,percent of total billed charges,
SCREW CANN TI 4X38MM   604638,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,393,278.24,Aetna First Health,Commercial,,334.05,85,,,174.18,334.05,percent of total billed charges,
SCREW CANN TI 4X44MM   604644,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,393,278.24,Aetna First Health,Commercial,,334.05,85,,,174.18,334.05,percent of total billed charges,
SCREW SYNT LCK S-TAP STRDRV 3.5 X 45MM  212.119,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,403,285.32,Aetna First Health,Commercial,,342.55,85,,,178.61,342.55,percent of total billed charges,
SCREW CANN TI 4X42MM   604642,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,408,288.86,Aetna First Health,Commercial,,346.8,85,,,180.83,346.8,percent of total billed charges,
PIN STRY GAMMA4 PRECISION 3.2/3.9 X 450MM  1420-0065S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,411,290.99,Aetna First Health,Commercial,,349.35,85,,,182.16,349.35,percent of total billed charges,
SCREW SYNT CONICAL S-TAP PT 3.5 X 75MM  212.427,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,414,293.11,Aetna First Health,Commercial,,351.9,85,,,183.48,351.9,percent of total billed charges,
SCREW SYNT VA LCK S-TAP STRDRV T8 2.7 X 12MM  02.211.012,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,415,293.82,Aetna First Health,Commercial,,352.75,85,,,183.93,352.75,percent of total billed charges,
SCREW SYNT VA LCK S-TAP STRDRV T8 2.7 X 20MM  02.211.020,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,415,293.82,Aetna First Health,Commercial,,352.75,85,,,183.93,352.75,percent of total billed charges,
SCREW SYNT VA LCK S-TAP STRDRV T8 2.7 X 26MM  02.211.026,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,415,293.82,Aetna First Health,Commercial,,352.75,85,,,183.93,352.75,percent of total billed charges,
SCREW SYNT VA LCK S-TAP STRDRV T8 2.7 X 50MM  02.211.050,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,415,293.82,Aetna First Health,Commercial,,352.75,85,,,183.93,352.75,percent of total billed charges,
SCREW SYNT LCK S-TAP FT STRDRV 5 X 38MM  212.213,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,444,314.35,Aetna First Health,Commercial,,377.4,85,,,196.78,377.4,percent of total billed charges,
SCREW SYNT LCK S-TAP FT STRDRV 5 X 40MM  212.214,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,444,314.35,Aetna First Health,Commercial,,377.4,85,,,196.78,377.4,percent of total billed charges,
SCREW SYNT LCK S-TAP FT STRDRV 5 X 42MM  212.215,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,444,314.35,Aetna First Health,Commercial,,377.4,85,,,196.78,377.4,percent of total billed charges,
SCREW SYNT LCK S-TAP FT STRDRV 5 X 50MM  212.219,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,444,314.35,Aetna First Health,Commercial,,377.4,85,,,196.78,377.4,percent of total billed charges,
SCREW SYNT LCK S-TAP FT STRDRV 5 X 75MM  212.224,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,444,314.35,Aetna First Health,Commercial,,377.4,85,,,196.78,377.4,percent of total billed charges,
SCREW SYNT LCK S-TAP STRDRV 3.5 X 80MM  212.128,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,447,316.48,Aetna First Health,Commercial,,379.95,85,,,198.11,379.95,percent of total billed charges,
WIRE FIXATION K-WIRE 2.5MM NON-THREADED  KN1115,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,120,84.96,Aetna First Health,Commercial,,102,85,,,53.18,102,percent of total billed charges,
SCREW BONE 5X57.5MM ADVANCED T2 LCK STRL  2360-5057S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
SCREW LCK IMN STRYKER 5 X 80MM   2360-5080S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
SCREW LCK IMN STRYKER 5 X 85MM   2360-5085S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
SCREW STRYKER VARIAX 2 LCK 3.5 X 16MM  657316,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
SCREW STRY T2 LCK 5 X 30MM STRL  2360-5030S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 30MM  02.127.130,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 32MM  02.127.132,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 36MM  02.127.136,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 40MM  02.127.140,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 70MM  02.127.170,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 75MM  02.127.175,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
CEMENT BONE REFOBACIN R 1 X 40   110034355,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,495,350.46,Aetna First Health,Commercial,,420.75,85,,,219.38,420.75,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 58MM  02.127.158,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,495,350.46,Aetna First Health,Commercial,,420.75,85,,,219.38,420.75,percent of total billed charges,
WIRE K-WIRE SYNT 1.6MM X 150MM THREADED TIP  292.71,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,503,356.12,Aetna First Health,Commercial,,427.55,85,,,222.93,427.55,percent of total billed charges,
SLEEVE SHOULDER POSITIONING HUMERAL FRACTURE 14MM  113582,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,522,369.58,Aetna First Health,Commercial,,443.7,85,,,231.35,443.7,percent of total billed charges,
SCREW ZIMM CORTICAL 5.0 X 32MM S-TAP  0203150032,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,545,385.86,Aetna First Health,Commercial,,463.25,85,,,241.54,463.25,percent of total billed charges,
SCREW ZIMM CORTICAL 5.0 X 34MM S-TAP  0203150034,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,545,385.86,Aetna First Health,Commercial,,463.25,85,,,241.54,463.25,percent of total billed charges,
SCREW ZIMM CORTICAL 5.0 X 40MM S-TAP  0203150040,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,545,385.86,Aetna First Health,Commercial,,463.25,85,,,241.54,463.25,percent of total billed charges,
SCREW ZIMM CORTICAL 5.0 X 42MM S-TAP  0203150042,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,545,385.86,Aetna First Health,Commercial,,463.25,85,,,241.54,463.25,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 32MM  02.231.232,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 36MM  02.231.236,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 38MM  02.231.238,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 42MM  02.231.242,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 44MM  02.231.244,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 65MM  02.231.265,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 34MM STRL  04.005.524S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 38MM STRL  04.005.528S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 40MM STRL  04.005.530S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 42MM STRL  04.005.532S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 48MM STRL  04.005.538S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 52MM STRL  04.005.542S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 54MM STRL  04.005.544S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT LCK TI STRDRV T25 5 X 60MM STRL  04.005.550S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 34MM  02.231.234,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 50MM  02.231.250,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 70MM  02.231.270,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 75MM  02.231.275,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 80MM  02.231.280,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 90MM  02.231.290,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,559,395.77,Aetna First Health,Commercial,,475.15,85,,,247.75,475.15,percent of total billed charges,
PLATE SYNT LCP ONE-THIRD TUBULAR W/COLLAR 8H 93MM  241.381,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,563,398.6,Aetna First Health,Commercial,,478.55,85,,,249.52,478.55,percent of total billed charges,
SCREW SYNT CANN CONICAL 5 X 85MM  02.205.285,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,574.5,406.75,Aetna First Health,Commercial,,488.32,85,,,254.62,488.32,percent of total billed charges,
SCREW STRYKER VARIAX 2 NONLCK 3.5 X 18MM  657418,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,288,203.9,Aetna First Health,Commercial,,244.8,85,,,127.64,244.8,percent of total billed charges,
SCREW BONE LCK 5 X 45MM STRL   2360-5045S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW LCK IMN STRYKER 5 X 35MM   2360-5035S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW LCK IMN STRYKER 5 X 47.5MM  2360-5047S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW LCK IMN STRYKER 5 X 70MM   2360-5070S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY T2 LCK 5 X 32MM STRL  2360-5032S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY T2 LCK 5 X 37.5MM STRL  2360-5037S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY T2 LCK 5 X 40MM STRL  2360-5040S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY T2 LCK 5 X 50MM STRL  2360-5050S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY T2 LCK 5 X 65MM   2360-5065S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY T2 LCK 5 X 75MM STRL  2360-5075S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY TI T2 LCK FT 5 X 42.5MM  2360-5042S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY TI T2 LCK FT 5 X 55MM  2360-5055S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW STRY TI T2 LCK FT 5 X 60MM  2360-5060S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW SYNT CANN ST 4 X 50MM   207.650,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
SCREW SYNT CANN ST 4 X 56MM   207.656,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
SCREW SYNT CANN LCK 5 X 80MM 02.205.080,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,606,429.05,Aetna First Health,Commercial,,515.1,85,,,268.58,515.1,percent of total billed charges,
SCREW ZIMM CAP LCK NCB   0203150300,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,610,431.88,Aetna First Health,Commercial,,518.5,85,,,270.35,518.5,percent of total billed charges,
PLATE STRY 1/3 TUBULAR 2H 23MM   626672,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,615,435.42,Aetna First Health,Commercial,,522.75,85,,,272.57,522.75,percent of total billed charges,
SCREW BONE T10 3.5X12MM   40-35012,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,218,154.34,Aetna First Health,Commercial,,185.3,85,,,96.62,185.3,percent of total billed charges,
PLATE STRYKER VARIAX 1/3 TUBULAR 8H 95MM  626678,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,662,468.7,Aetna First Health,Commercial,,562.7,85,,,293.4,562.7,percent of total billed charges,
SCREW ZIMM CORTICAL 5.0X36MM   0203150036,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,668,472.94,Aetna First Health,Commercial,,567.8,85,,,296.06,567.8,percent of total billed charges,
SCREW SYNT DHS/DCS LAG OCTAGON COUPLING 12.7 X 70MM  280.270,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,680,481.44,Aetna First Health,Commercial,,578,85,,,301.38,578,percent of total billed charges,
SCREW SYNT DHS/DCS LAG OCTAGON COUPLING 12.7 X 80MM  280.280,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,680,481.44,Aetna First Health,Commercial,,578,85,,,301.38,578,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 100MM 16MM THREAD  208.415,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 75MM 16MM THREAD  208.410,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 85MM 32MM THREAD  208.439,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 90MM 32MM THREAD  208.440,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW SYNT DHS/DCS LAG OCTAGON COUPLING 12.7 X 85MM  280.285,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,756,535.25,Aetna First Health,Commercial,,642.6,85,,,335.06,642.6,percent of total billed charges,
SCREW CANN TI 4X40MM   604640,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,393,278.24,Aetna First Health,Commercial,,334.05,85,,,174.18,334.05,percent of total billed charges,
SCREW STRY HEADLESS MINI 2.5 X 30MM  IH2530,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,795,562.86,Aetna First Health,Commercial,,675.75,85,,,352.34,675.75,percent of total billed charges,
SCREW SYNT VA LCK S-TAP STRDRV T8 2.7 X 28MM  02.211.028,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,415,293.82,Aetna First Health,Commercial,,352.75,85,,,183.93,352.75,percent of total billed charges,
CLAMP EX-FIX PIN LG 6 POSITION MR CONDITIONAL  390.010,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,841,595.43,Aetna First Health,Commercial,,714.85,85,,,372.73,714.85,percent of total billed charges,
SCREW SYNT LCK S-TAP FT STRDRV 5 X 80MM  212.225,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,444,314.35,Aetna First Health,Commercial,,377.4,85,,,196.78,377.4,percent of total billed charges,
SCREW SYNT LCK S-TAP STRDRV 3.5 X 75MM  212.127,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,447,316.48,Aetna First Health,Commercial,,379.95,85,,,198.11,379.95,percent of total billed charges,
CEMENT BONE 41G FULL DOSE TOBRAMYCIN SIMPLEX P  6197-9-001,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,901,637.91,Aetna First Health,Commercial,,765.85,85,,,399.32,765.85,percent of total billed charges,
SCREW STRY GAMMA3 LAG 10.5 X 95MM  8160-0095S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,932,659.86,Aetna First Health,Commercial,,792.2,85,,,413.06,792.2,percent of total billed charges,
SCREW STRY GAMMA4 LAG 10.5 X 85MM  8160-0085S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,932,659.86,Aetna First Health,Commercial,,792.2,85,,,413.06,792.2,percent of total billed charges,
SCREW STRY GAMMA LAG 10.5 X 100MM  8160-0100S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,932,659.86,Aetna First Health,Commercial,,792.2,85,,,413.06,792.2,percent of total billed charges,
SCREW STRY GAMMA LAG 10.5 X 110MM  8160-0110S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,932,659.86,Aetna First Health,Commercial,,792.2,85,,,413.06,792.2,percent of total billed charges,
SCREW STRY GAMMA LAG 10.5 X 80MM  8160-0080S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,932,659.86,Aetna First Health,Commercial,,792.2,85,,,413.06,792.2,percent of total billed charges,
SCREW STRY LAG GAMMA 10.5 X 105MM  8160-0105S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,932,659.86,Aetna First Health,Commercial,,792.2,85,,,413.06,792.2,percent of total billed charges,
SCREW STRY LAG GAMMA 10.5 X 90MM  8160-0090S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,932,659.86,Aetna First Health,Commercial,,792.2,85,,,413.06,792.2,percent of total billed charges,
GRAFT CHIP BONE CANCELL 30CC 1.7-10MM FRZE DRIED 3-6MM  T00040,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,951,673.31,Aetna First Health,Commercial,,808.35,85,,,421.48,808.35,percent of total billed charges,
SCREW STRYKER VARIAX 2 LCK 3.5 X 14MM  657314,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 56MM  02.127.156,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,495,350.46,Aetna First Health,Commercial,,420.75,85,,,219.38,420.75,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 60MM  02.127.160,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,495,350.46,Aetna First Health,Commercial,,420.75,85,,,219.38,420.75,percent of total billed charges,
SCREW SYNT SCHANZ S-DRILL 5 X 175MM  294.785,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,497,351.88,Aetna First Health,Commercial,,422.45,85,,,220.27,422.45,percent of total billed charges,
WIRE K-WIRE FIXATION T2 TIBIA 3X285MM  1806-1417S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,250,177,Aetna First Health,Commercial,,212.5,85,,,110.8,212.5,percent of total billed charges,
SCREW BONE T10 3.5X18MM   40-35018,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,257,181.96,Aetna First Health,Commercial,,218.45,85,,,113.9,218.45,percent of total billed charges,
SCREW SYNT VA LCK STRDRV S-TAP 5 X 85MM  02.231.285,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
SCREW BIO FIXED LCK 4.75MM X 20MM  180551,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,381,269.75,Aetna First Health,Commercial,,323.85,85,,,168.86,323.85,percent of total billed charges,
SCREW BIO FIXED LCK HEX 4.75MM X 15MM  180550,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,381,269.75,Aetna First Health,Commercial,,323.85,85,,,168.86,323.85,percent of total billed charges,
CABLE W/CRIMP 1.8 X 25   00223200418,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1148,812.78,Aetna First Health,Commercial,,975.8,85,,,508.79,975.8,percent of total billed charges,
CABLE W/CRIMP 1.8 X 25  00223200418,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1148,812.78,Aetna First Health,Commercial,,975.8,85,,,508.79,975.8,percent of total billed charges,
SCREW BONE 5X52.5MM ADVANCED T2 LCK  2360-5052S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,584,413.47,Aetna First Health,Commercial,,496.4,85,,,258.83,496.4,percent of total billed charges,
SCREW SYNT TFNA FENESTRATED 100MM STRL  04.038.200S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1181,836.15,Aetna First Health,Commercial,,1003.85,85,,,523.42,1003.85,percent of total billed charges,
SCREW SYNT TFNA FENESTRATED 85MM STRL  04.038.185S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1181,836.15,Aetna First Health,Commercial,,1003.85,85,,,523.42,1003.85,percent of total billed charges,
SCREW SYNT TFNA FENESTRATED 90MM STRL  04.038.190S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1181,836.15,Aetna First Health,Commercial,,1003.85,85,,,523.42,1003.85,percent of total billed charges,
PLATE FIBULA DISTAL LATERAL 4H   40-20904,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1188,841.1,Aetna First Health,Commercial,,1009.8,85,,,526.52,1009.8,percent of total billed charges,
SCREW SYNT CANN ST 4 X 60MM   207.660,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,600,424.8,Aetna First Health,Commercial,,510,85,,,265.92,510,percent of total billed charges,
SIDEPLATE SYNT 140 DEG LCP DHHS STANDARD BARREL 5H  282.633,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1200,849.6,Aetna First Health,Commercial,,1020,85,,,531.84,1020,percent of total billed charges,
FILLER BONE VOID GRAFTON DBM PUTTY 5CC  T43105,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1267,897.04,Aetna First Health,Commercial,,1076.95,85,,,561.53,1076.95,percent of total billed charges,
SCREW SYNT TFNA FENESTRATED 105MM STRL  04.038.205S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1300,920.4,Aetna First Health,Commercial,,1105,85,,,576.16,1105,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 105MM 16MM THREAD  208.416,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 80MM 16MM THREAD  208.411,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 85MM 16MM THREAD  208.412,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 95MM 16MM THREAD  208.414,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
SCREW STRY 3.5X12MM LCK FT T10   657312,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,489,346.21,Aetna First Health,Commercial,,415.65,85,,,216.72,415.65,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 80MM  02.127.180,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
SCREW SYNT VA LCK S-TAP T15 STRDRV 3.5 X 85MM  02.127.185,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,494,349.75,Aetna First Health,Commercial,,419.9,85,,,218.94,419.9,percent of total billed charges,
PLATE SYNT 3.5MM LCP SUP CLAV 8H RT 115MM  02.112.084,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,2013,1425.2,Aetna First Health,Commercial,,1711.05,85,,,892.16,1711.05,percent of total billed charges,
SCREW SYNT CANN S-DRILL 6.5 X 95MM 32MM THREAD  208.441,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,727,514.72,Aetna First Health,Commercial,,617.95,85,,,322.21,617.95,percent of total billed charges,
CABLE CERCLAGE SYNT W/CRIMP 1.7MM STAINLESS STEEL STRL  298.801.01S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1112,787.3,Aetna First Health,Commercial,,945.2,85,,,492.84,945.2,percent of total billed charges,
PLATE SYNT 2.7/3.5MM VA-LCP OLECRANON 2H LT 90MM  02.107.302,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,2357,1668.76,Aetna First Health,Commercial,,2003.45,85,,,1044.62,2003.45,percent of total billed charges,
PLATE SYNT 2.7/3.5MM VA-LCP OLECRANON 6H LT 142MM  02.107.306,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,2462,1743.1,Aetna First Health,Commercial,,2092.7,85,,,1091.16,2092.7,percent of total billed charges,
CABLE BUTTON 2.5MM   47223206001,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,633,448.16,Aetna First Health,Commercial,,538.05,85,,,280.55,538.05,percent of total billed charges,
PLATE SYNT TI MATRIXRIB 8H   04.501.009,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,2755,1950.54,Aetna First Health,Commercial,,2341.75,85,,,1221.02,2341.75,percent of total billed charges,
NAIL STRY GAMMA 10 X 170MM X 125 DEG TROCHANTER  8125-0170S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3018,2136.74,Aetna First Health,Commercial,,2565.3,85,,,1337.58,2565.3,percent of total billed charges,
NAIL STRY GAMMA4 11 X 170MM X 125 DEG TROCHANTER  8125-1170S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3018,2136.74,Aetna First Health,Commercial,,2565.3,85,,,1337.58,2565.3,percent of total billed charges,
SLEEVE NAIL INSERTION T2 TIBIA 08-13  1806-1407S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3143,2225.24,Aetna First Health,Commercial,,2671.55,85,,,1392.98,2671.55,percent of total billed charges,
NAIL 10MM 130 DEG TI CANN TFNA 200MM STRL  04.037.043S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3182,2252.86,Aetna First Health,Commercial,,2704.7,85,,,1410.26,2704.7,percent of total billed charges,
NAIL 11MM 125 DEG TI CANN TFNA 170MM STRL 04.037.112S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3277,2320.12,Aetna First Health,Commercial,,2785.45,85,,,1452.37,2785.45,percent of total billed charges,
NAIL 11MM 130 DEG TI CANN TFNA 170MM STRL  04.037.142S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3353,2373.92,Aetna First Health,Commercial,,2850.05,85,,,1486.05,2850.05,percent of total billed charges,
PLATE SYNT 3.5MM LCP MEDIAL PROX TIB 4H RT 93MM  239.954,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3392,2401.54,Aetna First Health,Commercial,,2883.2,85,,,1503.33,2883.2,percent of total billed charges,
NAIL T2 TIBIAL 9 X 360MM STRL   2341-0936S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3692,2613.94,Aetna First Health,Commercial,,3138.2,85,,,1636.29,3138.2,percent of total billed charges,
PLATE SYNT 4.5MM CRVD CONDY 6H LT  02.124.407,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3709,2625.97,Aetna First Health,Commercial,,3152.65,85,,,1643.83,3152.65,percent of total billed charges,
PLATE BONE TROCH NCB NARROW LT  0202263301,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3737,2645.8,Aetna First Health,Commercial,,3176.45,85,,,1656.24,3176.45,percent of total billed charges,
PLATE SYNT 3.5MM VA-LCP PROX TIBIA SM BEND 4H 87MM RT  02.127.210,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3947,2794.48,Aetna First Health,Commercial,,3354.95,85,,,1749.31,3354.95,percent of total billed charges,
PLATE SYNT 3.5MM VA-LCP PROX TIBIA SM BEND 6H 117MM RT  02.127.220,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3992,2826.34,Aetna First Health,Commercial,,3393.2,85,,,1769.25,3393.2,percent of total billed charges,
NAIL STRY GAMMA LONG LT 10 X 380MM X 125 DEG STRL  8525-0380S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4078,2887.22,Aetna First Health,Commercial,,3466.3,85,,,1807.37,3466.3,percent of total billed charges,
NAIL STRY GAMMA LONG RT 10 X 360MM X 125 DEG STRL  8425-0360S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4078,2887.22,Aetna First Health,Commercial,,3466.3,85,,,1807.37,3466.3,percent of total billed charges,
NAIL STRY GAMMA LONG RT 10 X 380MM X 125 DEG STRL  8425-0380S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4078,2887.22,Aetna First Health,Commercial,,3466.3,85,,,1807.37,3466.3,percent of total billed charges,
NAIL INTRAMEDULLARY T2 FEM RETROGRADE 10X360MM  2339-1036S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4362,3088.3,Aetna First Health,Commercial,,3707.7,85,,,1933.24,3707.7,percent of total billed charges,
SCREW SYNT TI MATRIXRIB LCK S-DRILL 2.7 X 10MM  04.501.210.01,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,732,518.26,Aetna First Health,Commercial,,622.2,85,,,324.42,622.2,percent of total billed charges,
SCREW SYNT TI MATRIXRIB LCK S-DRILL 2.7 X 8MM  04.501.208.01,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,732,518.26,Aetna First Health,Commercial,,622.2,85,,,324.42,622.2,percent of total billed charges,
NAIL 11MM 125 DEG TI CANN TFNA 420MM RT STRL 04.037.132S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4591,3250.43,Aetna First Health,Commercial,,3902.35,85,,,2034.73,3902.35,percent of total billed charges,
NAIL 11MM 130 DEG TI CANN TFNA 320MM RT STRL  04.037.152S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4591,3250.43,Aetna First Health,Commercial,,3902.35,85,,,2034.73,3902.35,percent of total billed charges,
PLATE SYNT 4.5MM VA-LCP CRVD CONDY 14H 301MM LT  02.124.415,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4686,3317.69,Aetna First Health,Commercial,,3983.1,85,,,2076.84,3983.1,percent of total billed charges,
NAIL 11MM 130 DEG TI CANN TFNA 380MM RT STRL  04.037.158S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4699,3326.89,Aetna First Health,Commercial,,3994.15,85,,,2082.6,3994.15,percent of total billed charges,
PLATE SYNT 4.5MM VA-LCP CRVD CONDY 18H 370MM LT  02.124.419,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4740,3355.92,Aetna First Health,Commercial,,4029,85,,,2100.77,4029,percent of total billed charges,
PLATE SYNT 4.5MM CRVD CONDY 16H RT  02.124.416,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4776,3381.41,Aetna First Health,Commercial,,4059.6,85,,,2116.72,4059.6,percent of total billed charges,
PIN POSITIONING 4.5MM THREADED CERCLAGE STRL  298.803S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,486,344.09,Aetna First Health,Commercial,,413.1,85,,,215.4,413.1,percent of total billed charges,
CEMENT BONE HYDROSET XT 10CC   897010,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,4937,3495.4,Aetna First Health,Commercial,,4196.45,85,,,2188.08,4196.45,percent of total billed charges,
CLAMP SYNT LG COMBINATION   390.005,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,1456,1030.85,Aetna First Health,Commercial,,1237.6,85,,,645.3,1237.6,percent of total billed charges,
NAIL T2 ALPHA TIBIAL 9 X 330MM   2341-0933S,C1713,CDM,C1713,CPT,278,RC,,,facility,inpatient,,,3692,2613.94,Aetna First Health,Commercial,,3138.2,85,,,1636.29,3138.2,percent of total billed charges,
CATHETER BALLOON DILATION RX 1.5 X 12MM TAKERU (BX/1)  DC-RY1512UA1,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,345,244.26,Aetna First Health,Commercial,,293.25,85,,,152.9,293.25,percent of total billed charges,
BALLOON COR RX 2.00 X 15MM NC EMERGE  H7493926715200,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.00 X 8MM NC EMERGE  H7493926708200,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.25 X 15MM NC EMERGE  H7493926715220,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.25 X 8MM NC EMERGE  H7493926708220,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.50 X 12MM NC EMERGE  H7493926712250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.50 X 15MM NC EMERGE  H7493926715250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.50 X 20MM NC EMERGE  H7493926720250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.50 X 30MM NC EMERGE  H7493926730250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.50 X 8MM NC EMERGE  H7493926708250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 2.75 X 12MM NC EMERGE  H7493926712270,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.00 X 12MM NC EMERGE  H7493926712300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.00 X 15MM NC EMERGE  H7493926715300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.00 X 30MM NC EMERGE  H7493926730300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.00 X 6MM NC EMERGE  H7493926706300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.00 X 8MM NC EMERGE  H7493926708300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.25 X 12MM NC EMERGE  H7493926712320,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.25 X 15MM NC EMERGE  H7493926715320,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.25 X 8MM NC EMERGE  H7493926708320,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.50 X 12MM NC EMERGE  H7493926712350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.50 X 15MM NC EMERGE  H7493926715350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.50 X 30MM NC EMERGE  H7493926730350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.50 X 6MM NC EMERGE  H7493926706350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.75 X 12MM NC EMERGE  H7493926712370,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.75 X 15MM NC EMERGE  H7493926715370,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 3.75 X 8MM NC EMERGE  H7493926708370,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.00 X 12MM NC EMERGE  H7493926712400,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.00 X 15MM NC EMERGE  H7493926715400,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.00 X 20MM NC EMERGE  H7493926720400,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.00 X 30MM NC EMERGE  H7493926730400,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.00 X 8MM NC EMERGE  H7493926708400,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.50 X 12MM NC EMERGE  H7493926712450,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.50 X 15MM NC EMERGE  H7493926715450,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 4.50 X 8MM NC EMERGE  H7493926708450,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 5.00 X 12MM NC EMERGE  H7493926712500,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 5.00 X 8MM NC EMERGE  H7493926708500,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR RX 5.50 X 8MM NC EMERGE  H7493926708550,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON EUPHORA RX 2.25X12MM   EUP22512X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON EUPHORA RX 2.5X12MM   EUP2512X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON EUPHORA RX 2.5X15MM   EUP2515X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON RX COR 2.5 X 12 NC EUPHORA  NCEUP2512X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON RX COR 2.5 X 15 NC EUPHORA  NCEUP2515X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON RX COR 2.75 X 15 NC EUPHORA  NCEUP27515X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON RX COR 2.75 X 8 NC EUPHORA  NCEUP27508X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON RX COR 3.0 X 12 NC EUPHORA  NCEUP3012X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON RX COR 3.5 X 15 NC EUPHORA  NCEUP3515X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
CATHETER BALLOON EUPHORA RX 3X12MM  EUP3012X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
CATHETER BALLOON EUPHORA RX 3X15MM  EUP3015X,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
BALLOON COR 2.0 X 12MM EMERGE MR  H7493918912200,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.0 X 15MM EMERGE MR  H7493918915200,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.0 X 8MM EMERGE MR  H7493918908200,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.5 X 12MM EMERGE MR  H7493918912250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.5 X 15MM EMERGE MR  H7493918915250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.5 X 20MM EMERGE MR  H7493918920250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.5 X 8MM EMERGE MR  H7493918908250,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.75 X 12MM EMERGE MR  H7493918912270,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 2.75 X 15MM EMERGE MR  H7493918915270,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 3.0 X 12MM EMERGE MR  H7493918912300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 3.0 X 15MM EMERGE MR  H7493918915300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 3.0 X 20MM EMERGE MR  H7493918920300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 3.0 X 8MM EMERGE MR  H7493918908300,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 3.5 X 12MM EMERGE MR  H7493918912350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 3.5 X 15MM EMERGE MR  H7493918915350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 4.0 X 12MM EMERGE MR  H7493918912400,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 4.0 X 20MM EMERGE MR  H7493918920400,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON COR 1.5 X 12MM EMERGE MR  H7493918912150,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,613,434,Aetna First Health,Commercial,,521.05,85,,,271.68,521.05,percent of total billed charges,
BALLOON COR RX 3.50 X 20MM NC EMERGE  H7493926720350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,435,307.98,Aetna First Health,Commercial,,369.75,85,,,192.79,369.75,percent of total billed charges,
CATHETER MICRODILIATION THREADER MR 1.2 X 12MM  H7493926912120,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,900,637.2,Aetna First Health,Commercial,,765,85,,,398.88,765,percent of total billed charges,
BALLOON COR 3.5 X 20MM EMERGE MR  H7493918920350,C1725,CDM,C1725,CPT,278,RC,,,facility,inpatient,,,472,334.18,Aetna First Health,Commercial,,401.2,85,,,209.19,401.2,percent of total billed charges,
BALLOON ESOPHAGEAL DILATION HERCULES 15-16.5-18MM  G48732,C1726,CDM,C1726,CPT,278,RC,,,facility,inpatient,,,504,356.83,Aetna First Health,Commercial,,428.4,85,,,223.37,428.4,percent of total billed charges,
SET AMPLATZ RENAL DILATOR   G57459,C1726,CDM,C1726,CPT,278,RC,,,facility,inpatient,,,575,407.1,Aetna First Health,Commercial,,488.75,85,,,254.84,488.75,percent of total billed charges,
BALLOON COLONIC DILATION WG HERCULES 12-13.5-15MM  G51796,C1726,CDM,C1726,CPT,278,RC,,,facility,inpatient,,,618,437.54,Aetna First Health,Commercial,,525.3,85,,,273.9,525.3,percent of total billed charges,
LIGHT FIBER LED XPRESS 6X 20MM LOPROFILE PATH ASSIST LPLF-106,C1726,CDM,C1726,CPT,278,RC,,,facility,inpatient,,,3467,2454.64,Aetna First Health,Commercial,,2946.95,85,,,1536.57,2946.95,percent of total billed charges,
CATHETER URETH 18FR INTERMITTENT RED RUBBER  277718,C1729,CDM,C1729,CPT,278,RC,,,facility,inpatient,,,3,2.12,Aetna First Health,Commercial,,2.55,85,,,1.33,2.55,percent of total billed charges,
CATHETER THORACIC 32FR ANGLED PVC  8132,C1729,CDM,C1729,CPT,278,RC,,,facility,inpatient,,,29,20.53,Aetna First Health,Commercial,,24.65,85,,,12.85,24.65,percent of total billed charges,
CATHETER URETH 18FR 5ML FOLEY IC RADIOPAQUE  0196SI18,C1729,CDM,C1729,CPT,278,RC,,,facility,inpatient,,,79,55.93,Aetna First Health,Commercial,,67.15,85,,,35.01,67.15,percent of total billed charges,
SET MALECOT CATHETER 24FR   G14510,C1729,CDM,C1729,CPT,278,RC,,,facility,inpatient,,,252,178.42,Aetna First Health,Commercial,,214.2,85,,,111.69,214.2,percent of total billed charges,
BAG DRAINAGE NEPHROSTOMY 600ML W/ATTACHED TUBING  MDD600,C1729,CDM,C1729,CPT,278,RC,,,facility,inpatient,,,558,395.06,Aetna First Health,Commercial,,474.3,85,,,247.31,474.3,percent of total billed charges,
TRAY PERICARDIOCENTESIS   PC101,C1729,CDM,C1729,CPT,278,RC,,,facility,inpatient,,,402,284.62,Aetna First Health,Commercial,,341.7,85,,,178.17,341.7,percent of total billed charges,
KIT PLEURX PLEURAL CATHETER AND STARTER  50-7700,C1729,CDM,C1729,CPT,278,RC,,,facility,inpatient,,,1849,1309.09,Aetna First Health,Commercial,,1571.65,85,,,819.48,1571.65,percent of total billed charges,
CATHETER PACING J 5FR   D97130F5,C1730,CDM,C1730,CPT,278,RC,,,facility,inpatient,,,330,233.64,Aetna First Health,Commercial,,280.5,85,,,146.26,280.5,percent of total billed charges,
URETEROSCOPE LITHOVIEW FLEXIBLE DISP REVERSE  M0067913600,C1747,CDM,C1747,CPT,278,RC,,,facility,inpatient,,,3525,2495.7,Aetna First Health,Commercial,,2996.25,85,,,1562.28,2996.25,percent of total billed charges,
CATHETER SWAN GANZ TD 7FR   131F7P,C1751,CDM,C1751,CPT,278,RC,,,facility,inpatient,,,189,133.81,Aetna First Health,Commercial,,160.65,85,,,83.76,160.65,percent of total billed charges,
CATHETER HICKMAN SINGLE LUMEN CV 9.6FR  0600560,C1751,CDM,C1751,CPT,278,RC,,,facility,inpatient,,,629.5,445.69,Aetna First Health,Commercial,,535.07,85,,,278.99,535.07,percent of total billed charges,
KIT CVC 7FR X 8IN (20CM) DUAL LUMEN PRESSURE INJECTABLE  CDC-46702-XP1A,C1751,CDM,C1751,CPT,278,RC,,,facility,inpatient,,,368,260.54,Aetna First Health,Commercial,,312.8,85,,,163.1,312.8,percent of total billed charges,
CATHETER OPTICROSS 5FR HD IVUS   H74939352040,C1753,CDM,C1753,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
CATHETER OPTICROSS 6FR HD IVUS   H74939354080,C1753,CDM,C1753,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
CATHETER ASPIRATION PLATFORM 6F .014IN 140CM (BX/1)  30-6100,C1757,CDM,C1757,CPT,272,RC,,,facility,inpatient,,,844,597.55,Aetna First Health,Commercial,,717.4,85,,,374.06,717.4,percent of total billed charges,
CATHETER INDIGO RX 140CM PLUS LG LUMEN ASPIRATION TUBING  CATRXKIT,C1757,CDM,C1757,CPT,272,RC,,,facility,inpatient,,,4559,3227.77,Aetna First Health,Commercial,,3875.15,85,,,2020.55,3875.15,percent of total billed charges,
CATHETER URETERAL 5FR X 70CM OPEN END FLEX TIP  G14521,C1758,CDM,C1758,CPT,278,RC,,,facility,inpatient,,,332,235.06,Aetna First Health,Commercial,,282.2,85,,,147.14,282.2,percent of total billed charges,
RELOAD PROXIMATE LINEAR CUTTER TI STANDARD BLUE 100MM  TCR10,C1760,CDM,C1760,CPT,278,RC,,,facility,inpatient,,,501,354.71,Aetna First Health,Commercial,,425.85,85,,,222.04,425.85,percent of total billed charges,
DEVICE CLOSURE VASC MYNX GRIP 5FR  MX5021,C1760,CDM,C1760,CPT,278,RC,,,facility,inpatient,,,642,454.54,Aetna First Health,Commercial,,545.7,85,,,284.53,545.7,percent of total billed charges,
DEVICE ANGIOSEAL VIP 6FR   610130,C1760,CDM,C1760,CPT,278,RC,,,facility,inpatient,,,660,467.28,Aetna First Health,Commercial,,561,85,,,292.51,561,percent of total billed charges,
SYSTEM CLOSURE PERCLOSE PROGLIDE  12673-03,C1760,CDM,C1760,CPT,278,RC,,,facility,inpatient,,,743,526.04,Aetna First Health,Commercial,,631.55,85,,,329.3,631.55,percent of total billed charges,
CUTTER ENDOPATH LINEAR PROXIMATE STANDARD BLUE 100MM  TLC10,C1760,CDM,C1760,CPT,278,RC,,,facility,inpatient,,,851,602.51,Aetna First Health,Commercial,,723.35,85,,,377.16,723.35,percent of total billed charges,
CATHETER SHOCKWAVE C2+ IVL 3.0 X 12MM  C2PIVL3012,C1761,CDM,C1761,CPT,278,RC,,,facility,inpatient,,,11045,7819.86,Aetna First Health,Commercial,,9388.25,85,,,4895.14,9388.25,percent of total billed charges,
CATHETER SHOCKWAVE C2+ IVL 3.5 X 12MM  C2PIVL3512,C1761,CDM,C1761,CPT,278,RC,,,facility,inpatient,,,11045,7819.86,Aetna First Health,Commercial,,9388.25,85,,,4895.14,9388.25,percent of total billed charges,
CATHETER SHOCKWAVE C2+ IVL 4.0 X 12MM  C2PIVL4012,C1761,CDM,C1761,CPT,278,RC,,,facility,inpatient,,,11045,7819.86,Aetna First Health,Commercial,,9388.25,85,,,4895.14,9388.25,percent of total billed charges,
BARRIER TC7 ABS ADH INTERCEED 3X4  4350,C1765,CDM,C1765,CPT,278,RC,,,facility,inpatient,,,810,573.48,Aetna First Health,Commercial,,688.5,85,,,358.99,688.5,percent of total billed charges,
GRAFT HEMACAROTID 8X75MM PATCH ULTRA THIN WALL  HGKTP08/75CPUT (1),C1768,CDM,C1768,CPT,278,RC,,,facility,inpatient,,,413,292.4,Aetna First Health,Commercial,,351.05,85,,,183.04,351.05,percent of total billed charges,
GUIDEWIRE FIXED CORE STRAIGHT .025IN X 150CM  M001491001,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,25,17.7,Aetna First Health,Commercial,,21.25,85,,,11.08,21.25,percent of total billed charges,
GUIDEWIRE J TIP 260CM INQUIRE   IQ35F260J3,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,42,29.74,Aetna First Health,Commercial,,35.7,85,,,18.61,35.7,percent of total billed charges,
GUIDEWIRE VASCULAR BENTSON 145CM  G00691,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,69,48.85,Aetna First Health,Commercial,,58.65,85,,,30.58,58.65,percent of total billed charges,
GUIDEWIRE AMPLATZ .035IN X 260CM  G03460,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,85,60.18,Aetna First Health,Commercial,,72.25,85,,,37.67,72.25,percent of total billed charges,
GUIDEWIRE STRAIGHT TIP .035IN 180CM 3CM LENGTH PTFE SS  G28781,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,95,67.26,Aetna First Health,Commercial,,80.75,85,,,42.1,80.75,percent of total billed charges,
INA GUIDEWIRE BENTSON PTFE MOV ABLECORE WIRE .038IN,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,98.9,70.02,Aetna First Health,Commercial,,84.06,85,,,43.83,84.06,percent of total billed charges,
GUIDEWIRE URETERAL .038IN X 150CM STR TIP  G59155,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,107,75.76,Aetna First Health,Commercial,,90.95,85,,,47.42,90.95,percent of total billed charges,
GUIDEWIRE .021IN J-TIP 180CM   G01793,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,58,41.06,Aetna First Health,Commercial,,49.3,85,,,25.71,49.3,percent of total billed charges,
GUIDEWIRE TFE COATED AMPLATZ .035IN X 180CM EXTRA STIFF  G03330,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,121,85.67,Aetna First Health,Commercial,,102.85,85,,,53.63,102.85,percent of total billed charges,
GUIDEWIRE AMPLATZ EXTRA STIFF .035IN X 300  G04001,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,139,98.41,Aetna First Health,Commercial,,118.15,85,,,61.6,118.15,percent of total billed charges,
GUIDEWIRE SYNT 2.8MM THREADED TROCAR POINT 300MM  292.68,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,161,113.99,Aetna First Health,Commercial,,136.85,85,,,71.36,136.85,percent of total billed charges,
GUIDEWIRE GLIDEWIRE .035X250CM STD ANGLE TIP  GR3509,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,167,118.24,Aetna First Health,Commercial,,141.95,85,,,74.01,141.95,percent of total billed charges,
GUIDEWIRE URET MOTION .035IN X 150CM STRAIGHT TIP  G44846,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,168,118.94,Aetna First Health,Commercial,,142.8,85,,,74.46,142.8,percent of total billed charges,
GUIDEWIRE ASNIS III 1.4X150MM FOR 4.0MM  702459,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,171,121.07,Aetna First Health,Commercial,,145.35,85,,,75.79,145.35,percent of total billed charges,
GUIDEWIRE GLIDEWIRE .035X180CM STD ANGLE TIP  GR3508,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,189,133.81,Aetna First Health,Commercial,,160.65,85,,,83.76,160.65,percent of total billed charges,
GUIDEWIRE W/TUNGS TIP .018IN X 45CM NITINOL  H787065972015,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,190,134.52,Aetna First Health,Commercial,,161.5,85,,,84.21,161.5,percent of total billed charges,
GUIDEWIRE SYNT 1.25MM NON-THREADED 150MM  900.721,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,98,69.38,Aetna First Health,Commercial,,83.3,85,,,43.43,83.3,percent of total billed charges,
GUIDEWIRE GLIDEWIRE .035X180CM STIFF ANGLE TIP  GS3508,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,224,158.59,Aetna First Health,Commercial,,190.4,85,,,99.28,190.4,percent of total billed charges,
GUIDEWIRE J WIRE WHOLEY MODIFIED 300CM  WWIJ35300,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,242,171.34,Aetna First Health,Commercial,,205.7,85,,,107.25,205.7,percent of total billed charges,
GUIDEWIRE FIELDER FC PTCA 180CM  AGP140001,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,244,172.75,Aetna First Health,Commercial,,207.4,85,,,108.14,207.4,percent of total billed charges,
GUIDEWIRE LUGE J TIP 182CM .014IN 3CM  H7491213001J2,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,244,172.75,Aetna First Health,Commercial,,207.4,85,,,108.14,207.4,percent of total billed charges,
GUIDEWIRE MAILMAN .014IN X 300CM J  H7491212001J2,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,245,173.46,Aetna First Health,Commercial,,208.25,85,,,108.58,208.25,percent of total billed charges,
GUIDEWIRE PT GRAPHIX .014IN X 180CM STR  H74914902012,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,245,173.46,Aetna First Health,Commercial,,208.25,85,,,108.58,208.25,percent of total billed charges,
GUIDEWIRE RUNTHROUGH NS 180CM   25-1011,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,280,198.24,Aetna First Health,Commercial,,238,85,,,124.1,238,percent of total billed charges,
GUIDEWIRE RUNTHROUGH NS 300CM   25-1013,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
GUIDEWIRE SION BLUE 190CM PTCA GW  AHW14R104S,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
GUIDEWIRE SAVARY 200CM   G57280,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
GUIDEWIRE SYNT 3.2MM 400MM   357.399,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
GUIDEWIRE SYNT 2.5MM THREADED 230MM SPADE POINT  900.723,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,171,121.07,Aetna First Health,Commercial,,145.35,85,,,75.79,145.35,percent of total billed charges,
GUIDEWIRE BALL TIP 3.0 X 800MM   1806-0080S,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,349,247.09,Aetna First Health,Commercial,,296.65,85,,,154.68,296.65,percent of total billed charges,
GUIDEWIRE SYNT 1.25MM THREADED 150MM  900.722,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,188,133.1,Aetna First Health,Commercial,,159.8,85,,,83.32,159.8,percent of total billed charges,
GUIDEWIRE SYNT 2MM THREADED SPADE POINT 230MM  292.652,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,138,97.7,Aetna First Health,Commercial,,117.3,85,,,61.16,117.3,percent of total billed charges,
GUIDEWIRE FORTE FLOPPY MARKER J TIP 185CM  H7493494901J2,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,420,297.36,Aetna First Health,Commercial,,357,85,,,186.14,357,percent of total billed charges,
GUIDEWIRE CHOICE PT .014IN X 182CM J CURVE  H7491216001J2,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,447,316.48,Aetna First Health,Commercial,,379.95,85,,,198.11,379.95,percent of total billed charges,
WIRE K-WIRE 3MM X 285MM   1806-0050S,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,458,324.26,Aetna First Health,Commercial,,389.3,85,,,202.99,389.3,percent of total billed charges,
GUIDEWIRE BALL TIP 3 X 1000M   1806-0085S,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,576,407.81,Aetna First Health,Commercial,,489.6,85,,,255.28,489.6,percent of total billed charges,
GUIDEWIRE HI-TORQUE PILOT 50 .014IN X 190CM  1010480H,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,709,501.97,Aetna First Health,Commercial,,602.65,85,,,314.23,602.65,percent of total billed charges,
GUIDEWIRE VASCULAR .014IN WHISPER WIRE J TIP 190CM  1005357HJ,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,709,501.97,Aetna First Health,Commercial,,602.65,85,,,314.23,602.65,percent of total billed charges,
GUIDEWIRE PILOT 50 STRAIGHT 300CM  1010483-H,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,788,557.9,Aetna First Health,Commercial,,669.8,85,,,349.24,669.8,percent of total billed charges,
GUIDEWIRE FIELDER XT .014IN X 190CM STR  AGP140002,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,988,699.5,Aetna First Health,Commercial,,839.8,85,,,437.88,839.8,percent of total billed charges,
BALLOON COR RX 5.00 X 15MM NC EMERGE  H7493926715500,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,1032,730.66,Aetna First Health,Commercial,,877.2,85,,,457.38,877.2,percent of total billed charges,
GUIDEWIRE FFR 185CM COMET II   H74939359110,C1769,CDM,C1769,CPT,272,RC,,,facility,inpatient,,,1300,920.4,Aetna First Health,Commercial,,1105,85,,,576.16,1105,percent of total billed charges,
POSITIONER DISTAL 15 BIO  162659,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,309,218.77,Aetna First Health,Commercial,,262.65,85,,,136.95,262.65,percent of total billed charges,
CENTRALIZER STEM INGL ANSWER IMPACT DISTAL POSITIONER 9  162656,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,361,255.59,Aetna First Health,Commercial,,306.85,85,,,160,306.85,percent of total billed charges,
PLUG BONE INTRAMEDULLARY MD 16MM  130611,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,462,327.1,Aetna First Health,Commercial,,392.7,85,,,204.76,392.7,percent of total billed charges,
PLUG INTRAMEDULLARY SM   130609,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,462,327.1,Aetna First Health,Commercial,,392.7,85,,,204.76,392.7,percent of total billed charges,
SLEEVE BIOLOX OPTION TAPER 0 ADAPTER TYPE 1  650-1066,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,462,327.1,Aetna First Health,Commercial,,392.7,85,,,204.76,392.7,percent of total billed charges,
SLEEVE BIOLOX OPTION TAPER -3 ADAPTER TYPE 1  650-1065,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,462,327.1,Aetna First Health,Commercial,,392.7,85,,,204.76,392.7,percent of total billed charges,
BAR LCK MODULAR TIBIAL BIO   141205,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,534,378.07,Aetna First Health,Commercial,,453.9,85,,,236.67,453.9,percent of total billed charges,
CENTRALIZER DISTAL POSITIONER 10MM BIO 162640,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,561,397.19,Aetna First Health,Commercial,,476.85,85,,,248.64,476.85,percent of total billed charges,
CENTRALIZER DISTAL POSITIONER 13 BIO 162658,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,561,397.19,Aetna First Health,Commercial,,476.85,85,,,248.64,476.85,percent of total billed charges,
HEAD FEM ZIMM G7 COCR -3MM 40MM OFFSET TYPE 1  010001036,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,900,637.2,Aetna First Health,Commercial,,765,85,,,398.88,765,percent of total billed charges,
HEAD FEM ZIMM G7 COCR -3MM 40MM OFFSET TYPE 1 010001036,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,900,637.2,Aetna First Health,Commercial,,765,85,,,398.88,765,percent of total billed charges,
HEAD FEM ZIMM G7 COCR 40MM STANDARD OFFSET TYPE 1  010001035,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,900,637.2,Aetna First Health,Commercial,,765,85,,,398.88,765,percent of total billed charges,
HEAD FEM ZIMM G7 COCR -6MM 40MM OFFSET TYPE 1 010001037,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,900,637.2,Aetna First Health,Commercial,,765,85,,,398.88,765,percent of total billed charges,
BEARING TIBIAL BIO PS PLUS 10 X 71/75MM VANGUARD 183740,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1000,708,Aetna First Health,Commercial,,850,85,,,443.2,850,percent of total billed charges,
LINER ACET G7 NEUTRAL 40MM G 10 DEG LONGEVITY  20114007,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1000,708,Aetna First Health,Commercial,,850,85,,,443.2,850,percent of total billed charges,
CUP RINGLOC BIPOLAR 28 X 54MM  11-165232,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1068,756.14,Aetna First Health,Commercial,,907.8,85,,,473.34,907.8,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28MM X 42MM BIO  11-165208,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1068,756.14,Aetna First Health,Commercial,,907.8,85,,,473.34,907.8,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28MM X 42MM BIO 11-165208,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1068,756.14,Aetna First Health,Commercial,,907.8,85,,,473.34,907.8,percent of total billed charges,
PLUG BONE INTRAMEDULLARY LG 22MM 130613,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,543,384.44,Aetna First Health,Commercial,,461.55,85,,,240.66,461.55,percent of total billed charges,
LINER ACET G7 36MM SZ 3 LONGEVITY 20113605,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1100,778.8,Aetna First Health,Commercial,,935,85,,,487.52,935,percent of total billed charges,
LINER ACET G7 NEUTRAL 36MM E LONGEVITY  20103605,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1100,778.8,Aetna First Health,Commercial,,935,85,,,487.52,935,percent of total billed charges,
LINER ACET G7 NEUTRAL 40MM G LONGEVITY  20104007,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1100,778.8,Aetna First Health,Commercial,,935,85,,,487.52,935,percent of total billed charges,
SIDEPLATE SYNT 135 DEG LCP DHHS STANDARD BARREL 3H  282.611,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1200,849.6,Aetna First Health,Commercial,,1020,85,,,531.84,1020,percent of total billed charges,
HEAD FEM G7 COCR 28MM STANDARD OFFSET  163662,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1316,931.73,Aetna First Health,Commercial,,1118.6,85,,,583.25,1118.6,percent of total billed charges,
HEAD FEM G7 COCR -3MM 28MM OFFSET MODULAR  163661,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1316,931.73,Aetna First Health,Commercial,,1118.6,85,,,583.25,1118.6,percent of total billed charges,
HEAD FEM G7 COCR +3MM 28MM OFFSET MODULAR  163663,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1316,931.73,Aetna First Health,Commercial,,1118.6,85,,,583.25,1118.6,percent of total billed charges,
HEAD FEM G7 COCR +3MM 28MM OFFSET MODULAR 163663,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1316,931.73,Aetna First Health,Commercial,,1118.6,85,,,583.25,1118.6,percent of total billed charges,
HEAD FEM G7 COCR -6MM 28MM OFFSET  163660,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1316,931.73,Aetna First Health,Commercial,,1118.6,85,,,583.25,1118.6,percent of total billed charges,
HEAD FEM G7 COCR 32MM STANDARD OFFSET MODULAR 163669,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1346,952.97,Aetna First Health,Commercial,,1144.1,85,,,596.55,1144.1,percent of total billed charges,
HEAD FEM G7 COCR -3MM 36MM OFFSET MODULAR  11-363661,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1346,952.97,Aetna First Health,Commercial,,1144.1,85,,,596.55,1144.1,percent of total billed charges,
HEAD HMODULAR 36MMTAPER   11-363663,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1346,952.97,Aetna First Health,Commercial,,1144.1,85,,,596.55,1144.1,percent of total billed charges,
ROD SYNT CARBON FIBER 11 X 400MM  394.87,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,729,516.13,Aetna First Health,Commercial,,619.65,85,,,323.09,619.65,percent of total billed charges,
SHELL ACET 48MM HIP 3 H FIN PPS G7 C 110017101,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1500,1062,Aetna First Health,Commercial,,1275,85,,,664.8,1275,percent of total billed charges,
SHELL ACET 52MM HIP 3 H FIN PPS G7 E 110017103,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1500,1062,Aetna First Health,Commercial,,1275,85,,,664.8,1275,percent of total billed charges,
SHELL ACET 58MM HIP 4H FIN PPS G7 G  110017106,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1500,1062,Aetna First Health,Commercial,,1275,85,,,664.8,1275,percent of total billed charges,
STEM ECHO BIO FRACTURE STD OFFSET 13MM  12-151313,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
STEM ECHO BIO FRACTURE STD OFFSET 7MM  12-151307,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
STEM ECHO BIO FRACTURE STD OFFSET 9MM  12-151309,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
CUP ACET RING LOC 28MM X 44MM BIPOLAR  11-165212,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
RING LOC BIPOLAR ACE CUP   11-165216,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28X45MM   11-165214,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28X47MM   11-165218,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28X48MM   11-165220,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28X49MM   11-165222,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28X51MM  11-165226,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1611,1140.59,Aetna First Health,Commercial,,1369.35,85,,,714,1369.35,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28MM X 43MM BIO  11-165210,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1650,1168.2,Aetna First Health,Commercial,,1402.5,85,,,731.28,1402.5,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28MM X 56MM BIO  11-165236,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1650,1168.2,Aetna First Health,Commercial,,1402.5,85,,,731.28,1402.5,percent of total billed charges,
ADAPTER OFFSET BMT 360 2.5MM   185210,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1674,1185.19,Aetna First Health,Commercial,,1422.9,85,,,741.92,1422.9,percent of total billed charges,
SHELL BIPOLAR RINGLOC 28MM X 50MM BIO  11-165224,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1750,1239,Aetna First Health,Commercial,,1487.5,85,,,775.6,1487.5,percent of total billed charges,
AUGMENT TIBIAL BIO 63X5MM VANGUARD 360 185221,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1814,1284.31,Aetna First Health,Commercial,,1541.9,85,,,803.96,1541.9,percent of total billed charges,
AUGMENT TIBIAL BIO 71 X 10MM BMT VANGUARD 360  185233,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1814,1284.31,Aetna First Health,Commercial,,1541.9,85,,,803.96,1541.9,percent of total billed charges,
LINER ACET G7 NEUTRAL VIVACIT-E 36MM G  30103607,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1850,1309.8,Aetna First Health,Commercial,,1572.5,85,,,819.92,1572.5,percent of total billed charges,
SURFACE ARTICULAR 12MM VIVACIT-E 10-12 G-H R PERSONA 42522601012,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1950,1380.6,Aetna First Health,Commercial,,1657.5,85,,,864.24,1657.5,percent of total billed charges,
BEARING TIBIAL BIO CR LIP 10MM X 79/83MM VANGUARD 183560,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2023,1432.28,Aetna First Health,Commercial,,1719.55,85,,,896.59,1719.55,percent of total billed charges,
BEARING VANGUARD CR TIBIAL 12X79/83  183462,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2023,1432.28,Aetna First Health,Commercial,,1719.55,85,,,896.59,1719.55,percent of total billed charges,
PLATE BIO TIBIAL I-BEAM 75MM   141224,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2095,1483.26,Aetna First Health,Commercial,,1780.75,85,,,928.5,1780.75,percent of total billed charges,
STEM ECHO BIO FRACTURE STD OFFSET 11MM 12-151311,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2117,1498.84,Aetna First Health,Commercial,,1799.45,85,,,938.25,1799.45,percent of total billed charges,
LINER ACET G7 NEUTRAL 40MM F LONGEVITY  20104006,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1100,778.8,Aetna First Health,Commercial,,935,85,,,487.52,935,percent of total billed charges,
COMPONENT PATELLA SERIES A STD 37MMX 10.0MM 3-PEG  184768,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1103,780.92,Aetna First Health,Commercial,,937.55,85,,,488.85,937.55,percent of total billed charges,
AUGMENT FEM TIBIAL CRUCIATE WING 360 SM  185650,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2350,1663.8,Aetna First Health,Commercial,,1997.5,85,,,1041.52,1997.5,percent of total billed charges,
BEARING TIBIAL BIO CR LIP 10MM X 71/75MM VANGUARD  183540,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2360,1670.88,Aetna First Health,Commercial,,2006,85,,,1045.95,2006,percent of total billed charges,
SPHERE GLENOID 36MM COMP STD SHOULDER GLENOSPHERE REVERSE  115310,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3159,2236.57,Aetna First Health,Commercial,,2685.15,85,,,1400.07,2685.15,percent of total billed charges,
SPHERE GLENOID 36MM CURVED +3MM OFFSET  115313,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3182,2252.86,Aetna First Health,Commercial,,2704.7,85,,,1410.26,2704.7,percent of total billed charges,
BEARING HUMERAL COMP REVERSE SHOULDER STD 36MM 110031418,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
SHELL ACET 54MM HIP 4 H FIN PPS G7 F 110017104,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
STEM EXTENSION SPLINED KNEE 19 X 80MM VANGUARD 148309,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3375,2389.5,Aetna First Health,Commercial,,2868.75,85,,,1495.8,2868.75,percent of total billed charges,
STEM EXT KNEE 10X80MM SPLINED VANGUARD 148300,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3375,2389.5,Aetna First Health,Commercial,,2868.75,85,,,1495.8,2868.75,percent of total billed charges,
STEM KNEE SPLINED 13 X 80MM  148303,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3375,2389.5,Aetna First Health,Commercial,,2868.75,85,,,1495.8,2868.75,percent of total billed charges,
STEM KNEE SPLINED 16 X 80MM   148306,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3375,2389.5,Aetna First Health,Commercial,,2868.75,85,,,1495.8,2868.75,percent of total billed charges,
STEM KNEE SPLINED 18 X 80MM  148308,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3375,2389.5,Aetna First Health,Commercial,,2868.75,85,,,1495.8,2868.75,percent of total billed charges,
STEM TIBIAL KNEE SPLINE 15X120MM 148318,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3375,2389.5,Aetna First Health,Commercial,,2868.75,85,,,1495.8,2868.75,percent of total billed charges,
BEARING TIBIAL BIO CR LIP 12MM X71/75MM VANGUARD  183542,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3395,2403.66,Aetna First Health,Commercial,,2885.75,85,,,1504.66,2885.75,percent of total billed charges,
PLATE BIO TIBIAL I-BEAM 71MM  141223,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3395,2403.66,Aetna First Health,Commercial,,2885.75,85,,,1504.66,2885.75,percent of total billed charges,
BEARING HIP VIVACIT-E DM SZ G 28 X 46MM 110031013,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,4243,3004.04,Aetna First Health,Commercial,,3606.55,85,,,1880.5,3606.55,percent of total billed charges,
HEAD BIOLOX DELTA OPTION CERAMIC 36MM  650-1057,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,4783,3386.36,Aetna First Health,Commercial,,4065.55,85,,,2119.83,4065.55,percent of total billed charges,
BEARING TIBIAL BIO SSK PSC 18X71/75 VANGUARD  183888,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,4874,3450.79,Aetna First Health,Commercial,,4142.9,85,,,2160.16,4142.9,percent of total billed charges,
BEARING TIBIAL BIO PS 10MM X 79/83MM VANGUARD  EP-183660,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5109,3617.17,Aetna First Health,Commercial,,4342.65,85,,,2264.31,4342.65,percent of total billed charges,
LINER ACET G7 NEUTRAL 46MM G HIP DUAL MOB  110024465,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5119,3624.25,Aetna First Health,Commercial,,4351.15,85,,,2268.74,4351.15,percent of total billed charges,
STEM COMP SHOULDER SYS 12MM HUMERAL W/MACRO BOND 11-113562,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5192,3675.94,Aetna First Health,Commercial,,4413.2,85,,,2301.09,4413.2,percent of total billed charges,
LINER ACET G7 NEUTRAL 38MM C HIP DUAL MOB  110024461,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5323,3768.68,Aetna First Health,Commercial,,4524.55,85,,,2359.15,4524.55,percent of total billed charges,
TRAY TIBIAL BIO 75MM VANGUARD 360 185204,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5459,3864.97,Aetna First Health,Commercial,,4640.15,85,,,2419.43,4640.15,percent of total billed charges,
BASEPLATE BIO SHOULDER REVERSE MINI 25MM  010000589,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2750,1947,Aetna First Health,Commercial,,2337.5,85,,,1218.8,2337.5,percent of total billed charges,
COMPONENT VANGUARD CR FEM 70MM LT  183032,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5623,3981.08,Aetna First Health,Commercial,,4779.55,85,,,2492.11,4779.55,percent of total billed charges,
COMPONENT VANGUARD CR INTERLOK FEM RT 70  183012,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5623,3981.08,Aetna First Health,Commercial,,4779.55,85,,,2492.11,4779.55,percent of total billed charges,
IMPLANT ECHO BI-METRIC FPP STANDARD 14MM 135 DEG NECK  192014,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO BI-METRIC 11MM X 135MM  192011,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO BIO POROUS COLLARLESS 16MM X 160MM  192016,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO BIO POROUS COLLARLESS 9MM X 125MM  192009,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO BIO POROUS RED COLLARLESS 10MM X 130MM 192410,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO BIO POROUS RED COLLARLESS 12MM X 140MM 192412,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO POR FEM NC 12 X 140   192012,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO POR FMRL NC 10 X 130   192010,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECHO POR FMRL NC 15 X 155   192015,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM ECH POR 9MM X 125MM  192109,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
STEM FEM BIO TAPERLOC 16 X 119MM POR STD OFFSET  51-106170,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5648,3998.78,Aetna First Health,Commercial,,4800.8,85,,,2503.19,4800.8,percent of total billed charges,
TRAY TIBIAL BIO 67MM VANGUARD 360  185202,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5702,4037.02,Aetna First Health,Commercial,,4846.7,85,,,2527.13,4846.7,percent of total billed charges,
TRAY HUMERAL MINI STD THKNS +0MM TAPERED OFFSET 40MM DIA  110031399,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,2997,2121.88,Aetna First Health,Commercial,,2547.45,85,,,1328.27,2547.45,percent of total billed charges,
COMPONENT FEM OPEN BOX 70MM RIGHT INTERLOK VANGUARD  183112,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,6067,4295.44,Aetna First Health,Commercial,,5156.95,85,,,2688.89,5156.95,percent of total billed charges,
PLATE BIO TIBIAL I-BEAM 79MM   141225,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,3395,2403.66,Aetna First Health,Commercial,,2885.75,85,,,1504.66,2885.75,percent of total billed charges,
STEM DISTAL BIO ARCOS 17 X 150MM SPL TPR 11-300817,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,7095,5023.26,Aetna First Health,Commercial,,6030.75,85,,,3144.5,6030.75,percent of total billed charges,
STEM DISTAL BIO ARCOS 16X150MM SPL TPR 11-300816,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,7732,5474.26,Aetna First Health,Commercial,,6572.2,85,,,3426.82,6572.2,percent of total billed charges,
STEM DISTAL TAPERED W/LKSCREW 15 X 150MM 11-300815,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,7732,5474.26,Aetna First Health,Commercial,,6572.2,85,,,3426.82,6572.2,percent of total billed charges,
STEM STRAIGHT TAPERED ARCOS MOD REVISION 14X150MM 11-300814,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,7732,5474.26,Aetna First Health,Commercial,,6572.2,85,,,3426.82,6572.2,percent of total billed charges,
STEM HIP INTERSPACE TAPER 46MM SHORT  SPC0023,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,8952,6338.02,Aetna First Health,Commercial,,7609.2,85,,,3967.53,7609.2,percent of total billed charges,
STEM HIP INTERSPACE TAPER MD WEDGE SS,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,9283,6572.36,Aetna First Health,Commercial,,7890.55,85,,,4114.23,7890.55,percent of total billed charges,
SPACER FEM LG INTERSPACE KNEE HIGH RELEASE,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,9377,6638.92,Aetna First Health,Commercial,,7970.45,85,,,4155.89,7970.45,percent of total billed charges,
SHELL ACET G7 TI 52MM MULTI-H SZ E OSSEO  110010264,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,9382,6642.46,Aetna First Health,Commercial,,7974.7,85,,,4158.1,7974.7,percent of total billed charges,
TRAY TIBIAL 360   185203,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5702,4037.02,Aetna First Health,Commercial,,4846.7,85,,,2527.13,4846.7,percent of total billed charges,
STEM FEM COMP BIO 60MM RT VANGUARD 360 185262,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,13673,9680.48,Aetna First Health,Commercial,,11622.05,85,,,6059.87,11622.05,percent of total billed charges,
BODY CONE ARCOS TI C STDOFFSET 60MM MOD 11-301303,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,13764,9744.91,Aetna First Health,Commercial,,11699.4,85,,,6100.2,11699.4,percent of total billed charges,
BODY CONE COMPONENT PROX BIO ARCOS SZ B STD 60MM 11-301302,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,13764,9744.91,Aetna First Health,Commercial,,11699.4,85,,,6100.2,11699.4,percent of total billed charges,
BODY CONE PROX BIO ARCOS SZ A HO 50MM  11-301310,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,13764,9744.91,Aetna First Health,Commercial,,11699.4,85,,,6100.2,11699.4,percent of total billed charges,
CONE PROXIMAL SZ A STD OFFSET 70MM  11-301321,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,13764,9744.91,Aetna First Health,Commercial,,11699.4,85,,,6100.2,11699.4,percent of total billed charges,
COMPONENT FEM BIO 65MM LT VANGUARD 360 185284,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,14907,10554.16,Aetna First Health,Commercial,,12670.95,85,,,6606.78,12670.95,percent of total billed charges,
BODY PROX CONE TYPE I SZ 8  11-301322,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,15003,10622.12,Aetna First Health,Commercial,,12752.55,85,,,6649.33,12752.55,percent of total billed charges,
ADAPTER OFFSET 360 5MM   185211,C1776,CDM,C1776,CPT,278,RC,,,facility,inpatient,,,5702,4037.02,Aetna First Health,Commercial,,4846.7,85,,,2527.13,4846.7,percent of total billed charges,
MESH HERNIA POLY SOFT 12X12IN (CA/1)  0117016,C1781,CDM,C1781,CPT,278,RC,,,facility,inpatient,,,732,518.26,Aetna First Health,Commercial,,622.2,85,,,324.42,622.2,percent of total billed charges,
PACEMAKER ACCOLADE MRI DR-EL US  L331,C1785,CDM,C1785,CPT,278,RC,,,facility,inpatient,,,10366,7339.13,Aetna First Health,Commercial,,8811.1,85,,,4594.21,8811.1,percent of total billed charges,
PACEMAKER ACCOLADE MRI SR US   L310,C1786,CDM,C1786,CPT,278,RC,,,facility,inpatient,,,8051,5700.11,Aetna First Health,Commercial,,6843.35,85,,,3568.2,6843.35,percent of total billed charges,
CATHETER POWER PORT 8FR   1808060,C1788,CDM,C1788,CPT,278,RC,,,facility,inpatient,,,1153,816.32,Aetna First Health,Commercial,,980.05,85,,,511.01,980.05,percent of total billed charges,
STENT ONYX FRONTIER RX 2.00 X 12MM  ONYXNG20012UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.00 X 15MM  ONYXNG20015UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.25 X 15MM  ONYXNG22515UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX2.50 X 12MM  ONYXNG25012UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.50 X 15MM  ONYXNG25015UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.50 X 18MM  ONYXNG25018UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.50 X 26MM  ONYXNG25026UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.50 X 34MM  ONYXNG25034UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.75 X 15MM  ONYXNG27515UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 2.75 X 18MM  ONYXNG27518UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 08MM  ONYXNG30008UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 12MM  ONYXNG30012UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 15MM  ONYXNG30015UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 18MM  ONYXNG30018UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 22MM  ONYXNG30022UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 26MM  ONYXNG30026UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 34MM  ONYXNG30034UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.0 X 38MM  ONYXNG30038UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.5 X 15MM  ONYXNG35015UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.5 X 18MM  ONYXNG35018UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.5 X 22MM  ONYXNG35022UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.5 X 26MM  ONYXNG35026UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 3.5 X 38MM  ONYXNG35038UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 4.0 X 18MM  ONYXNG40018UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 4.0 X 30MM  ONYXNG40030UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 4.5 X 12MM  ONYXNG45012UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT ONYX FRONTIER RX 5.0 X 22MM  ONYXNG50022UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
STENT SYNERGY XD MR 2.25 X12MM   H7493941812220,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.25 X24MM   H7493941824220,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.50 X12MM   H7493941812250,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.50 X16MM   H7493941816250,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.50 X20MM   H7493941820250,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.50 X32MM   H7493941832250,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.50 X38MM   H7493941838250,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.50 X8MM   H7493941808250,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X12MM   H7493941812270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X16MM   H7493941816270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X24MM   H7493941824270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X28MM   H7493941828270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X32MM   H7493941832270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X38MM   H7493941838270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X8MM   H7493941808270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X12MM   H7493941812300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X16MM   H7493941816300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X20MM   H7493941820300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X24MM   H7493941824300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X28MM   H7493941828300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X32MM   H7493941832300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X38MM   H7493941838300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X12MM   H7493941812350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X16MM   H7493941816350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X20MM   H7493941820350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X24MM   H7493941824350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X28MM   H7493941828350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X32MM   H7493941832350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X38MM   H7493941838350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X8MM   H7493941808350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 4.00 X12MM   H7493941812400,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 4.00 X16MM   H7493941816400,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 4.00 X20MM   H7493941820400,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 4.00 X28MM   H7493941828400,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 4.00 X38MM   H7493941838400,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 4.00 X8MM   H7493941808400,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1570,1111.56,Aetna First Health,Commercial,,1334.5,85,,,695.82,1334.5,percent of total billed charges,
STENT SYNERGY XD MR 2.50 X48MM   H7493941848250,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1800,1274.4,Aetna First Health,Commercial,,1530,85,,,797.76,1530,percent of total billed charges,
STENT SYNERGY XD MR 2.75 X48MM   H7493941848270,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1800,1274.4,Aetna First Health,Commercial,,1530,85,,,797.76,1530,percent of total billed charges,
STENT SYNERGY XD MR 3.00 X48MM   H7493941848300,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1800,1274.4,Aetna First Health,Commercial,,1530,85,,,797.76,1530,percent of total billed charges,
STENT SYNERGY XD MR 3.50 X48MM   H7493941848350,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1800,1274.4,Aetna First Health,Commercial,,1530,85,,,797.76,1530,percent of total billed charges,
STENT ONYX FRONTIER RX 3.5 X 34MM  ONYXNG35034UX,C1874,CDM,C1874,CPT,278,RC,,,facility,inpatient,,,1400,991.2,Aetna First Health,Commercial,,1190,85,,,620.48,1190,percent of total billed charges,
SYSTEM EMBOLIC PROTECTION 190CM .014IN CAROTID ARTERY  H749390711900,C1884,CDM,C1884,CPT,278,RC,,,facility,inpatient,,,3514,2487.91,Aetna First Health,Commercial,,2986.9,85,,,1557.4,2986.9,percent of total billed charges,
CATHETER 5F INF JL 4.0 100CM   534-520T,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,32,22.66,Aetna First Health,Commercial,,27.2,85,,,14.18,27.2,percent of total billed charges,
CATHETER 4FR INF JL4 100CM   538-420,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,51,36.11,Aetna First Health,Commercial,,43.35,85,,,22.6,43.35,percent of total billed charges,
CATHETER 4FR INF JR4 100CM   538-421,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,51,36.11,Aetna First Health,Commercial,,43.35,85,,,22.6,43.35,percent of total billed charges,
CATHETER 5F INF JL 3.5 100CM   534-518T,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,57,40.36,Aetna First Health,Commercial,,48.45,85,,,25.26,48.45,percent of total billed charges,
CATHETER 5F JL 3.0 100CM   MODC17642,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,119,84.25,Aetna First Health,Commercial,,101.15,85,,,52.74,101.15,percent of total billed charges,
CATHETER GUIDING OPTITORQUE JACKY RADIAL 3 5 5F 110CM  40-5023,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
CATHETER GUIDING OPTITORQUE PIGTAIL STRAIGHT 5F 110CM  40-5030,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
CATHETER GUIDING OPTITORQUE RADIAL TIG 4 0 5F 100CM  40-5011,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
CATHETER GUIDING OPTITORQUE RADIAL TIG 4.0 6F 100CM  40-6011,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,123,87.08,Aetna First Health,Commercial,,104.55,85,,,54.51,104.55,percent of total billed charges,
CATHETER GUIDE 5F 100CM AL75   LA5AL75,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
CATHETER GUIDING LAUNCHER 6FR 100CM  LA6EBU50,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
GUIDE EBU 3.0 6FR LAUNCHER   LA6EBU30,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
GUIDE MP1 6FR LAUNCHER   LA6MP1,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,140,99.12,Aetna First Health,Commercial,,119,85,,,62.05,119,percent of total billed charges,
CATHETER GUIDE CONVEY 7FR LEFTBU 3.5  H749392657140,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
"CATHETER, GUIDING",C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
CATHETER GUIDING 6FR VL3.5 MACH 1  H74934356720,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
CATHETER GUIDING 6FR VL4 MACH 1  H74934356730,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
CATHETER GUIDING 7FR FR 4 MACH 1  H74934357020,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
CATHETER RUNWAY 6F LT BU3.5   H749389697140,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
GUIDE JR 5.0 6FR LAUNCHER   LA6JR50,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,163,115.4,Aetna First Health,Commercial,,138.55,85,,,72.24,138.55,percent of total billed charges,
CATHETER 5F EBU35 LAUNCHER   LA5EBU35,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
CATHETER 5F EBU375 LAUNCHER   LA5EBU375,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
CATHETER 5F EBU3 LAUNCHER   LA5EBU30,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
CATHETER 5F HS1 LAUNCHER   LA5HSI,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
CATHETER PAPA 1 6FR   LA6PAPA1,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
GUIDE EBU 3.5 6FR LAUNCHER   LA6EBU35,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
GUIDE EBU 3.75 6FR LAUNCHER   LA6EBU375,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
GUIDE JR 4.0 SH 6FR LAUNCHER   LA6JR40SH,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
GUIDE LAUNCHER EBU 4.0 6FR   LA6EBU40,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,169,119.65,Aetna First Health,Commercial,,143.65,85,,,74.9,143.65,percent of total billed charges,
CATHETER 5F ALR1-2 110CM LAUNCHER  LA5ALR12A,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
CATHETER 5F JR4 110CM LAUNCHER   LA5JR40A,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
CATHETER 5F MP1 LAUNCHER   LA5MP1,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE 3DRC 6FR LAUNCHER   LA63DRC,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE AL 1 6FR LAUNCHER   LA6AL10,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE AR 1.0 6FR LAUNCHER   LA6AR10,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE HSII 6FR LAUNCHER   LA6HSII,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE JL 3.5 6FR LAUNCHER   LA6JL35,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE JL 4.0 6FR LAUNCHER   LA6JL40,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE JR 4.0 6FR LAUNCHER   LA6JR40,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE LAUNCHER IMA 6FR   LA6IMA,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
GUIDE MB 1 6FR LAUNCHER   LA6MB1,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,175,123.9,Aetna First Health,Commercial,,148.75,85,,,77.56,148.75,percent of total billed charges,
CATHETER CORONARY 6F AL75 SHERPA  SB6AL75,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,221.5,156.82,Aetna First Health,Commercial,,188.28,85,,,98.17,188.28,percent of total billed charges,
CATHETER CORONARY 6F HS1 SHERPA  SB6HSI,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,221.5,156.82,Aetna First Health,Commercial,,188.28,85,,,98.17,188.28,percent of total billed charges,
CATHETER GUIDING 5F CONVEY JR4 CURVE 100CM  H749392286860,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
CATHETER PACING STRAIGHT 5FR   D97120F5,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,330,233.64,Aetna First Health,Commercial,,280.5,85,,,146.26,280.5,percent of total billed charges,
INTRODUCER SHEATH DEST 6FR X 65CM TOUGHY-BORST STRAIGHT  RSP03,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,293,207.44,Aetna First Health,Commercial,,249.05,85,,,129.86,249.05,percent of total billed charges,
SHEATH GUIDING 6FR 75CM R2P DESTINATION SLENDER (BX/1)  GS-R6ST1C75W,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,710,502.68,Aetna First Health,Commercial,,603.5,85,,,314.67,603.5,percent of total billed charges,
CATHETER GUIDE LINER 5F   5569,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,844,597.55,Aetna First Health,Commercial,,717.4,85,,,374.06,717.4,percent of total billed charges,
CATHETER GUIDE LINER 6F 150CM   5571,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,871,616.67,Aetna First Health,Commercial,,740.35,85,,,386.03,740.35,percent of total billed charges,
CATHETER CORONARY EXTENSION TELESCOPE 6FR  TELE6F,C1887,CDM,C1887,CPT,278,RC,,,facility,inpatient,,,1600,1132.8,Aetna First Health,Commercial,,1360,85,,,709.12,1360,percent of total billed charges,
CATHETER SHOCKWAVE C2+ IVL 2.5 X 12MM  C2PIVL2512,C1889.01,CDM,C1889,CPT,278,RC,,,facility,inpatient,,,11045,7819.86,Aetna First Health,Commercial,,9388.25,85,,,4895.14,9388.25,percent of total billed charges,
INTRODUCER WIRE INTERVENTIONAL   H965914004001,C1892,CDM,C1892,CPT,278,RC,,,facility,inpatient,,,16,11.33,Aetna First Health,Commercial,,13.6,85,,,7.09,13.6,percent of total billed charges,
SHEATH 5FR PRELUDE PRO   PRO-5F-11-035,C1892,CDM,C1892,CPT,278,RC,,,facility,inpatient,,,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
SHEATH 6FR PRELUDE PRO   PRO-6F-11-035,C1892,CDM,C1892,CPT,278,RC,,,facility,inpatient,,,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
SHEATH 7FR PRELUDE PRO   PRO-7F-11-035,C1892,CDM,C1892,CPT,278,RC,,,facility,inpatient,,,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
SHEATH DESTINATION 7FR X 45CM   54-74501,C1892,CDM,C1892,CPT,278,RC,,,facility,inpatient,,,267,189.04,Aetna First Health,Commercial,,226.95,85,,,118.33,226.95,percent of total billed charges,
SHEATH 8FR TIFF   10-2534,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,42,29.74,Aetna First Health,Commercial,,35.7,85,,,18.61,35.7,percent of total billed charges,
SHEATH 6FRX25CM   RSS605,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,84,59.47,Aetna First Health,Commercial,,71.4,85,,,37.23,71.4,percent of total billed charges,
KIT MICROINTRODUCER 5FR 21G 7CM MINI STICK MAX STIFF  H965457590,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,101,71.51,Aetna First Health,Commercial,,85.85,85,,,44.76,85.85,percent of total billed charges,
SHEATH 4FR 11CM BRITE TIP   401411M,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,144,101.95,Aetna First Health,Commercial,,122.4,85,,,63.82,122.4,percent of total billed charges,
GLIDESHEATH SLENDER SS KIT .021 IN GW 6FR 10CM  80-1060,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,179,126.73,Aetna First Health,Commercial,,152.15,85,,,79.33,152.15,percent of total billed charges,
"INTRO/SHEATH, NON-LASER",C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,276,195.41,Aetna First Health,Commercial,,234.6,85,,,122.32,234.6,percent of total billed charges,
INTRODUCER SHEATH 6F OPTISEAL 13CM UNIV US  EXT-1000093-001,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,277,196.12,Aetna First Health,Commercial,,235.45,85,,,122.77,235.45,percent of total billed charges,
SHEATH ARROW 6FR X 45CM   CL-07645,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,303,214.52,Aetna First Health,Commercial,,257.55,85,,,134.29,257.55,percent of total billed charges,
GLIDESHEATH RADIAL 6FR 10CM   60-1060,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,305,215.94,Aetna First Health,Commercial,,259.25,85,,,135.18,259.25,percent of total billed charges,
INTRODUCER GLIDESHEATH SLENDER 7F 10CM  60-1070,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,305,215.94,Aetna First Health,Commercial,,259.25,85,,,135.18,259.25,percent of total billed charges,
SHEATH DEST 6FRX45CM BX1  RSR01,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,317,224.44,Aetna First Health,Commercial,,269.45,85,,,140.49,269.45,percent of total billed charges,
INTRODUCER SET LAP CHOLE CATHETER  CS-01700,C1894,CDM,C1894,CPT,272,RC,,,facility,inpatient,,,537,380.2,Aetna First Health,Commercial,,456.45,85,,,238,456.45,percent of total billed charges,
LEAD INGEVITY PLUS AF IS1 45CM   7840,C1898,CDM,C1898,CPT,275,RC,,,facility,inpatient,,,1026,726.41,Aetna First Health,Commercial,,872.1,85,,,454.72,872.1,percent of total billed charges,
LEAD INGEVITY PLUS AF IS1 52CM   7841,C1898,CDM,C1898,CPT,275,RC,,,facility,inpatient,,,1026,726.41,Aetna First Health,Commercial,,872.1,85,,,454.72,872.1,percent of total billed charges,
LEAD INGEVITY PLUS AF IS1 59CM   7842,C1898,CDM,C1898,CPT,275,RC,,,facility,inpatient,,,1026,726.41,Aetna First Health,Commercial,,872.1,85,,,454.72,872.1,percent of total billed charges,
STENT URETERAL FIRM 7X26   G23416,C2617,CDM,C2617,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
STENT URETERAL SOFT 6FR X 24   G23374,C2617,CDM,C2617,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
STENT URETERAL SOFT 6FR X 26   G23376,C2617,CDM,C2617,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
STENT URETERAL SOFT 6FR X 28   G23377,C2617,CDM,C2617,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
STENT URETERAL FIRM 7X24   G23415,C2617,CDM,C2617,CPT,278,RC,,,facility,inpatient,,,174,123.19,Aetna First Health,Commercial,,147.9,85,,,77.12,147.9,percent of total billed charges,
autofuser pump 1 Each Package,C2626.01,CDM,C1713,CPT,278,RC,08888800734,NDC,facility,both,1,EA,480,339.84,Aetna First Health,Commercial,,408,85,,,212.74,408,percent of total billed charges,
On-Q Pump 1 Each Package,C2626.01,CDM,C1713,CPT,278,RC,08888800758,NDC,facility,both,1,EA,513,363.2,Aetna First Health,Commercial,,436.05,85,,,227.36,436.05,percent of total billed charges,
"PALLADIUM-103, PER SOURCE",C2640.01,CDM,C2640,CPT,278,RC,,,facility,both,,,132,93.46,Aetna First Health,Commercial,,112.2,85,,,58.5,112.2,percent of total billed charges,
MR ANGIO ABDOMEN W/WO CONT TC,C8902,CDM,C8902,CPT,610,RC,,,facility,both,,,2765,1957.62,Aetna First Health,Commercial,TC,2350.25,85,,,1225.45,2350.25,percent of total billed charges,
"MRI BREAST, BILAT W/WO CONT TC",C8908,CDM,C8908,CPT,610,RC,,,facility,both,,,3078,2179.22,Aetna First Health,Commercial,TC,2616.3,85,,,1364.17,2616.3,percent of total billed charges,
LEVOleucovorin 50 MG Recon Soln 1 Each Vial,C9043.01,CDM,C9043,CPT,636,RC,68152010100,NDC,facility,both,1,EA,112.5,79.65,Aetna First Health,Commercial,,95.62,85,,,49.86,95.62,percent of total billed charges,
cocaine hcl 40 MG/ML Solution 4 mL Bottle,C9046.01,CDM,C9143,CPT,636,RC,00527196174,NDC,facility,both,1,ML,496.13,351.26,Aetna First Health,Commercial,,421.71,85,,,219.88,421.71,percent of total billed charges,
cocaine hcl 40 MG/ML Solution 4 mL Bottle,C9046.01,CDM,C9046,CPT,636,RC,00527197174,NDC,facility,both,1,ML,882,624.46,Aetna First Health,Commercial,,749.7,85,,,390.9,749.7,percent of total billed charges,
cocaine hcl 40 MG/ML Solution 4 mL Bottle,C9046.01,CDM,C9046,CPT,636,RC,64950036204,NDC,facility,both,1,ML,980,693.84,Aetna First Health,Commercial,,833,85,,,434.34,833,percent of total billed charges,
clevidipine 25 MG/50ML Emulsion 50 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,65293000555,NDC,facility,both,1,ML,149.29,105.7,Aetna First Health,Commercial,,126.9,85,,,66.17,126.9,percent of total billed charges,
clevidipine 25 MG/50ML Emulsion 50 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,65293000550,NDC,facility,both,1,ML,186.86,132.3,Aetna First Health,Commercial,,158.83,85,,,82.82,158.83,percent of total billed charges,
clevidipine 25 MG/50ML Emulsion 50 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,10122061001,NDC,facility,both,1,ML,192.49,136.28,Aetna First Health,Commercial,,163.62,85,,,85.31,163.62,percent of total billed charges,
clevidipine 25 MG/50ML Emulsion 50 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,10122061010,NDC,facility,both,1,ML,192.49,136.28,Aetna First Health,Commercial,,163.62,85,,,85.31,163.62,percent of total billed charges,
clevidipine 50 MG/100ML Emulsion 100 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,65293000500,NDC,facility,both,1,ML,298.58,211.39,Aetna First Health,Commercial,,253.79,85,,,132.33,253.79,percent of total billed charges,
clevidipine 50 MG/100ML Emulsion 100 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,65293000511,NDC,facility,both,1,ML,298.58,211.39,Aetna First Health,Commercial,,253.79,85,,,132.33,253.79,percent of total billed charges,
clevidipine 50 MG/100ML Emulsion 100 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,10122061101,NDC,facility,both,1,ML,384.98,272.57,Aetna First Health,Commercial,,327.23,85,,,170.62,327.23,percent of total billed charges,
clevidipine 50 MG/100ML Emulsion 100 mL Vial,C9248.01,CDM,C9248,CPT,636,RC,10122061110,NDC,facility,both,1,ML,384.98,272.57,Aetna First Health,Commercial,,327.23,85,,,170.62,327.23,percent of total billed charges,
lacosamide 200 MG/20ML Solution 20 mL Vial,C9254.01,CDM,C9254,CPT,636,RC,69543045520,NDC,facility,both,1,ML,87.75,62.13,Aetna First Health,Commercial,,74.59,85,,,38.89,74.59,percent of total billed charges,
lacosamide 200 MG/20ML Solution 20 mL Vial,C9254.01,CDM,C9254,CPT,636,RC,65219020401,NDC,facility,both,1,ML,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
lacosamide 200 MG/20ML Solution 20 mL Vial,C9254.01,CDM,C9254,CPT,636,RC,72205022001,NDC,facility,both,1,ML,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
lacosamide 200 MG/20ML Solution 20 mL Vial,C9254.01,CDM,C9254,CPT,636,RC,43598008711,NDC,facility,both,1,ML,90,63.72,Aetna First Health,Commercial,,76.5,85,,,39.89,76.5,percent of total billed charges,
lacosamide 200 MG/20ML Solution 20 mL Vial,C9254.01,CDM,C9254,CPT,636,RC,25021079120,NDC,facility,both,1,ML,147.24,104.25,Aetna First Health,Commercial,,125.15,85,,,65.26,125.15,percent of total billed charges,
lacosamide 200 MG/20ML Solution 20 mL Vial,C9254.01,CDM,C9254,CPT,636,RC,00131181067,NDC,facility,both,1,ML,217.49,153.98,Aetna First Health,Commercial,,184.87,85,,,96.39,184.87,percent of total billed charges,
"COVID-19 CONVALESCENT PLASMA HIGH TITER, EACH UNIT",C9507,CDM,C9507,CPT,390,RC,,,facility,both,,,2000,1416,Aetna First Health,Commercial,,1700,85,,,886.4,1700,percent of total billed charges,
PERC DRUG-EL COR STENT SING,C9600,CDM,C9600,CPT,481,RC,,,facility,both,,,22145,15678.66,Aetna First Health,Commercial,,18823.25,85,,,9814.66,18823.25,percent of total billed charges,
PERC DRUG-EL COR STENT BRAN,C9601,CDM,C9601,CPT,481,RC,,,facility,both,,,16995,12032.46,Aetna First Health,Commercial,,14445.75,85,,,7532.18,14445.75,percent of total billed charges,
PERC D-E COR STENT ATHER S,C9602,CDM,C9602,CPT,481,RC,,,facility,both,,,20555,14552.94,Aetna First Health,Commercial,,17471.75,85,,,9109.98,17471.75,percent of total billed charges,
PERC D-E COR STENT ATHER BR,C9603,CDM,C9603,CPT,481,RC,,,facility,both,,,17508,12395.66,Aetna First Health,Commercial,,14881.8,85,,,7759.55,14881.8,percent of total billed charges,
PERC D-E COR REVASC T CABG S,C9604,CDM,C9604,CPT,481,RC,,,facility,both,,,23053,16321.52,Aetna First Health,Commercial,,19595.05,85,,,10217.09,19595.05,percent of total billed charges,
PERC D-E COR REVASC W AMI S,C9606,CDM,C9606,CPT,481,RC,,,facility,both,,,27139,19214.41,Aetna First Health,Commercial,,23068.15,85,,,12028,23068.15,percent of total billed charges,
PERC D-E COR REVASC CHRO SIN,C9607,CDM,C9607,CPT,481,RC,,,facility,both,,,22611,16008.59,Aetna First Health,Commercial,,19219.35,85,,,10021.2,19219.35,percent of total billed charges,
PERC D-E COR REVASC CHRO ADD,C9608,CDM,C9608,CPT,481,RC,,,facility,both,,,19632,13899.46,Aetna First Health,Commercial,,16687.2,85,,,8700.9,16687.2,percent of total billed charges,
REVASC LOWER EXTREM ART W/ INTRA LITHOTRIPSY & STENT,C9765,CDM,C9765,CPT,481,RC,,,facility,both,,,21358,15121.46,Aetna First Health,Commercial,,18154.3,85,,,9465.87,18154.3,percent of total billed charges,
HOSPITAL OUTPATIENT CLINIC VISIT SPECIMEN COLLECTION FOR SARS-COV-2,C9803,CDM,C9803,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
CRUTCHES,E0114.06,CDM,E0114,CPT,290,RC,,,facility,both,,,38,26.9,Aetna First Health,Commercial,,32.3,85,,,16.84,32.3,percent of total billed charges,
"PSA, SCREENING",G0103,CDM,G0103,CPT,300,RC,,,facility,both,,,43,30.44,Aetna First Health,Commercial,,36.55,85,,,19.06,36.55,percent of total billed charges,
DSMT-INDIVIDUAL 1/2 HR,G0108,CDM,G0108,CPT,942,RC,,,facility,both,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
"DSMT,RD ONLY,INDIVIDUAL",G0108.RD,CDM,G0108,CPT,942,RC,,,facility,both,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
"DSMT,RDRN SHARED,INDIVIDUAL",G0108.RDRN,CDM,G0108,CPT,942,RC,,,facility,both,,,148,104.78,Aetna First Health,Commercial,,125.8,85,,,65.59,125.8,percent of total billed charges,
DSMT-RN-INDIVIDUAL 1/2 HR,G0108.RN,CDM,G0108,CPT,942,RC,,,facility,both,,,158,111.86,Aetna First Health,Commercial,,134.3,85,,,70.03,134.3,percent of total billed charges,
DSMT GROUP 1/2 HR,G0109,CDM,G0109,CPT,942,RC,,,facility,both,,,35,24.78,Aetna First Health,Commercial,,29.75,85,,,15.51,29.75,percent of total billed charges,
"DSMT,RD ONLY,GROUP",G0109.RD,CDM,G0109,CPT,942,RC,,,facility,both,,,68,48.14,Aetna First Health,Commercial,,57.8,85,,,30.14,57.8,percent of total billed charges,
RESP MUSCLES 1:1 PER 15 MIN,G0237,CDM,G0237,CPT,948,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,,96.9,85,,,50.52,96.9,percent of total billed charges,
RESP FUNCTION 1:1 PER 15 MIN,G0238,CDM,G0238,CPT,948,RC,,,facility,both,,,107,75.76,Aetna First Health,Commercial,,90.95,85,,,47.42,90.95,percent of total billed charges,
"OTH RESP PROC, GROUP",G0239,CDM,G0239,CPT,460,RC,,,facility,both,,,41,29.03,Aetna First Health,Commercial,,34.85,85,,,18.17,34.85,percent of total billed charges,
"INJ SACROILIAC JOINT, ANESTH",G0260,CDM,G0260,CPT,510,RC,,,facility,both,,,1424,1008.19,Aetna First Health,Commercial,,1210.4,85,,,631.12,1210.4,percent of total billed charges,
"ILIAC ART ANGIO, CARDIAC CATH",G0278F,CDM,G0278,CPT,480,RC,,,facility,both,,,114,80.71,Aetna First Health,Commercial,,96.9,85,,,50.52,96.9,percent of total billed charges,
FECAL BLOOD SCRN IMMUNOASSAY,G0328,CDM,G0328,CPT,300,RC,,,facility,both,,,113,80,Aetna First Health,Commercial,,96.05,85,,,50.08,96.05,percent of total billed charges,
DIRECT ADMIT HOSPITAL OBSERV,G0379,CDM,G0379,CPT,761,RC,,,facility,both,,,709,501.97,Aetna First Health,Commercial,,602.65,85,,,314.23,602.65,percent of total billed charges,
"HOME SLEEP STUDY W/ TYPE IV MONITOR, MIN 3 CHANNELS UNATTENDED",G040001,CDM,G0400,CPT,740,RC,,,facility,both,,,880,623.04,Aetna First Health,Commercial,TC,748,85,,,390.02,748,percent of total billed charges,
SAT BIOPSY ANY SPECS TC,G041601,CDM,G0416,CPT,310,RC,,,facility,both,,,1767,1251.04,Aetna First Health,Commercial,TC,1501.95,85,,,783.13,1501.95,percent of total billed charges,
HEPATITIS C ANTIBODY SCREEN,G0472,CDM,G0472,CPT,300,RC,,,facility,both,,,106,75.05,Aetna First Health,Commercial,,90.1,85,,,46.98,90.1,percent of total billed charges,
"DRUG SCREEN, DEFINITIVE 22 OR MORE CLASSES",G048390,CDM,G0483,CPT,300,RC,,,facility,both,,,225,159.3,Aetna First Health,Commercial,90,191.25,85,,,99.72,191.25,percent of total billed charges,
"MODERATE SEDATION ENDO SERVICE, 5 YRS OR OLDER",G0500F,CDM,G0500,CPT,370,RC,,,facility,both,,,585,414.18,Aetna First Health,Commercial,,497.25,85,,,259.27,497.25,percent of total billed charges,
SPECIMEN COLLECTION FOR SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2),G2023,CDM,G2023,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
NH SPECIMEN COLLECTION FOR SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2) (COVID),G2024,CDM,G2024,CPT,300,RC,,,facility,both,,,70,49.56,Aetna First Health,Commercial,,59.5,85,,,31.02,59.5,percent of total billed charges,
"SELF HELP/PEER SERVICES, PER 15 MINUTES",H0038.01,CDM,H0038,CPT,945,RC,,,facility,both,,,18,12.74,Aetna First Health,Commercial,,15.3,85,,,7.98,15.3,percent of total billed charges,
"ALCOHOL AND OR OTHER DRUG TREATMENT PROGRAM, PER DIEM",H2036,CDM,H2036,CPT,953,RC,,,facility,both,,,500,354,Aetna First Health,Commercial,,425,85,,,221.6,425,percent of total billed charges,
eravacycline 50 MG Recon Soln 1 Each Vial,J0122.01,CDM,J0122,CPT,636,RC,71773005005,NDC,facility,both,1,EA,138.38,97.97,Aetna First Health,Commercial,,117.62,85,,,61.33,117.62,percent of total billed charges,
eravacycline 50 MG Recon Soln 1 Each Vial,J0122.01,CDM,J0122,CPT,636,RC,71773005012,NDC,facility,both,1,EA,138.38,97.97,Aetna First Health,Commercial,,117.62,85,,,61.33,117.62,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Vial,J0131.01,CDM,J0131,CPT,636,RC,00781315606,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Glass Cont,J0131.01,CDM,J0131,CPT,636,RC,24201010001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Flex Cont,J0131.01,CDM,J0131,CPT,636,RC,67457094010,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Flex Cont,J0131.01,CDM,J0134,CPT,636,RC,63323043441,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Flex Cont,J0131.01,CDM,J0137,CPT,636,RC,00143938601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Glass Cont,J0131.01,CDM,J0131,CPT,636,RC,24201010024,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Vial,J0131.01,CDM,J0131,CPT,636,RC,00781315695,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Flex Cont,J0131.01,CDM,J0136,CPT,636,RC,00264410090,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acetaminophen 10 MG/ML Solution 100 mL Vial,J0131.01,CDM,J0131,CPT,636,RC,43825010201,NDC,facility,both,1,ML,106.65,75.51,Aetna First Health,Commercial,,90.65,85,,,47.27,90.65,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,72611086001,NDC,facility,both,1,ML,83.23,58.93,Aetna First Health,Commercial,,70.75,85,,,36.89,70.75,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,72611086004,NDC,facility,both,1,ML,83.23,58.93,Aetna First Health,Commercial,,70.75,85,,,36.89,70.75,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,25021081266,NDC,facility,both,1,ML,93.42,66.14,Aetna First Health,Commercial,,79.41,85,,,41.4,79.41,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,63323096330,NDC,facility,both,1,ML,247.52,175.24,Aetna First Health,Commercial,,210.39,85,,,109.7,210.39,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,00574080530,NDC,facility,both,1,ML,247.52,175.24,Aetna First Health,Commercial,,210.39,85,,,109.7,210.39,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,63323096321,NDC,facility,both,1,ML,247.52,175.24,Aetna First Health,Commercial,,210.39,85,,,109.7,210.39,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,25021081230,NDC,facility,both,1,ML,337.5,238.95,Aetna First Health,Commercial,,286.88,85,,,149.58,286.88,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,66220010730,NDC,facility,both,1,ML,373.88,264.71,Aetna First Health,Commercial,,317.8,85,,,165.7,317.8,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,55150025930,NDC,facility,both,1,ML,421.88,298.69,Aetna First Health,Commercial,,358.6,85,,,186.98,358.6,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,00574081530,NDC,facility,both,1,ML,423.02,299.5,Aetna First Health,Commercial,,359.57,85,,,187.48,359.57,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,00574080500,NDC,facility,both,1,ML,423.02,299.5,Aetna First Health,Commercial,,359.57,85,,,187.48,359.57,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,17478066030,NDC,facility,both,1,ML,423.02,299.5,Aetna First Health,Commercial,,359.57,85,,,187.48,359.57,percent of total billed charges,
acetylcysteine 200 MG/ML Solution 30 mL Vial,J0132.01,CDM,J0132,CPT,636,RC,66220020730,NDC,facility,both,1,ML,493.7,349.54,Aetna First Health,Commercial,,419.64,85,,,218.81,419.64,percent of total billed charges,
acyclovir 50 MG/ML Solution 10 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,63323032510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 10 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,55150015410,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 20 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,55150015520,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 10 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,63323032514,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 10 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,55150015411,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 10 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,63323032503,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 10 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,68382004801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 10 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,63323032541,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
acyclovir 50 MG/ML Solution 20 mL Vial,J0133.01,CDM,J0133,CPT,636,RC,63323032520,NDC,facility,both,1,ML,78.75,55.76,Aetna First Health,Commercial,,66.94,85,,,34.9,66.94,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,63323065102,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,25021030102,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,17478054202,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,17478054225,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,67457085502,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,17478095302,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,67457085500,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,72078003300,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,25021031802,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,63323065100,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 12 MG/4ML Solution 4 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,63323065104,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 12 MG/4ML Solution 4 mL Syringe,J0153.01,CDM,J0153,CPT,636,RC,64679063002,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 12 MG/4ML Solution 4 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,25021030104,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 12 MG/4ML Solution 4 mL Syringe,J0153.01,CDM,J0153,CPT,636,RC,25021030168,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 12 MG/4ML Solution 4 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,67457085404,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 12 MG/4ML Solution 4 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,67457085400,NDC,facility,both,0.5,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Syringe,J0153.01,CDM,J0153,CPT,636,RC,25021030172,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Syringe,J0153.01,CDM,J0153,CPT,636,RC,25021030167,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Syringe,J0153.01,CDM,J0153,CPT,636,RC,63323065121,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
adenosine 12 MG/4ML Solution 4 mL Syringe,J0153.01,CDM,J0153,CPT,636,RC,63323065190,NDC,facility,both,1,ML,58.28,41.26,Aetna First Health,Commercial,,49.54,85,,,25.83,49.54,percent of total billed charges,
adenosine 6 MG/2ML Solution 2 mL Syringe,J0153.01,CDM,J0153,CPT,636,RC,00469823412,NDC,facility,both,1,ML,81.07,57.4,Aetna First Health,Commercial,,68.91,85,,,35.93,68.91,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 20 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,00409193201,NDC,facility,both,1,ML,171.14,121.17,Aetna First Health,Commercial,,145.47,85,,,75.85,145.47,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,25021030767,NDC,facility,both,1,ML,185.63,131.43,Aetna First Health,Commercial,,157.79,85,,,82.27,157.79,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 20 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,00703877601,NDC,facility,both,1,ML,194.94,138.02,Aetna First Health,Commercial,,165.7,85,,,86.4,165.7,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,23155025832,NDC,facility,both,1,ML,216,152.93,Aetna First Health,Commercial,,183.6,85,,,95.73,183.6,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,00409193202,NDC,facility,both,1,ML,257.31,182.18,Aetna First Health,Commercial,,218.71,85,,,114.04,218.71,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,00703877701,NDC,facility,both,1,ML,287.21,203.34,Aetna First Health,Commercial,,244.13,85,,,127.29,244.13,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,17478054430,NDC,facility,both,1,ML,287.21,203.34,Aetna First Health,Commercial,,244.13,85,,,127.29,244.13,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 20 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,63323065120,NDC,facility,both,1,ML,289.58,205.02,Aetna First Health,Commercial,,246.14,85,,,128.34,246.14,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,55150019301,NDC,facility,both,1,ML,321.77,227.81,Aetna First Health,Commercial,,273.5,85,,,142.61,273.5,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,63323065130,NDC,facility,both,1,ML,436.59,309.11,Aetna First Health,Commercial,,371.1,85,,,193.5,371.1,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,67457085730,NDC,facility,both,1,ML,440.98,312.21,Aetna First Health,Commercial,,374.83,85,,,195.44,374.83,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,25021030730,NDC,facility,both,1,ML,440.98,312.21,Aetna First Health,Commercial,,374.83,85,,,195.44,374.83,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 20 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,00469087120,NDC,facility,both,1,ML,489.92,346.86,Aetna First Health,Commercial,,416.43,85,,,217.13,416.43,percent of total billed charges,
adenosine (diagnostic) 3 MG/ML Solution 30 mL Vial,J0153.01,CDM,J0153,CPT,636,RC,00469087130,NDC,facility,both,1,ML,734.87,520.29,Aetna First Health,Commercial,,624.64,85,,,325.69,624.64,percent of total billed charges,
EPINEPHrine 1 mg/mL in 0.9% sodium chloride Solution 10 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,,,facility,both,10,ML,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
EPINEPHrine 1 mg/1 mL in 0.9% sodium chloride 500 mL Bottle,J0171.01,CDM,J0171,CPT,636,RC,,,facility,both,1,ML,34,24.07,Aetna First Health,Commercial,,28.9,85,,,15.07,28.9,percent of total billed charges,
EPINEPHrine 30 MG/30ML Solution 30 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,42023016801,NDC,facility,both,0.01,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 30 MG/30ML Solution 30 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,76329906000,NDC,facility,both,0.01,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 30 MG/30ML Solution 30 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,42023016899,NDC,facility,both,0.01,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine PF 1 MG/ML Solution 1 mL Ampule,J0171.01,CDM,J0171,CPT,636,RC,00409724101,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine PF 1 MG/ML Solution 1 mL Ampule,J0171.01,CDM,J0171,CPT,636,RC,54288010301,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine PF 1 MG/ML Solution 1 mL Ampule,J0171.01,CDM,J0171,CPT,636,RC,00409724120,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/ML Solution 1 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,42023015925,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/ML Solution 1 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,42023015901,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine PF 1 MG/ML Solution 1 mL Ampule,J0171.01,CDM,J0171,CPT,636,RC,00409724110,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine PF 1 MG/ML Solution 1 mL Ampule,J0171.01,CDM,J0171,CPT,636,RC,00409724160,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 mg/mL in 0.9% sodium chloride Solution 10 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,88886800039,NDC,facility,both,1,ML,37,26.2,Aetna First Health,Commercial,,31.45,85,,,16.4,31.45,percent of total billed charges,
EPINEPHrine 1 mg/mL  n 0.9% sodium chloride Solution 10 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,88886800036,NDC,facility,both,1,ML,39,27.61,Aetna First Health,Commercial,,33.15,85,,,17.28,33.15,percent of total billed charges,
EPINEPHrine PF 1 MG/ML Solution 1 mL Ampule,J0171.01,CDM,J0171,CPT,636,RC,54288010310,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/ML VIAL Solution 30 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,76329906100,NDC,facility,both,0.01,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/ML VIAL Solution 10 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,54288012001,NDC,facility,both,0.03,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/ML VIAL Solution 1 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,54288011901,NDC,facility,both,0.3,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine (auto-injector) 0.3 MG/0.3ML Solution Auto-injector 1 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,49502010201,NDC,facility,both,1,EA,337.5,238.95,Aetna First Health,Commercial,,286.88,85,,,149.58,286.88,percent of total billed charges,
EPINEPHrine (auto-injector) 0.3 MG/0.3ML Solution Auto-injector 2 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,49502010202,NDC,facility,both,1,EA,337.5,238.95,Aetna First Health,Commercial,,286.88,85,,,149.58,286.88,percent of total billed charges,
EPINEPHrine (auto-injector) 0.3 MG/0.3ML Solution Auto-injector 2 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,00115169449,NDC,facility,both,1,EA,337.5,238.95,Aetna First Health,Commercial,,286.88,85,,,149.58,286.88,percent of total billed charges,
EPINEPHrine (auto-injector) 0.3 MG/0.3ML Solution Auto-injector 2 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,54505010202,NDC,facility,both,1,EA,349.57,247.5,Aetna First Health,Commercial,,297.13,85,,,154.93,297.13,percent of total billed charges,
EPINEPHrine (auto-injector) 0.3 MG/0.3ML Solution Auto-injector 2 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,49502050002,NDC,facility,both,1,EA,684.69,484.76,Aetna First Health,Commercial,,581.99,85,,,303.45,581.99,percent of total billed charges,
EPINEPHrine 0.15 MG/0.3ML Solution Auto-injector 1 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,49502050101,NDC,facility,both,1,EA,684.69,484.76,Aetna First Health,Commercial,,581.99,85,,,303.45,581.99,percent of total billed charges,
EPINEPHrine 0.15 MG/0.3ML Solution Auto-injector 2 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,49502010102,NDC,facility,both,1,EA,337.5,238.95,Aetna First Health,Commercial,,286.88,85,,,149.58,286.88,percent of total billed charges,
EPINEPHrine 0.15 MG/0.3ML Solution Auto-injector 2 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,00093598527,NDC,facility,both,1,EA,337.5,238.95,Aetna First Health,Commercial,,286.88,85,,,149.58,286.88,percent of total billed charges,
EPINEPHrine 0.15 MG/0.3ML Solution Auto-injector 2 Each Pen,J0171.01,CDM,J0171,CPT,636,RC,49502050102,NDC,facility,both,1,EA,684.69,484.76,Aetna First Health,Commercial,,581.99,85,,,303.45,581.99,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,00409492134,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,76329331601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,00409492120,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,69374092510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,00409493301,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,00409493311,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,76329331801,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 1 MG/10ML solution prefilled syringe 10 mL Syringe,J0171.01,CDM,J0171,CPT,636,RC,65302050710,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
EPINEPHrine 0.5 mg in BSS 500 mL 500 mL Bottle,J0171.01,CDM,J0171,CPT,636,RC,88888800297,NDC,facility,both,1,ML,83,58.76,Aetna First Health,Commercial,,70.55,85,,,36.79,70.55,percent of total billed charges,
EPINEPHrine in sodium chloride 20 mcg/mL Solution 250 mL Flex Cont,J0171.01,CDM,J0171,CPT,636,RC,76154081315,NDC,facility,both,1,ML,83.25,58.94,Aetna First Health,Commercial,,70.76,85,,,36.9,70.76,percent of total billed charges,
EPINEPHrine 0.25 mg in BSS 500 mL 500 mL Bag,J0171.01,CDM,J0171,CPT,636,RC,88888800292,NDC,facility,both,1,ML,143.5,101.6,Aetna First Health,Commercial,,121.98,85,,,63.6,121.98,percent of total billed charges,
EPINEPHrine 10 MG/10ML Solution 10 mL Vial,J0171.01,CDM,J0171,CPT,636,RC,54288060001,NDC,facility,both,1,ML,168.75,119.48,Aetna First Health,Commercial,,143.44,85,,,74.79,143.44,percent of total billed charges,
EPINEPHrine in sodium chloride 20 mcg/mL Solution 250 mL Bag,J0171.01,CDM,J0171,CPT,636,RC,08888800701,NDC,facility,both,1,ML,249.75,176.82,Aetna First Health,Commercial,,212.29,85,,,110.69,212.29,percent of total billed charges,
sodium thiosulfate 250 MG/ML Solution 50 mL Vial,J0209.01,CDM,J0209,CPT,636,RC,60267070550,NDC,facility,both,1,ML,177.75,125.85,Aetna First Health,Commercial,,151.09,85,,,78.78,151.09,percent of total billed charges,
alprostadil 500 MCG/ML Solution 1 mL Vial,J0270.01,CDM,J0270,CPT,636,RC,00703150102,NDC,facility,both,1,ML,91.32,64.65,Aetna First Health,Commercial,,77.62,85,,,40.47,77.62,percent of total billed charges,
alprostadil 500 MCG/ML Solution 1 mL Vial,J0270.01,CDM,J0270,CPT,636,RC,00703150101,NDC,facility,both,1,ML,91.33,64.66,Aetna First Health,Commercial,,77.63,85,,,40.48,77.63,percent of total billed charges,
alprostadil 500 MCG/ML Solution 1 mL Ampule,J0270.01,CDM,J0270,CPT,636,RC,00009316906,NDC,facility,both,1,ML,329.15,233.04,Aetna First Health,Commercial,,279.78,85,,,145.88,279.78,percent of total billed charges,
alprostadil 500 MCG/ML Solution 1 mL Ampule,J0270.01,CDM,J0270,CPT,636,RC,00009316901,NDC,facility,both,1,ML,329.15,233.04,Aetna First Health,Commercial,,279.78,85,,,145.88,279.78,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,25021017304,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,00703904001,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,00641616610,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,00641616601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,23155078631,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,63323081504,NDC,facility,both,1,ML,52.43,37.12,Aetna First Health,Commercial,,44.57,85,,,23.24,44.57,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,63323081522,NDC,facility,both,1,ML,52.43,37.12,Aetna First Health,Commercial,,44.57,85,,,23.24,44.57,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,23155029032,NDC,facility,both,1,ML,55.15,39.05,Aetna First Health,Commercial,,46.88,85,,,24.44,46.88,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,00703904003,NDC,facility,both,1,ML,55.15,39.05,Aetna First Health,Commercial,,46.88,85,,,24.44,46.88,percent of total billed charges,
amikacin 1 GM/4ML Solution 4 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,23155029042,NDC,facility,both,1,ML,55.15,39.05,Aetna First Health,Commercial,,46.88,85,,,24.44,46.88,percent of total billed charges,
amikacin 500 MG/2ML Solution 2 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,00703903201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 500 MG/2ML Solution 2 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,00703903203,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 500 MG/2ML Solution 2 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,23155029031,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 500 MG/2ML Solution 2 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,23155029041,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 500 MG/2ML Solution 2 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,63323081502,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amikacin 500 MG/2ML Solution 2 mL Vial,J0278.01,CDM,J0278,CPT,636,RC,00641616701,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminophylline 25 MG/ML Solution 20 mL Vial,J0280.01,CDM,J0280,CPT,636,RC,00409592201,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
aminophylline 25 MG/ML Solution 20 mL Vial,J0280.01,CDM,J0280,CPT,636,RC,00409592216,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 900 MG/18ML Solution 18 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,55150018218,NDC,facility,both,0.16667,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,63323061603,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,67457015303,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,00143987510,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,67457015300,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,00143987501,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,00143987525,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,55150018003,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,63323061601,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 900 MG/18ML Solution 18 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,67457015318,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 450 MG/9ML Solution 9 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,67457015399,NDC,facility,both,0.33333,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 450 MG/9ML Solution 9 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,63323061602,NDC,facility,both,0.33333,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 450 MG/9ML Solution 9 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,72078004609,NDC,facility,both,0.33333,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 450 MG/9ML Solution 9 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,72078004600,NDC,facility,both,0.33333,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150 MG/3ML Solution 3 mL Syringe,J0282.01,CDM,J0282,CPT,636,RC,25021030266,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 450 MG/9ML Solution 9 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,63323061609,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 450 MG/9ML Solution 9 mL Vial,J0282.01,CDM,J0282,CPT,636,RC,67457015309,NDC,facility,both,1,ML,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
amiodarone 150-4.21 MG/100ML-% Solution 100 mL Plas Cont,J0283.01,CDM,J0283,CPT,636,RC,43066015010,NDC,facility,both,1,ML,78.08,55.28,Aetna First Health,Commercial,,66.37,85,,,34.61,66.37,percent of total billed charges,
amiodarone 360-4.14 MG/200ML-% Solution 200 mL Plas Cont,J0283.01,CDM,J0283,CPT,636,RC,43066036020,NDC,facility,both,1,ML,103.95,73.6,Aetna First Health,Commercial,,88.36,85,,,46.07,88.36,percent of total billed charges,
amphotericin B 50 MG Recon Soln 1 Each Vial,J0285.01,CDM,J0285,CPT,636,RC,39822105505,NDC,facility,both,1,EA,108,76.46,Aetna First Health,Commercial,,91.8,85,,,47.87,91.8,percent of total billed charges,
amphotericin B lipid complex 5 MG/ML Suspension 20 mL Vial,J0287.01,CDM,J0287,CPT,636,RC,57665010141,NDC,facility,both,1,ML,236.25,167.26,Aetna First Health,Commercial,,200.81,85,,,104.71,200.81,percent of total billed charges,
amphotericin B liposome 50 MG Recon Susp 1 Each Vial,J0289.01,CDM,J0289,CPT,636,RC,62756023301,NDC,facility,both,1,EA,573.19,405.82,Aetna First Health,Commercial,,487.21,85,,,254.04,487.21,percent of total billed charges,
amphotericin B liposome 50 MG Recon Susp 1 Each Vial,J0289.01,CDM,J0289,CPT,636,RC,55150036501,NDC,facility,both,1,EA,573.19,405.82,Aetna First Health,Commercial,,487.21,85,,,254.04,487.21,percent of total billed charges,
amphotericin B liposome 50 MG Recon Susp 1 Each Vial,J0289.01,CDM,J0289,CPT,636,RC,00469305130,NDC,facility,both,1,EA,695.34,492.3,Aetna First Health,Commercial,,591.04,85,,,308.17,591.04,percent of total billed charges,
ampicillin 500 MG Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781940778,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 500 MG Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781340778,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 500 MG Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67850002400,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 500 MG Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67850002410,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 500 MG Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,44567010110,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 500 MG Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,70594008501,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 500 MG Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,70594008502,NDC,facility,both,0.25,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781340495,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781940495,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781940485,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781340485,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,55150011310,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67457035110,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00409372610,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67457035101,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67850002100,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67850002110,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,44567010210,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,63323038910,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,63323070408,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,36000007210,NDC,facility,both,0.5,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,25021013610,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 1 GM Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,70860011415,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781340895,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781940880,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781940892,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,25021013720,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,00781340880,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,55150011420,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67457035210,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67457035202,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67850002200,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,67850002210,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Soln 1 Each Vial,J0290.01,CDM,J0290,CPT,636,RC,72485042201,NDC,facility,both,1,EA,50,35.4,Aetna First Health,Commercial,,42.5,85,,,22.16,42.5,percent of total billed charges,
ampicillin 2 g Recon Sol